Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the society of abdominal radiology prostate cancer disease-focused panel

Antonio C. Westphalen; Charles E. McCulloch; Jordan M. Anaokar; Sandeep Arora; Nimrod S. Barashi; Jelle O. Barentsz; Tharakeswara K. Bathala; Leonardo K. Bittencourt; Michael T. Booker; Vaughn G. Braxton; Peter R. Carroll; David D. Casalino; Silvia D. Chang; Fergus V. Coakley; Ravjot Dhatt; Steven C. Eberhardt; Bryan R. Foster; Adam T. Froemming; Jurgen J. Fütterer; Dhakshina M. Ganeshan; Mark R. Gertner; Lori Mankowski Gettle; Sangeet Ghai; Rajan T. Gupta; Michael E. Hahn; Roozbeh Houshyar; Candice Kim; Chan Kyo Kim; Chandana Lall; Daniel J.A. Margolis; Stephen E. McRae; Aytekin Oto; Rosaleen B. Parsons; Nayana U. Patel; Peter A. Pinto; Thomas J. Polascik; Benjamin Spilseth; Juliana B. Starcevich; Varaha S. Tammisetti; Samir S. Taneja; Baris Turkbey; Sadhna Verma; John F. Ward; Christopher A. Warlick; Andrew R. Weinberger; Jinxing Yu; Ronald J. Zagoria; Andrew B. Rosenkrantz

doi:10.1148/radiol.2020190646

Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the society of abdominal radiology prostate cancer disease-focused panel

Antonio C. Westphalen, Charles E. McCulloch, Jordan M. Anaokar, Sandeep Arora, Nimrod S. Barashi, Jelle O. Barentsz, Tharakeswara K. Bathala, Leonardo K. Bittencourt, Michael T. Booker, Vaughn G. Braxton, Peter R. Carroll, David D. Casalino, Silvia D. Chang, Fergus V. Coakley, Ravjot Dhatt, Steven C. Eberhardt, Bryan R. Foster, Adam T. Froemming, Jurgen J. Fütterer, Dhakshina M. GaneshanMark R. Gertner, Lori Mankowski Gettle, Sangeet Ghai, Rajan T. Gupta, Michael E. Hahn, Roozbeh Houshyar, Candice Kim, Chan Kyo Kim, Chandana Lall, Daniel J.A. Margolis, Stephen E. McRae, Aytekin Oto, Rosaleen B. Parsons, Nayana U. Patel, Peter A. Pinto, Thomas J. Polascik, Benjamin Spilseth, Juliana B. Starcevich, Varaha S. Tammisetti, Samir S. Taneja, Baris Turkbey, Sadhna Verma, John F. Ward, Christopher A. Warlick, Andrew R. Weinberger, Jinxing Yu, Ronald J. Zagoria, Andrew B. Rosenkrantz

Research output: Contribution to journal › Article › peer-review

257 Scopus citations

Abstract

Background: Prostate MRI is used widely in clinical care for guiding tissue sampling, active surveillance, and staging. The Prostate Imaging Reporting and Data System (PI-RADS) helps provide a standardized probabilistic approach for identifying clinically significant prostate cancer. Despite widespread use, the variability in performance of prostate MRI across practices remains unknown. Purpose: To estimate the positive predictive value (PPV) of PI-RADS for the detection of high-grade prostate cancer across imaging centers. Materials and Methods: This retrospective cross-sectional study was compliant with the HIPAA. Twenty-six centers with members in the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel submitted data from men with suspected or biopsy-proven untreated prostate cancer. MRI scans were obtained between January 2015 and April 2018. This was followed with targeted biopsy. Only men with at least one MRI lesion assigned a PI-RADS score of 2–5 were included. Outcome was prostate cancer with Gleason score (GS) greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2). A mixed-model logistic regression with institution and individuals as random effects was used to estimate overall PPVs. The variability of observed PPV of PI-RADS across imaging centers was described by using the median and interquartile range. Results: The authors evaluated 3449 men (mean age, 65 years 6 8 [standard deviation]) with 5082 lesions. Biopsy results showed 1698 cancers with GS greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2) in 2082 men. Across all centers, the estimated PPV was 35% (95% confidence interval [CI]: 27%, 43%) for a PI-RADS score greater than or equal to 3 and 49% (95% CI: 40%, 58%) for a PI-RADS score greater than or equal to 4. The interquartile ranges of PPV at these same PI-RADS score thresholds were 27%–44% and 27%–48%, respectively. Conclusion: The positive predictive value of the Prostate Imaging and Reporting Data System was low and varied widely across centers.

