title: Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy.
abstract: OBJECTIVE
  To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy.
  
  
  METHODS
  Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher's exact test.
  
  
  RESULTS
  Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00.
  
  
  CONCLUSIONS
  Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions.
  
  
  CONCLUSIONS
  • Multiparametric MRIs were more often called negative in subspecialist reads (41 % vs 20 %). • Second readings of prostate mpMRIs by subspecialist uroradiologists significantly improved NPV and PPV. • Reporter experience may reduce overcalling and avoid overtargeting of lesions. • Greater education and training of radiologists in prostate MRI interpretation is advised.
authors: Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.|CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Nienke L
authors: NL
authors: Hansen
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.|Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Brendan C
authors: BC
authors: Koo
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.|Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Ferdia A
authors: FA
authors: Gallagher
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.|Department of Pathology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Anne Y
authors: AY
authors: Warren
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.|Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Andrew
authors: A
authors: Doble
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.|Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Vincent
authors: V
authors: Gnanapragasam
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.|Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Ola
authors: O
authors: Bratt
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK.|Department of Urology, Addenbrooke's Hospital, Hills Road, CB2 0QQ, Cambridge, UK.
authors: Christof
authors: C
authors: Kastner
authors: CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK. Tristan.barrett@addenbrookes.nhs.uk.|Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, CB2 0QQ, Cambridge, UK. Tristan.barrett@addenbrookes.nhs.uk.|Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. Tristan.barrett@addenbrookes.nhs.uk.
authors: Tristan
authors: T
authors: Barrett
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000592:standards; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D060787:Neoplasm Grading; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D000072177:Radiologists / Q000592:standards; D012017:Referral and Consultation; D062606:Tertiary Care Centers
keywords: MR/ultrasound fusion biopsy; Magnetic resonance imaging; Prostate cancer; Second read; Transperineal prostate biopsy