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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: Long-Term Follow-up of a Randomized Trial of Radiation with or without Androgen Deprivation Therapy for Localized Prostate Cancer
Taneja, Samir S
PMID: 27186728
ISSN: 1527-3792
CID: 2263672
Re: Androgen Receptor Splice Variant 7 and Efficacy of Taxane Chemotherapy in Patients with Metastatic Castration-Resistant Prostate Cancer
Taneja, Samir S
PMID: 27186729
ISSN: 1527-3792
CID: 2263682
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: DNA-Repair Defects and Olaparib in Metastatic Prostate Cancer
Taneja, Samir S
PMID: 27302781
ISSN: 1527-3792
CID: 2263742
Re: Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations
Taneja, Samir S
PMID: 27302782
ISSN: 1527-3792
CID: 2263752
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 =0.5 mm in depth) vs. established. Receiver operating characteristic analysis, logistic regression, and kappa coefficients were used to assess interpretive approaches on a side-specific basis. RESULTS: The optimal thresholds were 6 mm and 7 mm of contact using T2 WI and ADC for any EPE, and 10 mm and 7 mm using T2 WI and ADC for nonfocal EPE (AUCs 81.0-82.5%). Capsular contact had higher sensitivity, yet lower specificity, than subjective interpretations for any EPE and for nonfocal EPE (all P = 0.018, aside from any EPE for R2 using ADC). Length of contact exhibited more substantial gains in sensitivity (9-20% for any EPE; 34-41% for nonfocal EPE) than losses in specificity (6-13% for any EPE; 17-27% for nonfocal EPE) compared with subjective interpretations. Interreader agreement: 0.70 for assessments based on length of contact; 0.49-0.59 for subjective assessments. CONCLUSION: Length of capsular contact of dominant lesions can improve interreader agreement and sensitivity for EPE compared with subjective features, with relatively mild specificity loss. J. Magn. Reson. Imaging 2015.
PMID: 26395278
ISSN: 1522-2586
CID: 1786802
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