Index lesion contouring on prostate MRI for targeted MRI/US fusion biopsy – Evaluation of mismatch between radiologists and urologists

• Published in: European journal of radiology 2023-05, Vol.162, p.110763-110763, Article 110763
• Main Authors: Ghafoor, Soleen, Steinebrunner, Florian, Stocker, Daniel, Hötker, Andreas M., Schmid, Florian A., Eberli, Daniel, Donati, Olivio F.
• Format: Article
• Language: English
• Subjects: Aged; Biopsy; Humans; Image-Guided Biopsy - methods; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; Prostate; Prostate - diagnostic imaging; Prostate - pathology; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Radiologists; Retrospective Studies; Urologists
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2023.110763

•Segmentation errors of focal index lesions can affect targeted prostate biopsies.•There is substantial disagreement of lesion segmentations between urologists and radiologists.•Reproducibility of segmentations improves between radiologists but remains only moderate.•Knowledge of this segmentation mismatch encourages the potential use of perilesional biopsy. Mistargeting of focal lesions due to inaccurate segmentations can lead to false-negative findings on MRI-guided targeted biopsies. The purpose of this retrospective study was to examine inter-reader agreement of prostate index lesion segmentations from actual biopsy data between urologists and radiologists. Consecutive patients undergoing transperineal MRI-targeted prostate biopsy for PI-RADS 3–5 lesions between January 2020 and December 2021 were included. Agreement between segmentations on T2w-images between urologists and radiologists was assessed with Dice similarity coefficient (DSC) and 95 % Hausdorff distance (95 % HD). Differences in similarity scores were compared using Wilcoxon test. Differences depending on lesion features (size, zonal location, PI-RADS scores, lesion distinctness) were tested with Mann-Whitney U test. Correlation with prostate signal-intensity homogeneity score (PSHS) and lesion size was tested with Spearman’s rank correlation. Ninety-three patients (mean age 64.9 ± 7.1y, median serum PSA 6.5 [4.33–10.00]) were included. Mean similarity scores were statistically significantly lower between urologists and radiologists compared to radiologists only (DSC 0.41 ± 0.24 vs. 0.59 ± 0.23, p