title: Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis.
abstract: OBJECTIVE
  To evaluate the impact of dedicated reader education on accuracy/confidence of peripheral zone index cancer and anterior prostate cancer (PCa) diagnosis with mpMRI; secondary aim was to assess the ability of readers to differentiate low-grade cancer (Gleason 6 or below) from high-grade cancer (Gleason 7+).
  
  
  METHODS
  Five blinded radiology fellows evaluated 31 total prostate mpMRIs in this IRB-approved, HIPAA-compliant, retrospective study for index lesion detection, confidence in lesion diagnosis (1-5 scale), and Gleason grade (Gleason 6 or lower vs. Gleason 7+). Following a dedicated education program, readers reinterpreted cases after a memory extinction period, blinded to initial reads. Reference standard was established combining whole mount histopathology with mpMRI findings by a board-certified radiologist with 5 years of prostate mpMRI experience.
  
  
  RESULTS
  Index cancer detection: pre-education accuracy 74.2%; post-education accuracy 87.7% (p = 0.003). Confidence in index lesion diagnosis: pre-education 4.22 ± 1.04; post-education 3.75 ± 1.41 (p = 0.0004). Anterior PCa detection: pre-education accuracy 54.3%; post-education accuracy 94.3% (p = 0.001). Confidence in anterior PCa diagnosis: pre-education 3.22 ± 1.54; post-education 4.29 ± 0.83 (p = 0.0003). Gleason score accuracy: pre-education 54.8%; post-education 73.5% (p = 0.0005).
  
  
  CONCLUSIONS
  A dedicated reader education program on PCa detection with mpMRI was associated with a statistically significant increase in diagnostic accuracy of index cancer and anterior cancer detection as well as Gleason grade identification as compared to pre-education values. This was also associated with a significant increase in reader diagnostic confidence. This suggests that substantial interobserver variability in mpMRI interpretation can potentially be reduced with a focus on education and that this can occur over a fellowship training year.
authors.affiliation: Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA.
authors.forename: Kirema
authors.initials: K
authors.lastname: Garcia-Reyes
authors.forename: Niccolò M
authors.initials: NM
authors.lastname: Passoni
authors.forename: Mark L
authors.initials: ML
authors.lastname: Palmeri
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Kauffman
authors.forename: Kingshuk Roy
authors.initials: KR
authors.lastname: Choudhury
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Rajan T
authors.initials: RT
authors.lastname: Gupta
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004522:Educational Status; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D015588:Observer Variation; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies