title: Likert score 3 prostate lesions: Association between whole-lesion ADC metrics and pathologic findings at MRI/ultrasound fusion targeted biopsy.
abstract: BACKGROUND
  To assess associations between whole-lesion apparent diffusion coefficient (ADC) metrics and pathologic findings of Likert score 3 prostate lesions at MRI/ultrasound fusion targeted biopsy.
  
  
  METHODS
  This retrospective Institutional Review Board-approved study received a waiver of consent. We identified patients receiving a highest lesion score of 3 on 3 Tesla multiparametric MRI reviewed by a single experienced radiologist using a 5-point Likert scale and who underwent fusion biopsy. A total of 188 score 3 lesions in 158 patients were included. Three-dimensional volumes-of-interest encompassing each lesion were traced on ADC maps. Logistic regression was used to predict biopsy results based on whole-lesion ADC metrics and patient biopsy history. Biopsy yield was compared between metrics.
  
  
  RESULTS
  By lesion, targeted biopsy identified tumor in 22.3% and Gleason score (GS) > 6 tumor in 8.5%, although results varied by biopsy history: biopsy-naïve (n = 80), 20.0%/8.8%; prior negative biopsy (n = 53), 9.4%/1.9%; prior positive biopsy (n = 55): 40.0%/14.5%. Biopsy history, whole-lesion mean ADC, whole-lesion ADC10-25 , and whole-lesion ADC25-50 were each significantly associated with tumor or GS > 6 tumor at fusion biopsy (P ≤ 0.047). In men without prior negative prostate biopsy, whole-lesion ADC25-50  ≤ 1.04*10(-3) mm2 /s achieved 90.0% sensitivity and 50.0% specificity for GS > 6 tumor, which was significantly higher (P < 0.001) than specificity of PSA (17.5%) at identical sensitivity.
  
  
  CONCLUSIONS
  For score 3 lesions in patients without prior negative biopsy, whole-lesion ADC metrics help detect GS > 6 cancer while avoiding negative biopsies. However, deferral of fusion biopsy may be considered for score 3 lesions in patients with prior negative biopsy (without applying whole-lesion ADC metrics) given exceedingly low (∼ 2%) frequency of GS > 6 tumor in this group.
authors.affiliation: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.affiliation: Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Xiaosong
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Ream
authors.affiliation: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.affiliation: Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Deng
authors.affiliation: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.affiliation: Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
authors.affiliation: Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Taneja
mesh_terms: D006801:Humans; D061705:Image-Guided Biopsy; D021621:Imaging, Three-Dimensional; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional
keywords: MRI; apparent diffusion coefficient; diffusion-weighted imaging; prostate biopsy; prostate cancer