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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},
}