A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs
Background and objective: The European Council advises evaluating the feasibility of organized prostate cancer testing (OPT) programs, but it is unclear whether results from screening trials can be replicated in population-based testing. The aim of this study is to compare magnetic resonance imaging...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | European Urology Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168325001296 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850097978686046208 |
|---|---|
| author | Jonas Wallström Max Alterbeck Rebecka Arnsrud Godtman Ola Bratt Thomas Jiborn Erik Thimansson |
| author_facet | Jonas Wallström Max Alterbeck Rebecka Arnsrud Godtman Ola Bratt Thomas Jiborn Erik Thimansson |
| author_sort | Jonas Wallström |
| collection | DOAJ |
| description | Background and objective: The European Council advises evaluating the feasibility of organized prostate cancer testing (OPT) programs, but it is unclear whether results from screening trials can be replicated in population-based testing. The aim of this study is to compare magnetic resonance imaging (MRI) assessments and biopsy outcomes with and without a central review in two Swedish OPT programs. Methods: Two regional population-based OPT programs invited 65 000 men (2020–2022). MRI scans were read locally, and biopsies followed a strict MRI-based and prostate-specific antigen (PSA) density–based protocol. A blinded central review was done by two radiologists with 8 and 9 yr of experience. Reader agreement was assessed with percentages and kappa scores. Positive predictive values (PPVs) for detecting grade group (GG) 2–5 prostate cancer were calculated with 95% confidence intervals (CIs). Key findings and limitations: MRI scans for 416 men (median age 52 yr) with PSA ≥3 ng/ml were evaluated. In Skåne, 27% of scans were primarily assigned Prostate Imaging Reporting and Data System (PI-RADS) scores ≥4, compared with 10% in Västra Götaland. At the primary reading, 76 men had PI-RADS ≥4, yielding 43 GG 2–5 prostate cancer cases: PPV 0.57 (95% CI 0.45–0.67). At the central review, 65 men had PI-RADS ≥4. Out of 61 men biopsied, 50 had GG 2–5 prostate cancer: PPV 0.82 (95% CI 0.71–0.90, p < 0.001 for PPV difference). The central review radiologists’ kappa score was 0.83. No additional biopsies were taken based on the central review findings. Conclusions and clinical implications: In population-based screening with local MRI reading, MRI assignment may vary substantially. Centralized reading could reduce these differences and increase the biopsy PPV for GG ≥2 cancer. Patient summary: In this report, we reviewed local magnetic resonance imaging (MRI) reading in population-based screening. We found that MRI assignment varied between centers. We conclude that centralized reading could reduce differences and improve biopsy outcomes. |
| format | Article |
| id | doaj-art-abcac25cdf5e40aab5f52f460618e196 |
| institution | DOAJ |
| issn | 2666-1683 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj-art-abcac25cdf5e40aab5f52f460618e1962025-08-20T02:40:50ZengElsevierEuropean Urology Open Science2666-16832025-07-0177323810.1016/j.euros.2025.05.008A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing ProgramsJonas Wallström0Max Alterbeck1Rebecka Arnsrud Godtman2Ola Bratt3Thomas Jiborn4Erik Thimansson5Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Corresponding author. Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. Tel. +46 708 982 675.Department of Translational Medicine, Urological Cancers, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, SwedenDepartment of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, SwedenDepartment of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, SwedenDepartment of Urology, Helsingborg Hospital, Helsingborg, SwedenDepartment of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden; Department of Radiology, Helsingborg Hospital, Helsingborg, SwedenBackground and objective: The European Council advises evaluating the feasibility of organized prostate cancer testing (OPT) programs, but it is unclear whether results from screening trials can be replicated in population-based testing. The aim of this study is to compare magnetic resonance imaging (MRI) assessments and biopsy outcomes with and without a central review in two Swedish OPT programs. Methods: Two regional population-based OPT programs invited 65 000 men (2020–2022). MRI scans were read locally, and biopsies followed a strict MRI-based and prostate-specific antigen (PSA) density–based protocol. A blinded central review was done by two radiologists with 8 and 9 yr of experience. Reader agreement was assessed with percentages and kappa scores. Positive predictive values (PPVs) for detecting grade group (GG) 2–5 prostate cancer were calculated with 95% confidence intervals (CIs). Key findings and limitations: MRI scans for 416 men (median age 52 yr) with PSA ≥3 ng/ml were evaluated. In Skåne, 27% of scans were primarily assigned Prostate Imaging Reporting and Data System (PI-RADS) scores ≥4, compared with 10% in Västra Götaland. At the primary reading, 76 men had PI-RADS ≥4, yielding 43 GG 2–5 prostate cancer cases: PPV 0.57 (95% CI 0.45–0.67). At the central review, 65 men had PI-RADS ≥4. Out of 61 men biopsied, 50 had GG 2–5 prostate cancer: PPV 0.82 (95% CI 0.71–0.90, p < 0.001 for PPV difference). The central review radiologists’ kappa score was 0.83. No additional biopsies were taken based on the central review findings. Conclusions and clinical implications: In population-based screening with local MRI reading, MRI assignment may vary substantially. Centralized reading could reduce these differences and increase the biopsy PPV for GG ≥2 cancer. Patient summary: In this report, we reviewed local magnetic resonance imaging (MRI) reading in population-based screening. We found that MRI assignment varied between centers. We conclude that centralized reading could reduce differences and improve biopsy outcomes.http://www.sciencedirect.com/science/article/pii/S2666168325001296Prostatic neoplasmsEarly detection of cancerMagnetic resonance imagingObserver variation |
| spellingShingle | Jonas Wallström Max Alterbeck Rebecka Arnsrud Godtman Ola Bratt Thomas Jiborn Erik Thimansson A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs European Urology Open Science Prostatic neoplasms Early detection of cancer Magnetic resonance imaging Observer variation |
| title | A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs |
| title_full | A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs |
| title_fullStr | A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs |
| title_full_unstemmed | A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs |
| title_short | A Comparison of Magnetic Resonance Imaging Assessment and Biopsy Outcomes with and Without Central Review in Two Swedish Regional Organized Prostate Cancer Testing Programs |
| title_sort | comparison of magnetic resonance imaging assessment and biopsy outcomes with and without central review in two swedish regional organized prostate cancer testing programs |
| topic | Prostatic neoplasms Early detection of cancer Magnetic resonance imaging Observer variation |
| url | http://www.sciencedirect.com/science/article/pii/S2666168325001296 |
| work_keys_str_mv | AT jonaswallstrom acomparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT maxalterbeck acomparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT rebeckaarnsrudgodtman acomparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT olabratt acomparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT thomasjiborn acomparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT erikthimansson acomparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT jonaswallstrom comparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT maxalterbeck comparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT rebeckaarnsrudgodtman comparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT olabratt comparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT thomasjiborn comparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms AT erikthimansson comparisonofmagneticresonanceimagingassessmentandbiopsyoutcomeswithandwithoutcentralreviewintwoswedishregionalorganizedprostatecancertestingprograms |