Original language	English (US)
Pages (from-to)	76-84
Number of pages	9
Journal	Radiology
Volume	296
Issue number	1
DOIs	https://doi.org/10.1148/radiol.2020190646
State	Published - Jul 2020

Bibliographical note

Funding Information:
This investigator-initiated pragmatic retrospective multicenter cross-sectional study of PI-RADS was compliant with the Health Insurance Portability and Accountability Act. The study protocol was approved by each participating institution’s committee on human research, and the requirement to obtain written informed consent was waived. Four authors reported potential conflicts of interest (listed at the end of the article). This project was supported by a seed grant from the Department of Radiology and Biomedical Imaging, University of California, San Francisco, and the Clinical and Translational Science Institute, University of California, San Francisco. The funders had no influence on the design or conduct of the study and were not involved in data collection or analysis, in the writing of the manuscript, or in the decision to submit it for publication. No industry support was received for this project.

Funding Information:
article: has received grant funding from the University of California, San Francisco. Activities not related to the present article: receives payment for board membership from 3D Biopsy; has grants/grants pending with GE Healthcare. Other relationships: disclosed no relevant relationships. C.E.M. Activities related to the present article: author’s institution has received grant funding from the National Institutes of Health. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. J.M.A. disclosed no relevant relationships. S.A. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has grants/grants pending with RSNA; has a patent planned, pending, or issued; has received reimbursement for travel/accommodations/meeting expenses from Profound. Other relationships: disclosed no relevant relationships. N.S.B. disclosed no relevant relationships. J.O.B. disclosed no relevant relationships. T.K.B. disclosed no relevant relationships. L.K.B. disclosed no relevant relationships. M.T.B. disclosed no relevant relationships. V.G.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: received an honorarium from Profound Medical for participating in a usability study. Other relationships: disclosed no relevant relationships. P.R.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: serves on the board of Nutcracker Therapeutics; is a consultant for Insightec. Other relationships: disclosed no relevant relationships. D.D.C. disclosed no relevant relationships. S.D.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received payment for lectures, including service on speakers bureaus, from TerSera Therapeutics. Other relationships: disclosed no relevant relationships. F.V.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a founder of and stockholder in OmnEcoil Instruments. Other relationships: disclosed no relevant relationships. R.D. disclosed no relevant relationships. S.C.E. disclosed no relevant relationships. B.R.F. disclosed no relevant relationships. A.T.F. disclosed no relevant relationships. J.J.F. disclosed no relevant relationships. D.M.G. disclosed no relevant relationships. M.R.G. disclosed no relevant relationships. L.M.G. disclosed no relevant relationships. S.G. disclosed no relevant relationships. R.T.G. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for InVivo. Other relationships: disclosed no relevant relationships. M.E.H. disclosed no relevant relationships. R.H. disclosed no relevant relationships. C.K. disclosed no relevant relationships. C.K.K. disclosed no relevant relationships. C.L. disclosed no relevant relationships. D.J.A.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Blue Earth Diagnostics; author’s institution has grants/grants pending with Siemens Healthineers; has received payment for the development of educational presentations for the British Columbia Radiological Society. Other relationships: disclosed no relevant relationships. S.E.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Cook Medical. Other relationships: disclosed no relevant relationships. A.O. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: received payment for board membership from Profound Healthcare; has grants/grants pending with Guerbet, Philips, and Profound. Other relationships: disclosed no relevant relationships. R.B.P. disclosed no relevant relationships. N.U.P. disclosed no relevant relationships. P.A.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has patents planned, pending, or issued with the National Institutes of Health and Philips; receives royalties for a licensing agreement with Philips/InVivo. Other relationships: disclosed no relevant relationships. T.J.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives payment for lectures, including service on speakers bureaus, from Endocare. Other relationships: disclosed no relevant relationships. B.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Francis Medical. Other relationships: disclosed no relevant relationships. J.B.S. disclosed no relevant relationships. V.S.T. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received reimbursement for travel/accommodations/meeting expenses from Profound Medical. Other relationships: disclosed no relevant relationships. S.S.T. disclosed no relevant relationships. B.T. disclosed no relevant relationships. S.V. disclosed no relevant relationships. J.F.W. disclosed no relevant relationships. C.A.W. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received reimbursement for travel/accommodations/meeting expenses from Ningbao Hospital No. 2. Other relationships: disclosed no relevant relationships. A.R.W. disclosed no relevant relationships. J.Y. disclosed no relevant relationships. R.J.Z. disclosed no relevant relationships. A.B.R. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives royalties from Thieme Medical Publishers. Other relationships: disclosed no relevant relationships.

