A prospective comparative analysis of the accuracy of HistoScanning and multiparametric magnetic resonance imaging in the localization of prostate cancer among men undergoing radical prostatectomy.
BACKGROUND
There is increasing interest in using imaging in the detection and localization of prostate cancer (PCa). Both multiparametric magnetic resonance imaging (mpMRI) and HistoScanning (HS) have been independently evaluated in the detection and localization of PCa. We undertook a prospective, blinded comparison of mpMRI and HS for cancer localization among men undergoing radical prostatectomy.


METHODS
Following approval by the institutional review board, men scheduled to undergo radical prostatectomy, who had previously undergone mpMRI at our institution, were offered inclusion in the study. Those consenting underwent preoperative HS following induction of anesthesia; mpMRI, HS, and surgical step-section pathology were independently read by a single radiologist, urologist, and pathologist, respectively, in a blinded fashion. Disease maps created by each independent reader were compared and evaluated for concordance by a 5 persons committee consisting of 2 urologists, 2 pathologists, and 1 radiologist. Logistic regression for correlated data was used to assess and compare mpMRI and HS in terms of diagnostic accuracy for cancer detection. Generalized estimating equations based on binary logistic regression were used to model concordance between reader opinion and the reference standard assessment of the same lesion site or region as a function of imaging modality.


RESULTS
Data from 31/35 men enrolled in the trial were deemed to be evaluable. On evaluation of cancer localization, HS identified cancer in 36/78 (46.2%) regions of interest, as compared with 41/78 (52.6%) on mpMRI (P = 0.3968). The overall accuracy, positive predictive value, negative predictive value, and specificity for detection of disease within a region of interest were significantly better with mpMRI as compared with HS. HS detected 36/84 (42.9%) cancer foci as compared with 42/84 (50%) detected by mpMRI (P = 0.3678). Among tumors with Gleason score>6, mpMRI detected 19/22 (86.4%) whereas HS detected only 11/22 (50%, P = 0.0078). Similarly, among tumors>10mm in maximal diameter, mpMRI detected 28/34 (82.4%) whereas HS detected only 19/34 (55.9%, P = 0.0352).


CONCLUSIONS
In our institution, the diagnostic accuracy of HS was inferior to that of mpMRI in PCa for PCa detection and localization. Although our study warrants validation from larger cohorts, it would suggest that the HS protocol requires further refinement before clinical implementation.
Department of Urology, New York University Langone Medical Center, New York, NY; Department of Surgery, University Hospital of Caen, Normandy, France; UMR 6301, ISTCT, CERVoxy Team, Cyceron GIP, Caen, France.
Clement
C
Orczyk
Department of Radiology, New York University Langone Medical Center, New York, NY.
Andrew B
AB
Rosenkrantz
Department of Pathology, New York University Langone Medical Center, New York, NY.
Fang-Ming
FM
Deng
Department of Pathology, New York University Langone Medical Center, New York, NY.
Jonathan
J
Melamed
Department of Radiology, New York University Langone Medical Center, New York, NY.
James
J
Babb
Department of Urology, New York University Langone Medical Center, New York, NY.
James
J
Wysock
Department of Urology, New York University Langone Medical Center, New York, NY.
Emil
E
Kheterpal
Department of Urology, New York University Langone Medical Center, New York, NY.
William C
WC
Huang
Department of Urology, New York University Langone Medical Center, New York, NY.
Michael
M
Stifelman
Department of Urology, New York University Langone Medical Center, New York, NY.
Herbert
H
Lepor
Department of Urology, New York University Langone Medical Center, New York, NY; Department of Radiology, New York University Langone Medical Center, New York, NY. Electronic address: Samir.Taneja@nyumc.org.
Samir S
SS
Taneja
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010340:Pathology, Surgical; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery
Detection; HistoScanning; Imaging; MRI; Prostate cancer; Radical prostatectomy