title: Are histopathological features of prostate cancer lesions associated with identification of extracapsular extension on magnetic resonance imaging?
abstract: OBJECTIVE
  To assess the effect of histopathological lesion characteristics on the sensitivity of magnetic resonance imaging (MRI) for per-lesion identification of extracapsular extension (ECE) of prostate cancer.
  
  
  METHODS
  The study included 176 patients (median age 58.9 years, range 38-77) who underwent endorectal MRI before radical prostatectomy between January 2001 and July 2004, had no previous treatment and had whole-mount step-section pathological specimens showing at least one capsule-abutting lesion. The likelihood of ECE of capsule-abutting lesions was retrospectively scored from 1 to 5 based on radiologists' prospective MRI interpretations. Generalized estimating equation regression models were used to determine the effect of the following histological variables on the sensitivity of MRI for identifying ECE of capsule-abutting lesions: maximum diameter, largest perpendicular diameter (LPD), bi-dimensional diameter product, Gleason grade, and zonal extent.
  
  
  RESULTS
  On histopathology, 339 capsule-abutting lesions were found, including 54 with ECE. MRI correctly identified ECE in 36/54 capsule-abutting lesions, including nine of 18 with focal ECE and 27/36 with established ECE, giving sensitivities (95% confidence interval) of 67 (53-78)%, 50 (27-73)% and 75 (58-87)%, respectively. MRI incorrectly identified ECE in 27/285 (9%) capsule-abutting lesions without ECE. MRI sensitivity for per-lesion ECE identification was significantly associated only with histopathological LPD (P = 0.009). Fifty-one patients (29%) had ECE. MRI had a sensitivity (95% confidence interval) of 69 (54-81)% and specificity of 90 (83-94)% for per-patient ECE identification.
  
  
  CONCLUSIONS
  The sensitivity of MRI in per-lesion identification of prostate cancer ECE is significantly associated with the lesion LPD at histopathology.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.forename: Oguz
authors.initials: O
authors.lastname: Akin
authors.forename: Yousef
authors.initials: Y
authors.lastname: Mazaheri
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ishill
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kuroiwa
authors.forename: Jingbo
authors.initials: J
authors.lastname: Zhang
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
mesh_terms: D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery
references.citation: J Clin Oncol. 2004 Jun 1;22(11):2141-9
references.pmid: 15169800
references.citation: J Urol. 2002 Nov;168(5):2011-5
references.pmid: 12394697
references.citation: Mod Pathol. 2005 Jul;18(7):886-90
references.pmid: 15803186
references.citation: Int J Radiat Oncol Biol Phys. 2009 Mar 1;73(3):665-71
references.pmid: 18760545
references.citation: Infirm Fr. 1981 Feb;(222):26, 28
references.pmid: 6907191
references.citation: Radiographics. 2004 Oct;24 Suppl 1:S167-80
references.pmid: 15486239
references.citation: Cancer. 1999 Jun 15;85(12):2630-7
references.pmid: 10375112
references.citation: J Urol. 2007 Dec;178(6):2260-7
references.pmid: 17936815
references.citation: Radiology. 1994 Nov;193(2):333-9
references.pmid: 7972739
references.citation: AJR Am J Roentgenol. 2007 Jan;188(1):84-90
references.pmid: 17179349
references.citation: Cancer. 2004 Jun 15;100(12):2655-63
references.pmid: 15197809
references.citation: Acta Radiol. 2001 Jul;42(4):348-54
references.pmid: 11442457
references.citation: Urology. 2000 Mar;55(3):382-6
references.pmid: 10699615
references.citation: Radiology. 2007 Apr;243(1):28-53
references.pmid: 17392247
references.citation: Eur Radiol. 2002 Sep;12(9):2294-302
references.pmid: 12195484
references.citation: J Urol. 1994 Nov;152(5 Pt 1):1520-5
references.pmid: 7523710
references.citation: Biometrics. 1992 Jun;48(2):577-85
references.pmid: 1637980
references.citation: Radiology. 1991 Mar;178(3):797-802
references.pmid: 1994421
references.citation: Radiology. 2007 Oct;245(1):176-85
references.pmid: 17717328
references.citation: J Urol. 2002 Feb;167(2 Pt 1):528-34
references.pmid: 11792912
references.citation: Radiology. 1997 Mar;202(3):697-702
references.pmid: 9051019
references.citation: Hum Pathol. 1998 Aug;29(8):856-62
references.pmid: 9712429
references.citation: Mod Pathol. 2004 Mar;17(3):349-59
references.pmid: 14765206
references.citation: J Urol. 2003 Dec;170(6 Pt 1):2292-5
references.pmid: 14634399
references.citation: AJR Am J Roentgenol. 1996 Apr;166(4):845-52
references.pmid: 8610561
references.citation: Urology. 2001 Apr;57(4):721-6
references.pmid: 11306390