PD62-04 EARLY EXPERIENCE WITH A STRUCTURED MULTIDISCIPLINARY QUALITY IMPROVEMENT PROTOCOL ON RECONCILING DISCORDANCE BETWEEN PI-RADS 4 LESIONS AND TARGETED BIOPSY HISTOLOGY
Journal of Urology(2024)SCI 1区
Abstract
You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety III (PD62)1 May 2024PD62-04 EARLY EXPERIENCE WITH A STRUCTURED MULTIDISCIPLINARY QUALITY IMPROVEMENT PROTOCOL ON RECONCILING DISCORDANCE BETWEEN PI-RADS 4 LESIONS AND TARGETED BIOPSY HISTOLOGY Sriram Deivasigamani, Srinath Kotamarti, Mahdi Mottaghi, Rajan Gupta, and Thomas J. Polascik Sriram DeivasigamaniSriram Deivasigamani , Srinath KotamartiSrinath Kotamarti , Mahdi MottaghiMahdi Mottaghi , Rajan GuptaRajan Gupta , and Thomas J. PolascikThomas J. Polascik View All Author Informationhttps://doi.org/10.1097/01.JU.0001008656.89655.67.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PI-RADS 4 lesions are considered to have a "high" likelihood of clinically significant prostate cancer (csPCa). However, patients undergoing targeted biopsy have a range of histologic findings. Understanding discordant cases is critical to improve diagnostic accuracy and inform subsequent management. We studied early findings from the implementation of a multidisciplinary Quality Improvement (QI) protocol for reconciling discordance and evaluating the potential heterogeneity of PI-RADS 4. METHODS: Patients with mpMRI PI-RADS 4 lesions undergoing fusion-targeted biopsy from Jan 2017 to May 2021 were retrospectively reviewed at Duke Health. The discordant targeted biopsy pathology (benign/GG1) was evaluated utilizing a QI protocol, including mpMRI re-review and a reverse fusion technique to determine whether targeted biopsies appeared to accurately sample the region of interest (ROI). We also investigated the potential heterogeneity of the PI-RADS 4 category itself. Lesions were sub-categorized as having higher suspicion (PI-RADS 4+) or lower suspicion (PI-RADS 4-) based on ADC values <1000 mm2/s for peripheral zone ROI or <800 mm2/s for transition zone ROI utilizing the area suspected to have the highest grade at QI protocol mpMRI re-review. Positive Predictive Value (PPV) for PI-RADS 4 lesions overall and the Cancer Detection Rate (CDR) for subcategorized lesions, PI-RADS 4+ and PI-RADS 4- were calculated. RESULTS: A total of 248 patients with 286 lesions were reviewed. Before re-review, PI-RADS 4 PPV for >GG1 and >GG2 lesions were 0.55 and 0.34, increasing to 0.67 and 0.43 following radiologic reconciliation. Lesion subcategorization based on ADC value as having higher suspicion (4+) and lower suspicion (4-) resulted in 158 and 117 lesions, with reverse-fusion analysis revealing that 61% and 17% of lesions contained csPCa, respectively. Subgroup analysis among PI-RADS 4+ lesions led to an increase in the CDR to 75% and 61% for >GG1 and >GG2, revealing that 52% of PI-RADS 4+ contained csPCa, compared to only 12% of PI-RADS 4- lesions with PPV closer to PI-RADS 3 lesions. CONCLUSIONS: The use of a multidisciplinary QI protocol to review discordant cases of PI-RADS 4 improves diagnostic accuracy and guides subsequent management. Our findings highlight the known heterogeneity of this category, suggesting the potential value of PI-RADS 4 subcategorization. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1286 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sriram Deivasigamani More articles by this author Srinath Kotamarti More articles by this author Mahdi Mottaghi More articles by this author Rajan Gupta More articles by this author Thomas J. Polascik More articles by this author Expand All Advertisement PDF downloadLoading ...
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