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External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy

Background: The aim of this study was to validate externally a nomogram that relies on MRI volumetric parameters and clinical data to determine the need for a standard biopsy in addition to a target biopsy for men with suspicious prostate MRI findings. Methods: We conducted a retrospective analysis...

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Autores principales: Ninivaggi, Antonella, Guzzi, Francesco, Degennaro, Alessio, Ricapito, Anna, Bettocchi, Carlo, Busetto, Gian Maria, Sanguedolce, Francesca, Milillo, Paola, Selvaggio, Oscar, Cormio, Luigi, Carrieri, Giuseppe, Falagario, Ugo Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10488903/
https://www.ncbi.nlm.nih.gov/pubmed/37685815
http://dx.doi.org/10.3390/jcm12175748
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author Ninivaggi, Antonella
Guzzi, Francesco
Degennaro, Alessio
Ricapito, Anna
Bettocchi, Carlo
Busetto, Gian Maria
Sanguedolce, Francesca
Milillo, Paola
Selvaggio, Oscar
Cormio, Luigi
Carrieri, Giuseppe
Falagario, Ugo Giovanni
author_facet Ninivaggi, Antonella
Guzzi, Francesco
Degennaro, Alessio
Ricapito, Anna
Bettocchi, Carlo
Busetto, Gian Maria
Sanguedolce, Francesca
Milillo, Paola
Selvaggio, Oscar
Cormio, Luigi
Carrieri, Giuseppe
Falagario, Ugo Giovanni
author_sort Ninivaggi, Antonella
collection PubMed
description Background: The aim of this study was to validate externally a nomogram that relies on MRI volumetric parameters and clinical data to determine the need for a standard biopsy in addition to a target biopsy for men with suspicious prostate MRI findings. Methods: We conducted a retrospective analysis of a prospectively maintained database of 469 biopsy-naïve men who underwent prostate biopsies. These biopsies were guided by pre-biopsy multiparametric Magnetic Resonance Imaging (mpMRI) and were performed at two different institutions. We included men with a PIRADSsv 2.1 score from 3 to 5. Each patient underwent both an MRI–ultrasound fusion biopsy of identified MRI-suspicious lesions and a systematic biopsy according to our protocol. The lesion volume percentage was determined as the proportion of cancer volume on MRI relative to the entire prostate volume. The study’s outcomes were iPCa (Gleason Grade Group 1) and csPCa (Gleason Grade Group > 1). We evaluated the model’s performance using AUC decision curve analyses and a systematic analysis of model-derived probability cut-offs in terms of the potential to avoid diagnosing iPCa and to accurately diagnose csPCa. Results: The nomogram includes age, PSA value, prostate volume, PIRADSsv 2.1 score, percentage of MRI-suspicious lesion volume, and lesion location. AUC was determined to be 0.73. By using various nomogram cut-off thresholds (ranging from 5% to 30%), it was observed that 19% to 58% of men could potentially avoid undergoing standard biopsies. In this scenario, the model might miss 0% to 10% of diagnosis of csPCa and could prevent identifying 6% to 31% of iPCa cases. These results are in line with findings from the multi-institutional external validation study based on the IMPROD trial (n = 122) and the MULTI-IMPROD trial (n = 262). According to DCA, the use of this nomogram led to an increased overall net clinical benefit when the threshold probability exceeded 10%. Conclusions: This study supports the potential value of a model relying on MRI volumetric measurements for selecting individuals with clinical suspicion of prostate cancer who would benefit from undergoing a standard biopsy in addition to a targeted biopsy.
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spelling pubmed-104889032023-09-09 External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy Ninivaggi, Antonella Guzzi, Francesco Degennaro, Alessio Ricapito, Anna Bettocchi, Carlo Busetto, Gian Maria Sanguedolce, Francesca Milillo, Paola Selvaggio, Oscar Cormio, Luigi Carrieri, Giuseppe Falagario, Ugo Giovanni J Clin Med Article Background: The aim of this study was to validate externally a nomogram that relies on MRI volumetric parameters and clinical data to determine the need for a standard biopsy in addition to a target biopsy for men with suspicious prostate MRI findings. Methods: We conducted a retrospective analysis of a prospectively maintained database of 469 biopsy-naïve men who underwent prostate biopsies. These biopsies were guided by pre-biopsy multiparametric Magnetic Resonance Imaging (mpMRI) and were performed at two different institutions. We included men with a PIRADSsv 2.1 score from 3 to 5. Each patient underwent both an MRI–ultrasound fusion biopsy of identified MRI-suspicious lesions and a systematic biopsy according to our protocol. The lesion volume percentage was determined as the proportion of cancer volume on MRI relative to the entire prostate volume. The study’s outcomes were iPCa (Gleason Grade Group 1) and csPCa (Gleason Grade Group > 1). We evaluated the model’s performance using AUC decision curve analyses and a systematic analysis of model-derived probability cut-offs in terms of the potential to avoid diagnosing iPCa and to accurately diagnose csPCa. Results: The nomogram includes age, PSA value, prostate volume, PIRADSsv 2.1 score, percentage of MRI-suspicious lesion volume, and lesion location. AUC was determined to be 0.73. By using various nomogram cut-off thresholds (ranging from 5% to 30%), it was observed that 19% to 58% of men could potentially avoid undergoing standard biopsies. In this scenario, the model might miss 0% to 10% of diagnosis of csPCa and could prevent identifying 6% to 31% of iPCa cases. These results are in line with findings from the multi-institutional external validation study based on the IMPROD trial (n = 122) and the MULTI-IMPROD trial (n = 262). According to DCA, the use of this nomogram led to an increased overall net clinical benefit when the threshold probability exceeded 10%. Conclusions: This study supports the potential value of a model relying on MRI volumetric measurements for selecting individuals with clinical suspicion of prostate cancer who would benefit from undergoing a standard biopsy in addition to a targeted biopsy. MDPI 2023-09-04 /pmc/articles/PMC10488903/ /pubmed/37685815 http://dx.doi.org/10.3390/jcm12175748 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ninivaggi, Antonella
Guzzi, Francesco
Degennaro, Alessio
Ricapito, Anna
Bettocchi, Carlo
Busetto, Gian Maria
Sanguedolce, Francesca
Milillo, Paola
Selvaggio, Oscar
Cormio, Luigi
Carrieri, Giuseppe
Falagario, Ugo Giovanni
External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy
title External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy
title_full External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy
title_fullStr External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy
title_full_unstemmed External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy
title_short External Validation of the IMPROD-MRI Volumetric Model to Predict the Utility of Systematic Biopsies at the Time of Targeted Biopsy
title_sort external validation of the improd-mri volumetric model to predict the utility of systematic biopsies at the time of targeted biopsy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10488903/
https://www.ncbi.nlm.nih.gov/pubmed/37685815
http://dx.doi.org/10.3390/jcm12175748
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