Three-year experience of a dedicated prostate mpMRI pre-biopsy programme and effect on timed cancer diagnostic pathways
Barrett, Tristan ...
Accepted 4 June 2019 AIM: To evaluate the effect of pre-biopsy magnetic resonance imaging (MRI) on cancer diagnostic times, and to report MRI-directed pathology outcomes. MATERIALS AND METHODS: In ...total, 1483 patients were referred with prostate cancer suspicion during a 30-month period. Upfront MRI was performed in 745 patients: 332 MRIs in the 15 months prior to dedicated scanning slots (group 1), and 413 in the 15 months post- introduction (group 2). A further 88 patients had initial MRI following clinical assessment. Biopsy via the transrectal (TR) or transperineal (TP) approach was performed, with MRI/ul- trasound fusion for MRI targets. Clinically significant cancer (csPCa) was defined as Gleason 3þ4. Negative MRIs were defined as Likert 1e2. Per-case clinical decisions were taken to biopsy or not. RESULTS: 44.4% of patients avoided biopsy. 484/833 (58.1%) MRIs were negative; 37.4% of these patients had biopsy with a negative predictive value (NPV) of 92.8% for Gleason 3þ4 and 98.3% for 4þ3. Overall prostate cancer prevalence was 34.3% (24.6% csPCa). In 323 MRI- positive cases, any cancer was present in 78.9% (csPCa 60.4%). Of the 1483 patients, 1232 (83.1%) completed all diagnostic tests within 28 days. Upfront MRI patients met this standard in 621/833 (74.5%), improving from 66.9% to 81.1% with reserved slots (group 2) with a reduced diagnostic time from median 25.5 to 20.9 days. Biopsy scheduling delayed the pathway in * Guarantor and correspondent: T. Barrett, Department of Radiology, Addenbrooke’s Hospital, Box 218, Cambridge University Hospitals, Hills Road, Cambridge CB2 0QQ, UK. E-mail address: tristan.barrett@addenbrookes.nhs.uk (T. Barrett). Contents lists available at ScienceDirect Clinical Radiology j o u r n a l h o m e p a g e : w w w . c l i n i c a l r a d i o l o g y o n l i n e . n e t https://doi.org/10.1016/j.crad.2019.06.004 0009-9260/Ó 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. Clinical Radiology 74 (2019) 894.e1e894.e9 T. Barret
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