Funding Information:
This project was supported by a seed grant from the Department of Radiology and Biomedical Imaging, University of California, San Francisco (grant 16-43) and Clinical and Translational Science Institute, University of California, San Francisco (grant UL1 TR001872).

Publisher Copyright:
© RSNA, 2020.

Keywords

Aged
Cross-Sectional Studies
Humans
Magnetic Resonance Imaging/methods
Male
Predictive Value of Tests
Prostate/diagnostic imaging
Prostatic Neoplasms/diagnostic imaging
Radiology Information Systems
Reproducibility of Results
Retrospective Studies
Societies, Medical

PubMed: MeSH publication types

Research Support, Non-U.S. Gov't
Multicenter Study
Journal Article
Research Support, N.I.H., Extramural

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1148/radiol.2020190646

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Cite this

Westphalen, A. C., McCulloch, C. E., Anaokar, J. M., Arora, S., Barashi, N. S., Barentsz, J. O., Bathala, T. K., Bittencourt, L. K., Booker, M. T., Braxton, V. G., Carroll, P. R., Casalino, D. D., Chang, S. D., Coakley, F. V., Dhatt, R., Eberhardt, S. C., Foster, B. R., Froemming, A. T., Fütterer, J. J., ... Rosenkrantz, A. B. (2020). Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the society of abdominal radiology prostate cancer disease-focused panel. Radiology, 296(1), 76-84. https://doi.org/10.1148/radiol.2020190646

Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the society of abdominal radiology prostate cancer disease-focused panel. / Westphalen, Antonio C.; McCulloch, Charles E.; Anaokar, Jordan M. et al.
In: Radiology, Vol. 296, No. 1, 07.2020, p. 76-84.

Research output: Contribution to journal › Article › peer-review

Westphalen, AC, McCulloch, CE, Anaokar, JM, Arora, S, Barashi, NS, Barentsz, JO, Bathala, TK, Bittencourt, LK, Booker, MT, Braxton, VG, Carroll, PR, Casalino, DD, Chang, SD, Coakley, FV, Dhatt, R, Eberhardt, SC, Foster, BR, Froemming, AT, Fütterer, JJ, Ganeshan, DM, Gertner, MR, Gettle, LM, Ghai, S, Gupta, RT, Hahn, ME, Houshyar, R, Kim, C, Kim, CK, Lall, C, Margolis, DJA, McRae, SE, Oto, A, Parsons, RB, Patel, NU, Pinto, PA, Polascik, TJ, Spilseth, B, Starcevich, JB, Tammisetti, VS, Taneja, SS, Turkbey, B, Verma, S, Ward, JF, Warlick, CA, Weinberger, AR, Yu, J, Zagoria, RJ & Rosenkrantz, AB 2020, 'Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the society of abdominal radiology prostate cancer disease-focused panel', Radiology, vol. 296, no. 1, pp. 76-84. https://doi.org/10.1148/radiol.2020190646

