Diagnostic utility of a likert scale versus qualitative descriptors and length of capsular contact for determining extraprostatic tumor extension at multiparametric prostate MRI

Daniel N Costa, Niccolo M. Passoni, John Leyendecker, Alberto Diaz De Leon III, Yair Lotan, Claus Roehrborn, Susana Otero-Muinelo, Harpreet Grewal, Yin Xi, Franto Francis, Neil M Rofsky, Ivan Pedrosa

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Abstract

OBJECTIVE. The purpose of this study is to determine the reproducibility and diagnostic performance of a Likert scale in comparison with the European Society of Urogenital Radiology (ESUR) criteria and tumor-pseudocapsule contact length (TCL) for the detection of extraprostatic extension (EPE) at multiparametric MRI. MATERIALS AND METHODS. This was a retrospective review of all men who underwent multiparametric MRI followed by prostatectomy between November 2015 and July 2016. Multiparametric 3-T MRI studies with an endorectal coil were independently reviewed by five readers who assigned the likelihood of EPE using a 1-5 Likert score, ESUR criteria, and TCL (> 10 mm). EPE outcome (absent or present) for the index lesion at whole-mount histopathologic analysis was the standard of reference. Odds ratios (ORs) and areas under the ROC curve (Az) were used for diagnostic accuracy. The interreader agreement was determined using a weighted kappa coefficient. A p < 0.05 was considered significant. RESULTS. Eighty men met the eligibility criteria. At univariate analysis, the Likert score showed the strongest association (OR, 1.8) with EPE, followed by prostate-specific antigen level (OR, 1.7), ESUR score (OR, 1.6), and index lesion size (OR, 1.2). At multivariable analysis, higher Likert score (OR, 1.8) and prostate-specific antigen level (OR, 1.6-1.7) were independent predictors of EPE. The Az value for Likert scores was statistically significantly higher (0.79) than that for TCL (0.74; p < 0.01), but not statistically significantly higher than the value for ESUR scores (0.77; p = 0.17). Interreader agreement with Likert (κ = 0.52) and ESUR scores (κ = 0.55) was moderate and slightly superior to that for TCL (κ = 0.43). Except for TCL among inexperienced readers (κ = 0.34), reader experience did not affect interreader agreement. CONCLUSION. A Likert score conveying the degree of suspicion at multiparametric MRI is a stronger predictor of EPE than is either ESUR score or TCL and may facilitate informed decision making, patient counseling, and treatment planning.

Original languageEnglish (US)
Pages (from-to)1066-1072
Number of pages7
JournalAmerican Journal of Roentgenology
Volume210
Issue number5
DOIs
StatePublished - May 1 2018

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Prostate
Radiology
Odds Ratio
Neoplasms
Prostate-Specific Antigen
Prostatectomy
ROC Curve
Area Under Curve
Counseling
Decision Making

Keywords

  • Imaging-pathology correlation
  • MRI
  • Prostate cancer
  • Risk stratification
  • Staging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{61807c65696441659c82b785d63513dc,
title = "Diagnostic utility of a likert scale versus qualitative descriptors and length of capsular contact for determining extraprostatic tumor extension at multiparametric prostate MRI",
abstract = "OBJECTIVE. The purpose of this study is to determine the reproducibility and diagnostic performance of a Likert scale in comparison with the European Society of Urogenital Radiology (ESUR) criteria and tumor-pseudocapsule contact length (TCL) for the detection of extraprostatic extension (EPE) at multiparametric MRI. MATERIALS AND METHODS. This was a retrospective review of all men who underwent multiparametric MRI followed by prostatectomy between November 2015 and July 2016. Multiparametric 3-T MRI studies with an endorectal coil were independently reviewed by five readers who assigned the likelihood of EPE using a 1-5 Likert score, ESUR criteria, and TCL (> 10 mm). EPE outcome (absent or present) for the index lesion at whole-mount histopathologic analysis was the standard of reference. Odds ratios (ORs) and areas under the ROC curve (Az) were used for diagnostic accuracy. The interreader agreement was determined using a weighted kappa coefficient. A p < 0.05 was considered significant. RESULTS. Eighty men met the eligibility criteria. At univariate analysis, the Likert score showed the strongest association (OR, 1.8) with EPE, followed by prostate-specific antigen level (OR, 1.7), ESUR score (OR, 1.6), and index lesion size (OR, 1.2). At multivariable analysis, higher Likert score (OR, 1.8) and prostate-specific antigen level (OR, 1.6-1.7) were independent predictors of EPE. The Az value for Likert scores was statistically significantly higher (0.79) than that for TCL (0.74; p < 0.01), but not statistically significantly higher than the value for ESUR scores (0.77; p = 0.17). Interreader agreement with Likert (κ = 0.52) and ESUR scores (κ = 0.55) was moderate and slightly superior to that for TCL (κ = 0.43). Except for TCL among inexperienced readers (κ = 0.34), reader experience did not affect interreader agreement. CONCLUSION. A Likert score conveying the degree of suspicion at multiparametric MRI is a stronger predictor of EPE than is either ESUR score or TCL and may facilitate informed decision making, patient counseling, and treatment planning.",
keywords = "Imaging-pathology correlation, MRI, Prostate cancer, Risk stratification, Staging",
author = "Costa, {Daniel N} and Passoni, {Niccolo M.} and John Leyendecker and {Diaz De Leon III}, Alberto and Yair Lotan and Claus Roehrborn and Susana Otero-Muinelo and Harpreet Grewal and Yin Xi and Franto Francis and Rofsky, {Neil M} and Ivan Pedrosa",
year = "2018",
month = "5",
day = "1",
doi = "10.2214/AJR.17.18849",
language = "English (US)",
volume = "210",
pages = "1066--1072",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "5",

}

TY - JOUR

T1 - Diagnostic utility of a likert scale versus qualitative descriptors and length of capsular contact for determining extraprostatic tumor extension at multiparametric prostate MRI

AU - Costa, Daniel N

AU - Passoni, Niccolo M.

