title: Predictive power of the ESUR scoring system for prostate cancer diagnosis verified with targeted MR-guided in-bore biopsy.
abstract: OBJECTIVE
  This study evaluates the diagnostic value of the ESUR scoring system (PI-RADS) regarding prostate cancer detection using MR-guided in-bore biopsies (IB-GB) as the reference standard.
  
  
  METHODS
  566 lesions in 235 consecutive patients (65.7 ± 7.9 years, PSA 9.9 ± 8.5 ng/ml) with a multiparametric (mp)-MRI (T2WI, DWI, DCE) of the prostate at 3T were scored using the PI-RADS scoring system. PI-RADS single (PSsingle), summed (PSsum), and overall (PSoverall) scores were determined. All lesions were histologically verified by IB-GB.
  
  
  RESULTS
  Lesions with a PSsum below 9 contained no prostate cancer (PCa) with Gleason score (GS) ≥ 4+3=7. A PSsum of 13-15 (PSoverall V) resulted in 87.8% (n=108) in PCa and in 42.3% (n=52) in GS ≥ 4+3=7. Transition zone (TZ) lesions with a PSsum of 13-15 (PSoverall V) resulted in 76.3% (n=36) in PCa and in 26.3% (n=10) in GS ≥ 4+3=7, whereas for peripheral zone (PZ) lesions cancer detection rate at this score was 92.9% (n=79) and 49.4% (n=42) for GS ≥ 4+3=7. Using a threshold of PSsum ≥ 10, sensitivity was 86.0%, and negative predictive value (NPV) was 86.2%. For higher grade PCa sensitivity was 98.6%, and NPV was 99.5%.
  
  
  CONCLUSIONS
  A PSsum below 9 excluded a higher grade PCa, whereas lesions with a PSsum ≥ 13 (PSoverall V) represented in 88% PCa, and in 42% higher grade PCa. The PSsum or PSoverall demonstrated a better diagnostic value for PZ lesions with higher detection rates for higher grade PCa compared to TZ lesions.
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Lars.Schimmoeller@med.uni-duesseldorf.de.
authors.forename: L
authors.initials: L
authors.lastname: Schimmöller
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Michael.Quentin@med.uni-duesseldorf.de.
authors.forename: M
authors.initials: M
authors.lastname: Quentin
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Urology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Cristian.Arsov@med.uni-duesseldorf.de.
authors.forename: C
authors.initials: C
authors.lastname: Arsov
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Urology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Andreas.Hiester@med.uni-duesseldorf.de.
authors.forename: A
authors.initials: A
authors.lastname: Hiester
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Patric.Kroepil@med.uni-duesseldorf.de.
authors.forename: P
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Urology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Robert.Rabenalt@med.uni-duesseldorf.de.
authors.forename: R
authors.initials: R
authors.lastname: Rabenalt
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Urology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: urologie@uni-duesseldorf.de.
authors.forename: P
authors.initials: P
authors.lastname: Albers
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Antoch@med.uni-duesseldorf.de.
authors.forename: G
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany. Electronic address: Dirk.Blondin@sk-mg.de.
authors.forename: D
authors.initials: D
authors.lastname: Blondin
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology*
keywords: ESUR scoring system; MRI-guided biopsy; PI-RADS; Prostate MRI; Prostate cancer