@article{971f437b921c4416a4396d2b26036263,

title = "Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the society of abdominal radiology prostate cancer disease-focused panel",

abstract = "Background: Prostate MRI is used widely in clinical care for guiding tissue sampling, active surveillance, and staging. The Prostate Imaging Reporting and Data System (PI-RADS) helps provide a standardized probabilistic approach for identifying clinically significant prostate cancer. Despite widespread use, the variability in performance of prostate MRI across practices remains unknown. Purpose: To estimate the positive predictive value (PPV) of PI-RADS for the detection of high-grade prostate cancer across imaging centers. Materials and Methods: This retrospective cross-sectional study was compliant with the HIPAA. Twenty-six centers with members in the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel submitted data from men with suspected or biopsy-proven untreated prostate cancer. MRI scans were obtained between January 2015 and April 2018. This was followed with targeted biopsy. Only men with at least one MRI lesion assigned a PI-RADS score of 2–5 were included. Outcome was prostate cancer with Gleason score (GS) greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2). A mixed-model logistic regression with institution and individuals as random effects was used to estimate overall PPVs. The variability of observed PPV of PI-RADS across imaging centers was described by using the median and interquartile range. Results: The authors evaluated 3449 men (mean age, 65 years 6 8 [standard deviation]) with 5082 lesions. Biopsy results showed 1698 cancers with GS greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2) in 2082 men. Across all centers, the estimated PPV was 35% (95% confidence interval [CI]: 27%, 43%) for a PI-RADS score greater than or equal to 3 and 49% (95% CI: 40%, 58%) for a PI-RADS score greater than or equal to 4. The interquartile ranges of PPV at these same PI-RADS score thresholds were 27%–44% and 27%–48%, respectively. Conclusion: The positive predictive value of the Prostate Imaging and Reporting Data System was low and varied widely across centers.",

keywords = "Aged, Cross-Sectional Studies, Humans, Magnetic Resonance Imaging/methods, Male, Predictive Value of Tests, Prostate/diagnostic imaging, Prostatic Neoplasms/diagnostic imaging, Radiology Information Systems, Reproducibility of Results, Retrospective Studies, Societies, Medical",

author = "Westphalen, {Antonio C.} and McCulloch, {Charles E.} and Anaokar, {Jordan M.} and Sandeep Arora and Barashi, {Nimrod S.} and Barentsz, {Jelle O.} and Bathala, {Tharakeswara K.} and Bittencourt, {Leonardo K.} and Booker, {Michael T.} and Braxton, {Vaughn G.} and Carroll, {Peter R.} and Casalino, {David D.} and Chang, {Silvia D.} and Coakley, {Fergus V.} and Ravjot Dhatt and Eberhardt, {Steven C.} and Foster, {Bryan R.} and Froemming, {Adam T.} and F{\"u}tterer, {Jurgen J.} and Ganeshan, {Dhakshina M.} and Gertner, {Mark R.} and Gettle, {Lori Mankowski} and Sangeet Ghai and Gupta, {Rajan T.} and Hahn, {Michael E.} and Roozbeh Houshyar and Candice Kim and Kim, {Chan Kyo} and Chandana Lall and Margolis, {Daniel J.A.} and McRae, {Stephen E.} and Aytekin Oto and Parsons, {Rosaleen B.} and Patel, {Nayana U.} and Pinto, {Peter A.} and Polascik, {Thomas J.} and Benjamin Spilseth and Starcevich, {Juliana B.} and Tammisetti, {Varaha S.} and Taneja, {Samir S.} and Baris Turkbey and Sadhna Verma and Ward, {John F.} and Warlick, {Christopher A.} and Weinberger, {Andrew R.} and Jinxing Yu and Zagoria, {Ronald J.} and Rosenkrantz, {Andrew B.}",