AU - Leyendecker, John

AU - Diaz De Leon III, Alberto

AU - Lotan, Yair

AU - Roehrborn, Claus

AU - Otero-Muinelo, Susana

AU - Grewal, Harpreet

AU - Xi, Yin

AU - Francis, Franto

AU - Rofsky, Neil M

AU - Pedrosa, Ivan

PY - 2018/5/1

Y1 - 2018/5/1

N2 - OBJECTIVE. The purpose of this study is to determine the reproducibility and diagnostic performance of a Likert scale in comparison with the European Society of Urogenital Radiology (ESUR) criteria and tumor-pseudocapsule contact length (TCL) for the detection of extraprostatic extension (EPE) at multiparametric MRI. MATERIALS AND METHODS. This was a retrospective review of all men who underwent multiparametric MRI followed by prostatectomy between November 2015 and July 2016. Multiparametric 3-T MRI studies with an endorectal coil were independently reviewed by five readers who assigned the likelihood of EPE using a 1-5 Likert score, ESUR criteria, and TCL (> 10 mm). EPE outcome (absent or present) for the index lesion at whole-mount histopathologic analysis was the standard of reference. Odds ratios (ORs) and areas under the ROC curve (Az) were used for diagnostic accuracy. The interreader agreement was determined using a weighted kappa coefficient. A p < 0.05 was considered significant. RESULTS. Eighty men met the eligibility criteria. At univariate analysis, the Likert score showed the strongest association (OR, 1.8) with EPE, followed by prostate-specific antigen level (OR, 1.7), ESUR score (OR, 1.6), and index lesion size (OR, 1.2). At multivariable analysis, higher Likert score (OR, 1.8) and prostate-specific antigen level (OR, 1.6-1.7) were independent predictors of EPE. The Az value for Likert scores was statistically significantly higher (0.79) than that for TCL (0.74; p < 0.01), but not statistically significantly higher than the value for ESUR scores (0.77; p = 0.17). Interreader agreement with Likert (κ = 0.52) and ESUR scores (κ = 0.55) was moderate and slightly superior to that for TCL (κ = 0.43). Except for TCL among inexperienced readers (κ = 0.34), reader experience did not affect interreader agreement. CONCLUSION. A Likert score conveying the degree of suspicion at multiparametric MRI is a stronger predictor of EPE than is either ESUR score or TCL and may facilitate informed decision making, patient counseling, and treatment planning.

AB - OBJECTIVE. The purpose of this study is to determine the reproducibility and diagnostic performance of a Likert scale in comparison with the European Society of Urogenital Radiology (ESUR) criteria and tumor-pseudocapsule contact length (TCL) for the detection of extraprostatic extension (EPE) at multiparametric MRI. MATERIALS AND METHODS. This was a retrospective review of all men who underwent multiparametric MRI followed by prostatectomy between November 2015 and July 2016. Multiparametric 3-T MRI studies with an endorectal coil were independently reviewed by five readers who assigned the likelihood of EPE using a 1-5 Likert score, ESUR criteria, and TCL (> 10 mm). EPE outcome (absent or present) for the index lesion at whole-mount histopathologic analysis was the standard of reference. Odds ratios (ORs) and areas under the ROC curve (Az) were used for diagnostic accuracy. The interreader agreement was determined using a weighted kappa coefficient. A p < 0.05 was considered significant. RESULTS. Eighty men met the eligibility criteria. At univariate analysis, the Likert score showed the strongest association (OR, 1.8) with EPE, followed by prostate-specific antigen level (OR, 1.7), ESUR score (OR, 1.6), and index lesion size (OR, 1.2). At multivariable analysis, higher Likert score (OR, 1.8) and prostate-specific antigen level (OR, 1.6-1.7) were independent predictors of EPE. The Az value for Likert scores was statistically significantly higher (0.79) than that for TCL (0.74; p < 0.01), but not statistically significantly higher than the value for ESUR scores (0.77; p = 0.17). Interreader agreement with Likert (κ = 0.52) and ESUR scores (κ = 0.55) was moderate and slightly superior to that for TCL (κ = 0.43). Except for TCL among inexperienced readers (κ = 0.34), reader experience did not affect interreader agreement. CONCLUSION. A Likert score conveying the degree of suspicion at multiparametric MRI is a stronger predictor of EPE than is either ESUR score or TCL and may facilitate informed decision making, patient counseling, and treatment planning.

KW - Imaging-pathology correlation

KW - MRI

KW - Prostate cancer

KW - Risk stratification

KW - Staging

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