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Use of a Quality Improvement Initiative to Achieve Consistent Reporting of Level of Suspicion for Tumor on Multiparametric Prostate MRI

Rosenkrantz, Andrew B; Pujara, Akshat C; Taneja, Samir S
OBJECTIVE: The purpose of this article is to evaluate the utility of a quality improvement (QI) initiative in achieving long-term adherence to an evolving structured format for reporting the level of suspicion for tumor on prostate MRI examinations. MATERIALS AND METHODS: The original QI initiative occurred over a 4-month period in 2010, before which prostate MRI was reported using free text. The initiative consisted of development of a section-wide macro, an initial group training session, ordering physician input regarding the structured report's value, subsequent weekly sessions for ongoing review, and timely individualized feedback in instances of nonuse. The initial structured report included pick lists for describing the level of suspicion for tumor as negative, low, medium, or high. Pick lists were modified in 2011 to incorporate a 5-point Likert scale and again in 2015 to incorporate Prostate Imaging Data and Reporting System (PI-RADS) version 2. These refinements were implemented after accelerated training periods. The frequency of reports providing an MRI-based suspicion level during these periods was assessed. RESULTS: Fifty-five percent of reports provided an MRI-based level of suspicion for tumor before the initiative. For various cohorts evaluated after the initiative (using structured reports based on the low, medium, or high scheme; a numeric Likert scale; or PI-RADS), this frequency improved to 95-100% (p < 0.001). Among reports without a suspicion level, potential confounding factors included marked artifact from hip prosthesis and overt diffuse tumor. CONCLUSION: The QI initiative achieved excellent adherence in reporting a suspicion level for tumor on prostate MRI examinations. The described components of the initiative were useful for maintaining long-term adherence that persisted after serial modifications to the report lexicon.
PMID: 27105339
ISSN: 1546-3141
CID: 2080232

Hypogonadism [Editorial]

Taneja, Samir S
PMID: 27132585
ISSN: 1558-318x
CID: 2100722

Re: DNA-Repair Defects and Olaparib in Metastatic Prostate Cancer

Taneja, Samir S
PMID: 27302781
ISSN: 1527-3792
CID: 2263742

Length of capsular contact for diagnosing extraprostatic extension on prostate MRI: Assessment at an optimal threshold

Rosenkrantz, Andrew B; Shanbhogue, Alampady K; Wang, Annie; Kong, Max Xiangtian; Babb, James S; Taneja, Samir S
PURPOSE: To evaluate the length of capsular contact of dominant lesions on multiparametric prostate magnetic resonance imaging (MRI) for predicting extraprostatic extension (EPE) and to determine a threshold value to apply in clinical practice. MATERIALS AND METHODS: Ninety patients undergoing 3T prostate MRI before prostatectomy were included. Two independent readers (R1, R2) recorded for each lobe the presence or absence of capsular irregularity on T2 -weighted imaging (T2 WI) and of overt measurable EPE. Readers also recorded the length of capsular contact of each lobe's dominant lesion for T2 WI and the apparent diffusion coefficient (ADC) map. Based on prostatectomy specimens, EPE was recorded for each lobe and classified as focal (single focus
PMID: 26395278
ISSN: 1522-2586
CID: 1786802

Re: Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations

Taneja, Samir S
PMID: 27302782
ISSN: 1527-3792
CID: 2263752

Re: Prospective Randomized Trial Comparing Magnetic Resonance Imaging (MRI)-Guided In-Bore Biopsy to MRI-Ultrasound Fusion and Transrectal Ultrasound-Guided Prostate Biopsy in Patients with Prior Negative Biopsies

Taneja, Samir S
PMID: 27302783
ISSN: 1527-3792
CID: 2263762

Re: Difference in Association of Obesity with Prostate Cancer Risk between US African American and Non-Hispanic White Men in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) [Comment]

Taneja, Samir S
PMID: 26887708
ISSN: 1527-3792
CID: 2263652

Investigation of Multisequence Magnetic Resonance Imaging for Detection of Recurrent Tumor After Transurethral Resection for Bladder Cancer

Rosenkrantz, Andrew B; Ego-Osuala, Islamiat O; Khalef, Victoria; Deng, Fang-Ming; Taneja, Samir S; Huang, William C
PURPOSE: The aim of this study was to evaluate multisequence magnetic resonance imaging (MRI) in detecting local recurrence after transurethral resection for bladder cancer. METHODS: Thirty-six patients with bladder cancer with previous transurethral resection underwent bladder MRI incorporating T2-weighted imaging, diffusion-weighted imaging, and delayed contrast-enhanced T1-weighted imaging, followed by cystoscopy. Two radiologists (R1 and R2) evaluated examinations for suspicious findings. RESULTS: Forty-seven percent of patients had recurrent tumor at cystoscopy and biopsy. Using multisequence MRI, sensitivity and specificity were 67% and 81% for R1 and 73% and 62% for R2. Both readers missed 1 high-grade pathologic stage T1 recurrent tumor; otherwise, all missed tumors were low-grade pathologic stage Ta lesions. All false positives for R1 and 7 of 9 false positives for R2 were in patients receiving previous bacillus Calmette-Guerin therapy. Furthermore, 40% to 50% of solitary abnormalities and 83% to 100% of multifocal abnormalities were tumor recurrences; 12% to 20% of smooth wall thickening, 50% to 75% of irregular wall thickening, and 88% to 100% of papillary masses were tumor recurrences. CONCLUSIONS: Although multisequence MRI exhibited moderate performance for detecting recurrent tumor, nearly all missed tumors were low grade and noninvasive.
PMID: 26760195
ISSN: 1532-3145
CID: 1912622

Re: Prostate Biopsy Specimens with Gleason 3+3=6 and Intraductal Carcinoma: Radical Prostatectomy Findings and Clinical Outcomes [Comment]

Taneja, Samir S
PMID: 26887707
ISSN: 1527-3792
CID: 2263642

Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion-targeted Prostate Biopsy Outcomes

Meng, Xiaosong; Rosenkrantz, Andrew B; Mendhiratta, Neil; Fenstermaker, Michael; Huang, Richard; Wysock, James S; Bjurlin, Marc A; Marshall, Susan; Deng, Fang-Ming; Zhou, Ming; Melamed, Jonathan; Huang, William C; Lepor, Herbert; Taneja, Samir S
BACKGROUND: Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB). OBJECTIVE: To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included. INTERVENTIONS: All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB. OUTCOMES: Detection rates for all PCa and high-grade PCa (Gleason score [GS] >/=7) were compared using the McNemar test. RESULTS AND LIMITATIONS: MRF-TB detected fewer GS 6 PCas (75 vs 121; p<0.001) and more GS >/=7 PCas (158 vs 117; p<0.001) than SB. Higher mSS was associated with higher detection of GS >/=7 PCa (p<0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS >/=7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS >/=7 PCas in men with no prior biopsy (88 vs 72; p=0.012), in men with a prior negative biopsy (28 vs 16; p=0.010), and in men with a prior cancer diagnosis (42 vs 29; p=0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p<0.001) and men with prior cancer (30 vs 46; p=0.034). Limitations include the retrospective design and the potential for selection bias given a referral population. CONCLUSIONS: MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted. PATIENT SUMMARY: We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.
PMCID:5104338
PMID: 26112001
ISSN: 1873-7560
CID: 1641022