title: Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy.
abstract: BACKGROUND
  We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies.
  
  
  METHODS
  In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar's test.
  
  
  RESULTS
  False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patient-by-patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult.
  
  
  CONCLUSIONS
  We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results.
authors.affiliation: Department of Radiology, Champalimaud Foundation, Lisbon, Portugal, and Department of Biochemistry, University of Cambridge and Cancer Research, Cambridge, UK;
authors.forename: Eva M
authors.initials: EM
authors.lastname: Serrao
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge, UK;; Department of Radiology, Addenbrooke's Hospital, Cambridge, UK;
authors.forename: Tristan
authors.initials: T
authors.lastname: Barrett
authors.affiliation: Department of Urology, Addenbrooke's Hospital, Cambridge, UK;
authors.forename: Karan
authors.initials: K
authors.lastname: Wadhwa
authors.affiliation: Cancer Research Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK;
authors.forename: Deepak
authors.initials: D
authors.lastname: Parashar
authors.affiliation: Department of Urology, Addenbrooke's Hospital, Cambridge, UK;
authors.forename: Julia
authors.initials: J
authors.lastname: Frey
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge, UK;
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Koo
authors.affiliation: Department of Histopathology, Addenbrooke's Hospital.
authors.forename: Anne Y
authors.initials: AY
authors.lastname: Warren
authors.affiliation: Department of Urology, Addenbrooke's Hospital, Cambridge, UK;
authors.forename: Andrew
authors.initials: A
authors.lastname: Doble
authors.affiliation: Department of Urology, Addenbrooke's Hospital, Cambridge, UK;
authors.forename: Christof
authors.initials: C
authors.lastname: Kastner
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge, UK;; University of Cambridge, Cambridge, UK;
authors.forename: Ferdia A
authors.initials: FA
authors.lastname: Gallagher