Variability in prostate MRI interpretation underlines importance of second-opinion reviews
Variability in the interpretation of prostate magnetic resonance images underlines the importance of gathering second opinions, according to new research published in Abdominal Radiology.
Multiparametric MRI is the investigation of choice when assessing the gland for cancer. However, there is a learning curve when conducting such work, with increased reader experience resulting in improved diagnostic accuracy, experts noted.
To alleviate any inconsistencies, patients treated by Vancouver Coastal Health typically have mpMRI performed at their referring community hospital. Abdominal radiologists later reinterpret such scans as part of a multidisciplinary review before a biopsy. Retrospectively analyzing MRIs from more than 300 patients assessed with these second reviews, researchers found powerful evidence of their importance.
“Variability in the interpretation of prostate MRI for cancer detection between community and tertiary care centers demonstrate the added value of multidisciplinary round review and highlight the need for ongoing education, quality assurance and feedback,” Jessica Li, with the Department of Radiology at Vancouver General Hospital, and co-authors wrote Dec. 16. “Potential avenues include virtual participation in multidisciplinary review boards for radiologists practicing outside of tertiary care centers,” they added.
Li and colleagues collected cases for their study from a single tertiary care center in Vancouver. Patients who met the criteria were treated between 2017-2020 and either had suspected prostate cancer or were on active surveillance and referred by a urologist for mpMRI. All scans were initially performed and interpreted by a radiologist at 1 of 27 community referral centers, while 2-3 fellowship-trained abdominal rads handled the second read.
All told, 332 lesions in 303 patients were reviewed, with 252 lesions in 198 patients biopsied. Prostate Imaging Reporting & Data System scores were concordant for 60.5% of lesions, while readers downgraded then in nearly 18% of cases and upgraded in 8%. Agreement between the community-based providers and tertiary care center was found to be fair (κ = 0.354), Li and co-authors noted. Higher concordance rates were recorded for higher grade and peripheral-zone lesions.
Li et al. also noted higher positive predictive values in the second reads, which could be for a variety of reasons.
“We posit that the higher PPVs for tertiary center interpretation were due to the advantages offered by a multidisciplinary board, including clinician input, clinical context, pooled expertise, and subspecialist interpretation,” the authors wrote. “During the second read the subspecialist radiologist accesses clinical parameters such as [prostate-specific antigen] density, PSA trend, sites of prior targeted or systematic biopsy, and family history via the electronic medical record, which offer additional insight into the degree of clinical suspicion for [clinically significant prostate cancer].”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.