Central zone lesions on magnetic resonance imaging: Should we be concerned?

• Published in: Urologic oncology 2017-01, Vol.35 (1), p.31.e7-31.e12
• Main Authors: Tan, Wei Phin, M.D, Mazzone, Andrew, B.S, Shors, Stephanie, M.D., M.S, Antoine, Nency, R.D.M.S, Ekbal, Shahid, M.D, Khare, Narendra, M.D, McKiel, Charles, M.D, Pessis, Dennis, M.D, Deane, Leslie, M.B.B.S., F.R.C.S.C., F.A.C.S
• Format: Article
• Language: English
• Subjects: Aged; Central zone lesion; Contrast Media; Diffusion Magnetic Resonance Imaging; Humans; Image-Guided Biopsy - methods; Male; Middle Aged; MRI/US biopsy; Multimodal Imaging; Multiparametric magnetic resonance imaging; Prostate - diagnostic imaging; Prostate - pathology; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; PSA; Retrospective Studies; Ultrasonography, Interventional; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2016.08.006

Abstract Introduction and objective The Prostate Imaging Reporting and Data System (PI-RADS) score was developed to evaluate lesions in the peripheral and transition zone on multiparametric magnetic resonance imaging (mpMRI) of the prostate. We aim to determine if the PI-RADS scoring system can be used to evaluate central zone lesions on mpMRI. Materials and methods A retrospective review of 73 patients who underwent mpMRI/ultrasound (US) fusion-guided biopsy of 143 suspicious lesions between February 2014 and October 2015 was performed. All patients underwent a 3 T mpMRI. Indications for mpMRI included an abnormal digital rectal examination, PSA velocity >0.75 ng/dl/y, and patients on active surveillance. The mpMRI sequence involved T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast enhancement. Using 3-dimensional model software (Invivo Corporation, Gainesville, FL, USA), a minimum of 3 magnetic resonance imaging (MRI)/US fusion-guided biopsy samples were taken from each prostate lesion seen on mpMRI irrespective of PI-RADS score, using local anesthesia in an outpatient clinic setting. Results A total of 73 patients underwent MRI/US fusion-guided biopsy of 85 peripheral zone lesions, 31 transitional zone lesions, and 27 central zone lesions. Only 2 (7%) of central zone lesions were positive for prostate cancer. Both patients had lesions which were graded as PI-RADS 3. Both the patients had multifocal lesions that encompassed≥50% of the central and transition zones on the sagittal view MRI images. Both patients previously had transrectal US-guided biopsy of the prostate which was negative for cancer. Both patients underwent a robotic-assisted laparoscopic prostatectomy, each revealing high-grade cancer. Conclusions Lesions involving only the central gland/zone seen on MRI are less concerning for malignancy and should not be given equal weight as peripheral zone lesions. In this series, no lesions involving solely the central gland/zone, regardless of PI-RADS score, was positive for malignancy on MRI/US fusion-guided biopsy. Consideration of a modified PI-RADS scoring system should be given to help identify central zone lesions with malignant potential.