Performance of PI-RADS v2 assessment categories assigned prior to MR-US fusion biopsy in a new fusion biopsy program

Graham P. Trent, Nancy Ye, Jasleen Chopra, Rong Chen, Jade Wong-You-Cheong, Michael Naslund, Mohummad M. Siddiqui, Amelia Wnorowski

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


OBJECTIVE: To validate the performance of PI-RADS v2 for detection of clinically significant prostate cancer (csPca, Gleason ≥7) within the context of a new fusion biopsy program.

MATERIAL AND METHODS: Patients with a PI-RADS v2 assessment category assigned on pre-biopsy mpMRI between March 2015 and November 2017 were identified. Diagnostic performance of PI-RADS v2 was calculated using fusion biopsy results as reference standard using receiver operating characteristic curve analysis. Patient and lesion characteristics were analyzed with one-way ANOVA and Wilcoxon rank sum test.

RESULTS: Of 83 patients with 175 lesions, 115/175 (65.7%) were benign, 21/175 (12%) were Gleason 6, and 39/175 (22.3%) were Gleason ≥7. csPCa rates were 0% (0/5) for PI-RADS 1, 7.4% (2/27) for PI-RADS 2, 5.8% (3/52) for PI-RADS 3, 31.2% (24/77) for PI-RADS 4, and 71.4% (10/14) for PI-RADS 5 (p < 0.0001). For prediction of csPCa, patient-level AUC was 0.68 and lesion-level AUC was 0.77. Biopsy threshold of PI-RADS ≥3 was 92.6% sensitive and 22.1% specific. A threshold of PI-RADS ≥4 was 87.2% sensitive and 58.1% specific. Rate of csPca detection on concurrent standard 12 core biopsy only was 6.7%.

CONCLUSION: PI-RADS v2 assessment categories assigned prior to biopsy predict pathologic outcome reasonably well in a new prostate fusion biopsy program. Biopsy threshold of PI-RADS ≥3 is highly sensitive. A threshold of ≥4 increases specificity but misses some csPCa.

Original languageEnglish (US)
Pages (from-to)29-34
Number of pages6
JournalClinical Imaging
StatePublished - Aug 2020

Bibliographical note

Publisher Copyright:
© 2020 Elsevier Inc.


  • Fusion biopsy
  • Multiparametric MRI of prostate
  • PI-RADS version 2
  • Prostate cancer
  • Image-Guided Biopsy/methods
  • Multiparametric Magnetic Resonance Imaging
  • Humans
  • Middle Aged
  • Magnetic Resonance Imaging/methods
  • Male
  • Algorithms
  • Sensitivity and Specificity
  • Prostatic Neoplasms/pathology
  • ROC Curve
  • Aged
  • Retrospective Studies
  • Biopsy, Large-Core Needle

PubMed: MeSH publication types

  • Journal Article


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