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@ARTICLE{Bonekamp:141169,
author = {D. Bonekamp$^*$ and P. Schelb$^*$ and M. Wiesenfarth$^*$
and T. A. Kuder$^*$ and F. Deister$^*$ and A. Stenzinger and
J. Nyarangi-Dix and M. Röthke$^*$ and M. Hohenfellner and
H.-P. Schlemmer$^*$ and J. P. Radtke$^*$},
title = {{H}istopathological to multiparametric {MRI} spatial
mapping of extended systematic sextant and
{MR}/{TRUS}-fusion-targeted biopsy of the prostate.},
journal = {European radiology},
volume = {29},
number = {4},
issn = {1432-1084},
address = {Heidelberg},
publisher = {Springer},
reportid = {DKFZ-2018-01696},
pages = {1820-1830},
year = {2019},
abstract = {MRI has limited ability to detect multifocal disease or the
full extent of prostate involvement with clinically
significant prostate cancer (sPC). We compare the spatial
co-localization at sextant resolution of MRI lesions and
histopathological mapping by combined targeted and extended
systematic biopsies.Sextants were mapped for sPC (ISUP group
≥ 2) by 24-core transperineal systematic biopsies in 316
patients with suspicion for sPC and by MR lesions of PI-RADS
score of ≥ 3. The gold standard is combined systematic
(median 23 cores) and targeted biopsies.Of 316 men, 121
$(38\%)$ harbored sPC. Of these 121 patients, 4 $(3\%)$ had
a negative MRI. MRI correctly identified 117/121 $(97\%)$
patients with sPC. In these patients, mpMRI missed no
additional sPC in 96 $(82\%),$ while MRI-negative sPC
lesions were present in 21 patients $(18\%).$ Of 1896
sextants, 379 $(20\%)$ harbored sPC. MR-positive sextants
contained sPC in $26\%$ (337/1275), compared to $7\%$
(42/621) in MR-negative sextants. On a patient basis,
sensitivity was 0.97, specificity 0.22, positive predictive
value 0.43, and negative predictive value 0.91. On a sextant
basis, sensitivity was 0.73, specificity 0.38, positive
predictive value 0.26, and negative predictive value
0.93.MpMRI mapping agreed well with histopathology with, at
the observed sPC prevalence and on a patient basis,
excellent sensitivity and negative predictive value, and
acceptable specificity and positive predictive value for
sPC. However, $18\%$ of sPC was outside the mpMRI mapped
region, quantifying limitations of MRI for complete
localization of disease extent.• Currently, exclusive MRI
mapping of the prostate for focal treatment planning cannot
be recommended, as significant prostate cancer may remain
untreated in a substantial number of cases. • At the
observed sPC prevalence and on a patient basis, mpMRI has
excellent sensitivity and NPV, and acceptable specificity
and PPV for detection of prostate cancer, supporting its use
to detect suspicious lesions before biopsy. • Despite the
excellent global performance, $18\%$ of sPC was outside the
mpMRI mapped region even when a security margin of 10 mm
was considered, indicating that prostate MRI has limited
ability to completely map all cancer foci within the
prostate.},
cin = {E010 / C060 / E020},
ddc = {610},
cid = {I:(DE-He78)E010-20160331 / I:(DE-He78)C060-20160331 /
I:(DE-He78)E020-20160331},
pnm = {315 - Imaging and radiooncology (POF3-315)},
pid = {G:(DE-HGF)POF3-315},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:30327861},
doi = {10.1007/s00330-018-5751-1},
url = {https://inrepo02.dkfz.de/record/141169},
}