1. Expected impact of MRI-related interreader variability on ProScreen prostate cancer screening trial: a pre-trial validation study
- Author
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Kari Natunen, Antti Rannikko, Johanna Ronkainen, Suvi Marjasuo, Anu Kenttämies, Outi Oksanen, Kati Lind, Ronja Hietikko, Tuomas Mirtti, Kimmo Taari, Teuvo L.J. Tammela, Juha Oksala, Tuomas Saarinen, Ritja Savolainen, Kirsty Ijäs, Tuomas P. Kilpeläinen, Anssi Auvinen, HUS Abdominal Center, Urologian yksikkö, University of Helsinki, Helsinki University Hospital Area, Research Program in Systems Oncology, Research Programs Unit, Faculty of Medicine, Department of Surgery, HUS Medical Imaging Center, Department of Diagnostics and Therapeutics, Clinicum, HUSLAB, Department of Pathology, Tampere University, Department of Radiology, and Health Sciences more...
- Subjects
Male ,medicine.medical_treatment ,ACCURACY ,GUIDELINES ,030218 nuclear medicine & medical imaging ,PI-RADS version 2 ,Random Allocation ,Prostate cancer ,0302 clinical medicine ,Observer Variation ,Clinical Trials as Topic ,education.field_of_study ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Prostatectomy ,General Medicine ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,3. Good health ,Prostate cancer screening ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Screening ,BIOPSY ,Radiology ,Pseudonymized ,Research Article ,Image-Guided Biopsy ,lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,lcsh:R895-920 ,Population ,3122 Cancers ,DIAGNOSIS ,lcsh:RC254-282 ,Agreement ,03 medical and health sciences ,Magnetic resonance imaging ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Aged ,business.industry ,Prostatic Neoplasms ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,3141 Health care science ,Neoplasm Grading ,business - Abstract
Background The aim of this study is to investigate the potential impact of prostate magnetic resonance imaging (MRI) -related interreader variability on a population-based randomized prostate cancer screening trial (ProScreen). Methods From January 2014 to January 2018, 100 men aged 50–63 years with clinical suspicion of prostate cancer (PCa) in Helsinki University Hospital underwent MRI. Nine radiologists individually reviewed the pseudonymized MRI scans of all 100 men in two ProScreen trial centers. All 100 men were biopsied according to a histological composite variable comprising radical prostatectomy histology (N = 38) or biopsy result within 1 year from the imaging (N = 62). Fleiss’ kappa (κ) was used to estimate the combined agreement between all individual radiologists. Sample data were subsequently extrapolated to 1000-men subgroups of the ProScreen cohort. Results Altogether 89% men of the 100-men sample were diagnosed with PCa within a median of 2.4 years of follow-up. Clinically significant PCa (csPCa) was identified in 76% men. For all PCa, mean sensitivity was 79% (SD ±10%, range 62–96%), and mean specificity 60% (SD ±22%, range 27–82%). For csPCa (Gleason Grade 2–5) MRI was equally sensitive (mean 82%, SD ±9%, range 67–97%) but less specific (mean 47%, SD ±20%, range 21–75%). Interreader agreement for any lesion was fair (κ 0.40) and for PI-RADS 4–5 lesions it was moderate (κ 0.60). Upon extrapolating these data, the average sensitivity and specificity to a screening positive subgroup of 1000 men from ProScreen with a 30% prevalence of csPCa, 639 would be biopsied. Of these, 244 men would be true positive, and 395 false positive. Moreover, 361 men would not be referred to biopsy and among these, 56 csPCas would be missed. The variation among the radiologists was broad as the least sensitive radiologist would have twice as many men biopsied and almost three times more men would undergo unnecessary biopsies. Although the most sensitive radiologist would miss only 2.6% of csPCa (false negatives), the least sensitive radiologist would miss every third. Conclusions Interreader agreement was fair to moderate. The role of MRI in the ongoing ProScreen trial is crucial and has a substantial impact on the screening process. more...
- Published
- 2020