This prospective study analyzed initial and second-opinion multiparametric MRI reports of 158 patients prior to transperineal MRI/ultrasound fusion biopsy over a three-year period.
MRI scans were ruled as negative more often in uroradiologist reads (41%) than in initial interpretations (20%), with significantly higher negative predictive value (NPV) for patients with Gleason scores between 7 and 10 in the second reads (89% versus 72%). Multiparametric MRI scans also were less often called suspicious in subspecialist reads (51%) than in initial reports (39%), with significantly higher positive predictive value (PPV) for subspecialist second-reads (56% versus 34%).
While the results make the case for subspecialist reading of multiparametric MRI, particularly in the context of repeat biopsy, second-reading of all multiparametric MRI scans at a tertiary center may be "an unrealistic option," said study presenter Dr. Nienke Hansen from RWTH University Hospital Aachen. "The findings, therefore, emphasize the necessity of adequate training for radiologists reporting prostate multiparametric MRIs."
One solution may be to create a temporary intermediate competency certification process based on the experience of 50 to 100 cases with a supervised systematic double-reading by an experienced reader and pathology feedback, Hansen suggested to AuntMinnie.com.
"Our study shows that a negative MRI result may need to be treated with caution as this informs the decision to avoid biopsy altogether," Hansen added. "An improvement was also found in PPV from 28% to 61% with specialist reading, which makes the case for target-only biopsy of suspicious lesions with limited or no background sampling."
