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

Research output: Contribution to journalArticle

14 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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