note = "Funding Information: This investigator-initiated pragmatic retrospective multicenter cross-sectional study of PI-RADS was compliant with the Health Insurance Portability and Accountability Act. The study protocol was approved by each participating institution{\textquoteright}s committee on human research, and the requirement to obtain written informed consent was waived. Four authors reported potential conflicts of interest (listed at the end of the article). This project was supported by a seed grant from the Department of Radiology and Biomedical Imaging, University of California, San Francisco, and the Clinical and Translational Science Institute, University of California, San Francisco. The funders had no influence on the design or conduct of the study and were not involved in data collection or analysis, in the writing of the manuscript, or in the decision to submit it for publication. No industry support was received for this project. Funding Information: article: has received grant funding from the University of California, San Francisco. Activities not related to the present article: receives payment for board membership from 3D Biopsy; has grants/grants pending with GE Healthcare. Other relationships: disclosed no relevant relationships. C.E.M. Activities related to the present article: author{\textquoteright}s institution has received grant funding from the National Institutes of Health. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. J.M.A. disclosed no relevant relationships. S.A. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has grants/grants pending with RSNA; has a patent planned, pending, or issued; has received reimbursement for travel/accommodations/meeting expenses from Profound. Other relationships: disclosed no relevant relationships. N.S.B. disclosed no relevant relationships. J.O.B. disclosed no relevant relationships. T.K.B. disclosed no relevant relationships. L.K.B. disclosed no relevant relationships. M.T.B. disclosed no relevant relationships. V.G.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: received an honorarium from Profound Medical for participating in a usability study. Other relationships: disclosed no relevant relationships. P.R.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: serves on the board of Nutcracker Therapeutics; is a consultant for Insightec. Other relationships: disclosed no relevant relationships. D.D.C. disclosed no relevant relationships. S.D.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received payment for lectures, including service on speakers bureaus, from TerSera Therapeutics. Other relationships: disclosed no relevant relationships. F.V.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a founder of and stockholder in OmnEcoil Instruments. Other relationships: disclosed no relevant relationships. R.D. disclosed no relevant relationships. S.C.E. disclosed no relevant relationships. B.R.F. disclosed no relevant relationships. A.T.F. disclosed no relevant relationships. J.J.F. disclosed no relevant relationships. D.M.G. disclosed no relevant relationships. M.R.G. disclosed no relevant relationships. L.M.G. disclosed no relevant relationships. S.G. disclosed no relevant relationships. R.T.G. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for InVivo. Other relationships: disclosed no relevant relationships. M.E.H. disclosed no relevant relationships. R.H. disclosed no relevant relationships. C.K. disclosed no relevant relationships. C.K.K. disclosed no relevant relationships. C.L. disclosed no relevant relationships. D.J.A.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Blue Earth Diagnostics; author{\textquoteright}s institution has grants/grants pending with Siemens Healthineers; has received payment for the development of educational presentations for the British Columbia Radiological Society. Other relationships: disclosed no relevant relationships. S.E.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Cook Medical. Other relationships: disclosed no relevant relationships. A.O. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: received payment for board membership from Profound Healthcare; has grants/grants pending with Guerbet, Philips, and Profound. Other relationships: disclosed no relevant relationships. R.B.P. disclosed no relevant relationships. N.U.P. disclosed no relevant relationships. P.A.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has patents planned, pending, or issued with the National Institutes of Health and Philips; receives royalties for a licensing agreement with Philips/InVivo. Other relationships: disclosed no relevant relationships. T.J.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives payment for lectures, including service on speakers bureaus, from Endocare. Other relationships: disclosed no relevant relationships. B.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Francis Medical. Other relationships: disclosed no relevant relationships. J.B.S. disclosed no relevant relationships. V.S.T. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received reimbursement for travel/accommodations/meeting expenses from Profound Medical. Other relationships: disclosed no relevant relationships. S.S.T. disclosed no relevant relationships. B.T. disclosed no relevant relationships. S.V. disclosed no relevant relationships. J.F.W. disclosed no relevant relationships. C.A.W. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received reimbursement for travel/accommodations/meeting expenses from Ningbao Hospital No. 2. Other relationships: disclosed no relevant relationships. A.R.W. disclosed no relevant relationships. J.Y. disclosed no relevant relationships. R.J.Z. disclosed no relevant relationships. A.B.R. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives royalties from Thieme Medical Publishers. Other relationships: disclosed no relevant relationships. Funding Information: This project was supported by a seed grant from the Department of Radiology and Biomedical Imaging, University of California, San Francisco (grant 16-43) and Clinical and Translational Science Institute, University of California, San Francisco (grant UL1 TR001872). Publisher Copyright: {\textcopyright} RSNA, 2020.",

