Interreader agreement in different PI-RADS systems in multiparametric prostate magnetic resonance imaging: A head-to-head comparison between PI-RADSv2 and v2.1

Abstract

Aim The purpose of this study is to compare PI-RADSv2 with v2.1 in terms of interreader agreement and diagnostic performance in clinically significant prostate cancer (CSCa) detection. Materials and Methods Two hundred-two patients who had both multiparametric prostate magnetic resonance imaging (mpMRI) and 12 quadrant systematic biopsies were included in this retrospective study. Acquisition parameters were totally complied with proposal of PI-RADSv2 and 2.1 guidelines. mpMRIs were evaluated by two radiologists independently. Index lesion’s score was used to determine diagnostic performance of the systems. Gleason ≥ 3+4 tumors were considered CSCa. Kappa statistic was used to determine interreader agreement. Area under the curve (AUC) was calculated in detection of CSCa using receiver operating characteristic curve (ROC). Results The numbers of cases with PI-RADSv2 and v2.1 scores from 1 to 5 were 46, 21, 13, 41, 81 and 46, 26, 9, 43, 78, by reader 1 and 51, 10, 18, 43, 80 and 51, 15, 19, 37, 80 by reader 2, respectively. There was “substantial” agreement between two readers for both scoring systems. Kappa values were 0.600 in PI-RADSv2 and 0.624 in PI-RADSv2.1. Ninety-eight (48.5%) patients had CSCa. AUC values of PI-RADSv2 and v2.1 scoring systems were 0.861 and 0.851 for reader 1, 0.873 and 0.883 for reader 2, respectively. Conclusion Interreader agreement was “substantial” in mpMRI and slightly improved with PI-RADSv2.1. Diagnostic performance of the two systems were almost equal.

Keywords

• Gleason
• image-guided biopsy
• multiparametric MRI
• prostate cancer

Multiparametrik prostat manyetik rezonans görüntülemede farklı PI-RADS sistemlerinde okuyucular arası uyum: PI-RADSv2 ve v2.1’in bire bir karşılaştırılması

Abstract

Amaç Bu yazının amacı, okuyucular arası uyum ve klinik anlamlı prostat kanseri (KAK) tespitinde tanısal performans açısından PI-RADSv2 ile v2.1’in karşılaştırılmasıdır. Gereç ve Yöntem Multiparametrik prostat manyetik rezonans görüntüleme (mpMRG) ve 12 kadran sistematik biyopsi yapılan 202 olgu, bu retrospektif çalışmayı oluşturmaktadır. Görüntüleme parametrelerinde PI-RADSv2 ve v2.1’in sunduğu tüm önerilere uyuldu. mpMRG’ler iki radyolog tarafından ayrı ayrı değerlendirildi. Sistemlerin tanısal performansını belirlemede indeks lezyon esas alındı. Gleason ≥ 3+4 tümörler KAK kabul edildi. Okuyucular arası uyumun belirlenmesinde kappa istatistiği kullanıldı. KAK tespitinde eğrinin altındaki alan (EAA), alıcı işletim karakteristiği eğrisi kullanılarak hesaplandı. Bulgular PI-RADSv2 ve v2.1 için skoru 1’den 5’e olan olgu sayısı okuyucu 1 için sırasıyla 46, 21, 13, 41, 81 ve 46, 26, 9, 43, 78 iken, okuyucu 2 için sırasıyla 46, 21, 13, 41, 81 ve 46, 26, 9, 43, 78 idi. Her iki skorlama sistemi için iki okuyucu arasındaki uyum “iyi” düzeydeydi. Kappa değerleri PI-RADSv2 için 0,600, PI-RADSv2.1 için 0,624 idi. Doksan-sekiz (%48,5) olguda KAK görüldü. PI-RADSv2 ve v2.1 skorlama sistemi için EAA değerleri okuyucu 1 için sırasıyla 0,861 ve 0,851, okuyucu 2 için sırasıyla 0,873 ve 0,883 idi. Sonuç Okuyucular arası uyum mpMRG’de “iyi” olup PI-RADSv2.1 ile hafif artmıştır. Her iki sistemin tanısal performansı neredeyse eşittir.

