title: Characteristics of Detected and Missed Prostate Cancer Foci on 3-T Multiparametric MRI Using an Endorectal Coil Correlated With Whole-Mount Thin-Section Histopathology.
abstract: OBJECTIVE
  The objective of this study was to determine the characteristics of prostate cancer foci missed on 3-T multiparametric MRI performed with an endorectal coil.
  
  
  METHODS
  The MRI examinations of 122 patients who underwent 3-T multiparametric MRI of the prostate with an endorectal coil were compared with whole-mount histopathology obtained after radical prostatectomy. The mean age of the patients was 60.6 years (SD, 7.6 years), and the mean prostate-specific antigen value was 7.2 ng/mL (SD, 5.9 ng/mL). The clinical, multiparametric MRI (i.e., T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging), and histopathologic features were obtained. After an independent review, two blinded genitourinary radiologists matched each case with a genitourinary pathologist. A structured reporting system was used to classify the multiparametric MRI features of each MRI-detected lesion. A chi-square analysis was performed for categoric variables, and the t test was performed for continuous variables.
  
  
  RESULTS
  On whole-mount histopathology, 285 prostate cancer foci were detected in 122 patients. Of the 285 cancer foci detected at histopathology, 153 (53.3%) were missed on MRI and 132 (46.7%) were detected on MRI. Of the missed lesions, 75.2% were low-grade prostate cancer. Multiparametric MRI had a significantly higher sensitivity for prostate cancer foci 1 cm or larger than for subcentimeter foci (81.1% vs 18.9%, respectively; p < 0.001), for lesions with a Gleason score of 7 or greater than for lesions with a Gleason score of 6 (72.7% vs 27.3%; p < 0.01), and for index lesions than for satellite lesions (80.3% vs 20.8%; p < 0.01). The 3-T multiparametric MRI examinations showed a higher detection rate for lesions in the midgland or base of the gland compared with lesions in the apex (52.3% vs 22.0%, respectively; p < 0.01).
  
  
  CONCLUSIONS
  Compared with the prostate cancer lesions that were detected on multiparametric MRI, the prostate cancer lesions that were missed were significantly smaller, were more likely to be low-grade lesions (i.e., Gleason score of 6), were more commonly satellite lesions, and were more likely to be located in the prostatic apex.
authors.affiliation: 1 Department of Radiology, David Geffen School of Medicine at UCLA, Box 957437, RRUMC 1621, Los Angeles, CA 90095.
authors.forename: Nelly
authors.initials: N
authors.lastname: Tan
authors.affiliation: 1 Department of Radiology, David Geffen School of Medicine at UCLA, Box 957437, RRUMC 1621, Los Angeles, CA 90095.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: 2 Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Lu
authors.affiliation: 1 Department of Radiology, David Geffen School of Medicine at UCLA, Box 957437, RRUMC 1621, Los Angeles, CA 90095.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: King
authors.affiliation: 2 Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Jiaoti
authors.initials: J
authors.lastname: Huang
authors.affiliation: 3 Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Reiter
authors.affiliation: 1 Department of Radiology, David Geffen School of Medicine at UCLA, Box 957437, RRUMC 1621, Los Angeles, CA 90095.|3 Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Raman
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D001706:Biopsy; D003951:Diagnostic Errors; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity
keywords: multiparametric prostate MRI; prostate cancer