Clinical history doesn’t seem to have an impact on the maximum Prostate Imaging Recording and Data System (PI-RADS) version 2 score, but the PI-RADS v2 assessment can be viewed as an independent marker of prostate cancer risk, according to a study published in Radiology this April.
PI-RADS v2 works to detect clinically important prostate cancer through the classification of lesions on radiologic scans, the authors said, and it incorporates lesion location, morphology and MR signal characteristics into its diagnostic formula.
“However, PI-RADS v2 does not incorporate clinical history or patient demographics—it is purely an imaging-based risk-assessment tool,” Shankar et al. wrote. “Given the range of interrater agreement that has been observed in the formal study of PI-RADS v2, that raised a question—is there a latent clinical history bias impacting scoring?”
To assess this, Shankar and his team found 120 multiparametric prostate MRI studies performed between November and December 2016, randomly assigning sham clinical data to each case. Sham data fell into four domains—digital rectal examination, prostate-specific antigen level, plan for biopsy or prior prostate cancer history.
Six fellowship-trained abdominal radiologists were asked to independently review each case with the sham data. Each reader was apt to the patient’s age and exam, but blinded to interreader scoring, true clinical data and histologic findings. After evaluating each case, the radiologists were asked to assign a PI-RADS v2 value.
The authors found that in each case and among all six readers, access to clinical history had no relevant influence on maximum PI-RADS v2 score. Reader scoring with sham histories proved similar to clinical scoring with true histories in both population and case-by-case settings, they wrote.
Something new did emerge, though, when the researchers found PI-RADS v2 to be an independent predictor of cancer risk. The information could be crucial for clinical nomograms that plan to implement PI-RADS v2 and clinical data into their risk algorithms.
“We acknowledge that clinical history may still be important in the interpretation of multiparametric MR imaging studies on an individual basis, but on a population level, our findings suggest that PI-RADS v2 can be viewed as an independent marker of prostate cancer risk,” Shankar and colleagues said. “Future studies should assess the stepwise improvements PI-RADS v2 scoring can add to existing clinical nomograms of prostate cancer risk.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.