year = "2020",

month = jul,

doi = "10.1148/radiol.2020190646",

language = "English (US)",

volume = "296",

pages = "76--84",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America Inc.",

number = "1",

}

TY - JOUR

T1 - Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers

T2 - Experience of the society of abdominal radiology prostate cancer disease-focused panel

AU - Westphalen, Antonio C.

AU - McCulloch, Charles E.

AU - Anaokar, Jordan M.

AU - Arora, Sandeep

AU - Barashi, Nimrod S.

AU - Barentsz, Jelle O.

AU - Bathala, Tharakeswara K.

AU - Bittencourt, Leonardo K.

AU - Booker, Michael T.

AU - Braxton, Vaughn G.

AU - Carroll, Peter R.

AU - Casalino, David D.

AU - Chang, Silvia D.

AU - Coakley, Fergus V.

AU - Dhatt, Ravjot

AU - Eberhardt, Steven C.

AU - Foster, Bryan R.

AU - Froemming, Adam T.

AU - Fütterer, Jurgen J.

AU - Ganeshan, Dhakshina M.

AU - Gertner, Mark R.

AU - Gettle, Lori Mankowski

AU - Ghai, Sangeet

AU - Gupta, Rajan T.

AU - Hahn, Michael E.

AU - Houshyar, Roozbeh

AU - Kim, Candice

AU - Kim, Chan Kyo

AU - Lall, Chandana

AU - Margolis, Daniel J.A.

AU - McRae, Stephen E.

AU - Oto, Aytekin

AU - Parsons, Rosaleen B.

AU - Patel, Nayana U.

AU - Pinto, Peter A.

AU - Polascik, Thomas J.

AU - Spilseth, Benjamin

AU - Starcevich, Juliana B.

AU - Tammisetti, Varaha S.

AU - Taneja, Samir S.

AU - Turkbey, Baris

AU - Verma, Sadhna

AU - Ward, John F.

AU - Warlick, Christopher A.

AU - Weinberger, Andrew R.

AU - Yu, Jinxing

AU - Zagoria, Ronald J.

AU - Rosenkrantz, Andrew B.