Keywords

• Gleason
• görüntüleme eşliğinde biyopsi
• multiparametrik MRG
• prostat kanseri

References

1. 1. iarc.fr [World Health Organization]. Lyon: International agency for research on cancer, GLOBOCAN 2018. [updated October 2020; cited 1 November 2020] available from: https://gco.iarc.fr/today/data/factsheets/populations/792-turkey-fact-sheets.pdf.
2. 2. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10(2):63-89.
3. 3. Walker SM, Türkbey B. PI-RADSv2.1: Current status. Turk J Urol. 2020.
4. 4. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016;69(1):16-40.
5. 5. Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, et al. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019;76(3):340-51.
6. 6. Smith CP, Harmon SA, Barrett T, Bittencourt LK, Law YM, Shebel H, et al. Intra- and interreader reproducibility of PI-RADSv2: A multireader study. J Magn Reson Imaging. 2019;49(6):1694-703.
7. 7. Rosenkrantz AB, Babb JS, Taneja SS, Ream JM. Proposed Adjustments to PI-RADS Version 2 Decision Rules: Impact on Prostate Cancer Detection. Radiology. 2017;283(1):119-29.
8. 8. Greer MD, Shih JH, Lay N, Barrett T, Bittencourt L, Borofsky S, et al. Interreader Variability of Prostate Imaging Reporting and Data System Version 2 in Detecting and Assessing Prostate Cancer Lesions at Prostate MRI. AJR Am J Roentgenol. 2019:1-8.

9. 9. Girometti R, Giannarini G, Greco F, Isola M, Cereser L, Como G, et al. Interreader agreement of PI-RADS v. 2 in assessing prostate cancer with multiparametric MRI: A study using whole-mount histology as the standard of reference. J Magn Reson Imaging. 2019;49(2):546-55.
10. 10. Linhares Moreira AS, De Visschere P, Van Praet C, Villeirs G. How does PI-RADS v2.1 impact patient classification? A head-to-head comparison between PI-RADS v2.0 and v2.1. Acta Radiol. 2020:284185120941831.
11. 11. Muller BG, Shih JH, Sankineni S, Marko J, Rais-Bahrami S, George AK, et al. Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging. Radiology. 2015;277(3):741-50.
12. 12. Greer MD, Brown AM, Shih JH, Summers RM, Marko J, Law YM, et al. Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: A multireader study. J Magn Reson Imaging. 2017;45(2):579-85.
13. 13. Brembilla G, Dell'Oglio P, Stabile A, Damascelli A, Brunetti L, Ravelli S, et al. Interreader variability in prostate MRI reporting using Prostate Imaging Reporting and Data System version 2.1. Eur Radiol. 2020;30(6):3383-92.
14. 14. Tamada T, Kido A, Takeuchi M, Yamamoto A, Miyaji Y, Kanomata N, et al. Comparison of PI-RADS version 2 and PI-RADS version 2.1 for the detection of transition zone prostate cancer. Eur J Radiol. 2019;121:108704.
15. 15. Wei CG, Zhang YY, Pan P, Chen T, Yu HC, Dai GC, et al. Diagnostic Accuracy and Inter-observer Agreement of PI-RADS Version 2 and Version 2.1 for the Detection of Transition Zone Prostate Cancers. AJR Am J Roentgenol. 2020.
16. 16. Bhayana R, O'Shea A, Anderson MA, Bradley WR, Gottumukkala R, Mojtahed A, et al. PI-RADS versions 2 and 2.1: Interobserver Agreement and Diagnostic Performance in Peripheral and Transition Zone Lesions Among Six Radiologists. AJR Am J Roentgenol. 2020.
17. 17. Hötker AM, Blüthgen C, Rupp NJ, Schneider AF, Eberli D, Donati OF. Comparison of the PI-RADS 2.1 scoring system to PI-RADS 2.0: Impact on diagnostic accuracy and inter-reader agreement. PLoS One. 2020;15(10):e0239975.