TY - JOUR
AR - ACO-2021-2-102
TI - Validation of PI-RADS v2 Scores at Various Non-University Radiology Practices
AU - Evan, Thomas Austin
AU - Paul, Kang
AU - Chinedu, Mmeje
AU - Joseph, Mashni
AU - Mark, Brenner
AU - Phillip, Koo
AU - John C., Chang
JO - Annals of Clinical Oncology
PY - 2021
DA - Wed 29, Dec 2021
SN - 2674-3248
DO - http://dx.doi.org/10.31487/j.ACO.2021.02.02
UR - https://www.sciencerepository.org/validation-of-pi-rads_ACO-2021-2-102 
KW - PI-RADS, MR-guided biopsy, prostate cancer
AB - Purpose: The purpose of this study was to validate the second version of the Prostate Imaging Reporting and Data System (PI-RADSv2) scores in predicting positive in-bore MRI-guided targeted prostate biopsy results across different non-university related institutions. The study focuses on PI-RADS v2 scoring because during the study period, PI-RADS v2.1 had not been released. 
Materials and Methods: This was a retrospective review of 147 patients who underwent multiparametric magnetic resonance imaging (mpMRI) of the pelvis followed by in-bore MRI-guided targeted prostate biopsy from December 2014 to May 2018. All lesions on mpMRI were rated according to PI-RADS v2 criteria. PI-RADS v2 scores were then compared to MR-guided biopsy results and pre-biopsy PSA values. 
Results: Prostate Cancer (PCa) was detected in 54% (80/147) of patients, with more prostate cancer being detected with each subsequent increase in PI-RADS scores. Specifically, biopsy results in patients with PI-RADS 3, 4, and 5 lesions resulted in PCa in 25.6% (10/39), 58.1% (33/55), and 86.0% (37/43) respectively. Clinically significant PCa (Gleason score ≥7) was detected in 17.9% (7/39), 52.7% (29/55), and 72% (31/43) of cases for PI-RADS 3, 4, and 5 lesions respectively. When the PI-RADS scoring and biopsy results were compared across different institutions, there was no difference in the PI-RADS scoring of lesions or in the positive biopsy rates of the lesions. The sensitivity, specificity, PPV, and NPV for PI-RADS 3-4 lesions were also not statistically different across the institutions for detecting Gleason 7 or greater lesions.
Conclusion: Our results agree with prior studies that higher PI-RADS scores are associated with the presence of clinically significant PCa and suggest prostate lesions with PI-RADS scores 3-5 have sufficient evidence to warrant targeted biopsy. The comparison of PI-RADS score across different types of non-university practices revealed no difference in scoring and biopsy outcome, suggesting that PI-RADS v2 can be easily applied outside of the university medical center setting.
Clinical Relevance: PI-RADS v2 can be applied homogeneously in the non-university setting without significant difference in outcome.