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VALIDATION OF PIRADS VERSION 2.1 FOR PROSTATE TRANSITION ZONE CANCER DETECTION
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Abstract
Purpose: To confirm the association between prostate imaging data and reporting system (PI-RADS) version 2.1 score and prostate transition zone cancer in a group of patients undergoing transrectal ultrasound guided biopsy. Material and methods: A total of 67 transition zone lesions of 67 patients were included in the retrospective study from the database of patients undergoing prostate MRI during the continuous period from February 2019 to May 2022. Prostate transition zone lesions were graded according to PI-RADS version 2.1 with consensus of 2 independent readers who were blinded to histopathological and clinical findings. Prostate transition zone cancer detection rates for each category of PI-RADS version 2.1 lesion were evaluated. Then evaluate the performance of PI-RADS version 2.1 in detecting prostate transition zone cancer. Results: The PI-RADS version 2.1 classified 67 lesions of transition zone and found the number of PI-RADS category 2, 3, 4, 5 lesions were 2, 27, 13 and 25, respectively. Biopsy results of these nodules showed that there were 32 cancer nodules, accounting for 47.8% and 35 non-cancer lesions, accounting for 52.2%. Among 67 lesion undergoing biopsy, for PI- RADS category 2 lesions, the ratio of transition zone cancer was 0% (0/2). For PI-RADS category 3, 4, and 5 lesions, the overall cancer rates were 11% (3/27), 46.2% (6/13) and 92% (23/25), respectively. A higher PI-RADS version 2.1 score was associated with an increased likelihood of transition zon cancer (p < 0.001). There was a statistically significant difference between true PI-RADS category 4 and PI-RADS category 3 lesions upgraded to category 4 based on
the diffusion weighted imaging (all PI-RADS category 4 lesions were cancers and all PI-RADS category 3+1 lesions were non cancers, p < 0.001). Conclusion: Higher PI-RADS version 2.1 scores were associated with higher rates of cancers in the transition zone. PI- RADS category 2 lesions rarely associated with cancer and this lesion should not be targeted biopsies, whereas most PI-RADS category 5 lesions were cancerous.
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Keywords
PI-RADS classification version 2, prostate transition zone cancer, PIRADS 3 1
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