N1 - Funding Information: This investigator-initiated pragmatic retrospective multicenter cross-sectional study of PI-RADS was compliant with the Health Insurance Portability and Accountability Act. The study protocol was approved by each participating institution’s committee on human research, and the requirement to obtain written informed consent was waived. Four authors reported potential conflicts of interest (listed at the end of the article). This project was supported by a seed grant from the Department of Radiology and Biomedical Imaging, University of California, San Francisco, and the Clinical and Translational Science Institute, University of California, San Francisco. The funders had no influence on the design or conduct of the study and were not involved in data collection or analysis, in the writing of the manuscript, or in the decision to submit it for publication. No industry support was received for this project. Funding Information: article: has received grant funding from the University of California, San Francisco. Activities not related to the present article: receives payment for board membership from 3D Biopsy; has grants/grants pending with GE Healthcare. Other relationships: disclosed no relevant relationships. C.E.M. Activities related to the present article: author’s institution has received grant funding from the National Institutes of Health. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. J.M.A. disclosed no relevant relationships. S.A. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has grants/grants pending with RSNA; has a patent planned, pending, or issued; has received reimbursement for travel/accommodations/meeting expenses from Profound. Other relationships: disclosed no relevant relationships. N.S.B. disclosed no relevant relationships. J.O.B. disclosed no relevant relationships. T.K.B. disclosed no relevant relationships. L.K.B. disclosed no relevant relationships. M.T.B. disclosed no relevant relationships. V.G.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: received an honorarium from Profound Medical for participating in a usability study. Other relationships: disclosed no relevant relationships. P.R.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: serves on the board of Nutcracker Therapeutics; is a consultant for Insightec. Other relationships: disclosed no relevant relationships. D.D.C. disclosed no relevant relationships. S.D.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received payment for lectures, including service on speakers bureaus, from TerSera Therapeutics. Other relationships: disclosed no relevant relationships. F.V.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a founder of and stockholder in OmnEcoil Instruments. Other relationships: disclosed no relevant relationships. R.D. disclosed no relevant relationships. S.C.E. disclosed no relevant relationships. B.R.F. disclosed no relevant relationships. A.T.F. disclosed no relevant relationships. J.J.F. disclosed no relevant relationships. D.M.G. disclosed no relevant relationships. M.R.G. disclosed no relevant relationships. L.M.G. disclosed no relevant relationships. S.G. disclosed no relevant relationships. R.T.G. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for InVivo. Other relationships: disclosed no relevant relationships. M.E.H. disclosed no relevant relationships. R.H. disclosed no relevant relationships. C.K. disclosed no relevant relationships. C.K.K. disclosed no relevant relationships. C.L. disclosed no relevant relationships. D.J.A.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Blue Earth Diagnostics; author’s institution has grants/grants pending with Siemens Healthineers; has received payment for the development of educational presentations for the British Columbia Radiological Society. Other relationships: disclosed no relevant relationships. S.E.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Cook Medical. Other relationships: disclosed no relevant relationships. A.O. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: received payment for board membership from Profound Healthcare; has grants/grants pending with Guerbet, Philips, and Profound. Other relationships: disclosed no relevant relationships. R.B.P. disclosed no relevant relationships. N.U.P. disclosed no relevant relationships. P.A.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has patents planned, pending, or issued with the National Institutes of Health and Philips; receives royalties for a licensing agreement with Philips/InVivo. Other relationships: disclosed no relevant relationships. T.J.P. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives payment for lectures, including service on speakers bureaus, from Endocare. Other relationships: disclosed no relevant relationships. B.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Francis Medical. Other relationships: disclosed no relevant relationships. J.B.S. disclosed no relevant relationships. V.S.T. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received reimbursement for travel/accommodations/meeting expenses from Profound Medical. Other relationships: disclosed no relevant relationships. S.S.T. disclosed no relevant relationships. B.T. disclosed no relevant relationships. S.V. disclosed no relevant relationships. J.F.W. disclosed no relevant relationships. C.A.W. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: has received reimbursement for travel/accommodations/meeting expenses from Ningbao Hospital No. 2. Other relationships: disclosed no relevant relationships. A.R.W. disclosed no relevant relationships. J.Y. disclosed no relevant relationships. R.J.Z. disclosed no relevant relationships. A.B.R. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives royalties from Thieme Medical Publishers. Other relationships: disclosed no relevant relationships. Funding Information: This project was supported by a seed grant from the Department of Radiology and Biomedical Imaging, University of California, San Francisco (grant 16-43) and Clinical and Translational Science Institute, University of California, San Francisco (grant UL1 TR001872). Publisher Copyright: © RSNA, 2020.

PY - 2020/7

Y1 - 2020/7

N2 - Background: Prostate MRI is used widely in clinical care for guiding tissue sampling, active surveillance, and staging. The Prostate Imaging Reporting and Data System (PI-RADS) helps provide a standardized probabilistic approach for identifying clinically significant prostate cancer. Despite widespread use, the variability in performance of prostate MRI across practices remains unknown. Purpose: To estimate the positive predictive value (PPV) of PI-RADS for the detection of high-grade prostate cancer across imaging centers. Materials and Methods: This retrospective cross-sectional study was compliant with the HIPAA. Twenty-six centers with members in the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel submitted data from men with suspected or biopsy-proven untreated prostate cancer. MRI scans were obtained between January 2015 and April 2018. This was followed with targeted biopsy. Only men with at least one MRI lesion assigned a PI-RADS score of 2–5 were included. Outcome was prostate cancer with Gleason score (GS) greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2). A mixed-model logistic regression with institution and individuals as random effects was used to estimate overall PPVs. The variability of observed PPV of PI-RADS across imaging centers was described by using the median and interquartile range. Results: The authors evaluated 3449 men (mean age, 65 years 6 8 [standard deviation]) with 5082 lesions. Biopsy results showed 1698 cancers with GS greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2) in 2082 men. Across all centers, the estimated PPV was 35% (95% confidence interval [CI]: 27%, 43%) for a PI-RADS score greater than or equal to 3 and 49% (95% CI: 40%, 58%) for a PI-RADS score greater than or equal to 4. The interquartile ranges of PPV at these same PI-RADS score thresholds were 27%–44% and 27%–48%, respectively. Conclusion: The positive predictive value of the Prostate Imaging and Reporting Data System was low and varied widely across centers.

AB - Background: Prostate MRI is used widely in clinical care for guiding tissue sampling, active surveillance, and staging. The Prostate Imaging Reporting and Data System (PI-RADS) helps provide a standardized probabilistic approach for identifying clinically significant prostate cancer. Despite widespread use, the variability in performance of prostate MRI across practices remains unknown. Purpose: To estimate the positive predictive value (PPV) of PI-RADS for the detection of high-grade prostate cancer across imaging centers. Materials and Methods: This retrospective cross-sectional study was compliant with the HIPAA. Twenty-six centers with members in the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel submitted data from men with suspected or biopsy-proven untreated prostate cancer. MRI scans were obtained between January 2015 and April 2018. This was followed with targeted biopsy. Only men with at least one MRI lesion assigned a PI-RADS score of 2–5 were included. Outcome was prostate cancer with Gleason score (GS) greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2). A mixed-model logistic regression with institution and individuals as random effects was used to estimate overall PPVs. The variability of observed PPV of PI-RADS across imaging centers was described by using the median and interquartile range. Results: The authors evaluated 3449 men (mean age, 65 years 6 8 [standard deviation]) with 5082 lesions. Biopsy results showed 1698 cancers with GS greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2) in 2082 men. Across all centers, the estimated PPV was 35% (95% confidence interval [CI]: 27%, 43%) for a PI-RADS score greater than or equal to 3 and 49% (95% CI: 40%, 58%) for a PI-RADS score greater than or equal to 4. The interquartile ranges of PPV at these same PI-RADS score thresholds were 27%–44% and 27%–48%, respectively. Conclusion: The positive predictive value of the Prostate Imaging and Reporting Data System was low and varied widely across centers.

KW - Aged

KW - Cross-Sectional Studies

KW - Humans

KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Predictive Value of Tests

KW - Prostate/diagnostic imaging

KW - Prostatic Neoplasms/diagnostic imaging

KW - Radiology Information Systems

KW - Reproducibility of Results

KW - Retrospective Studies

KW - Societies, Medical

UR - http://www.scopus.com/inward/record.url?scp=85086495613&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85086495613&partnerID=8YFLogxK

U2 - 10.1148/radiol.2020190646

DO - 10.1148/radiol.2020190646

M3 - Article

C2 - 32315265

AN - SCOPUS:85086495613

SN - 0033-8419

VL - 296

SP - 76

EP - 84

JO - Radiology

JF - Radiology

IS - 1

ER -

Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the society of abdominal radiology prostate cancer disease-focused panel

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