Diagnostic accuracy of a ‘stage-gated’ approach for reporting prostate screening MRI: “Is less more?”
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Le résumé fourni par la source
OBJECTIVES: To evaluate whether a two-step, 'stage-gated' reporting approach could improve the positive predictive value (PPV) of biparametric (bp)MRI for prostate cancer (PCa) screening compared to conventional Likert/PI-RADS scoring. MATERIALS AND METHODS: This retrospective secondary analysis utilised data from IP1-PROSTAGRAM-a prospective, population-based study of men aged 50-69 years who underwent PCa screening with bpMRI, ultrasound and prostate-specific antigen (PSA) testing between October 2018 and May 2019 at two centres (NCT03702439). MRI scans from IP1-PROSTAGRAM were retrospectively evaluated using the 'stage-gated' approach: three radiologists independently reviewed limited MRI sequences (axial T2-weighted and b1500 diffusion-weighted images) and classified scans as positive or negative; if positive, the remaining bpMRI images were reviewed and a hypothetical "decision-to-biopsy" made. The PPV of 'stage-gated' reading was compared to PI-RADS and Likert scores ≥ 4 from the original IP1-PROSTAGRAM bpMRI reports. The reference standard was IP1-PROSTAGRAM biopsy results with grade group (GG) ≥ 2 cancer considered significant. RESULTS: Of 408 participants (median age 57 years [IQR 53, 61]), 405 had MRI scans available for secondary analysis. The prevalence of GG ≥ 2 cancer was 4% (17/405). The 'stage-gated' reporting approach achieved a PPV of 53% (95% CI: 30, 75; 8/15), compared to 29% (95% CI: 15, 47; 8/28) and 30% (95% CI: 17, 46; 11/37) for Likert and PI-RADS ≥ 4 pathways, respectively. The 'stage-gated' approach halved the number of recommended biopsies while maintaining similar cancer detection rates. CONCLUSION: The 'stage-gated' reporting approach, using limited sequences for the initial read, may improve the PPV and benefit-to-harm ratio of MRI-based screening. KEY POINTS: Question The PPV of MRI in PCa screening is low, likely because conventional assessment systems are not optimised for low disease prevalence populations. Findings A two-step, 'stage-gated' reading approach achieved a PPV of 53% (8/15), compared to 29% (8/28) for Likert and 30% (11/37) for PI-RADS scores ≥ 4. Clinical relevance The 'stage-gated' reporting approach, which uses limited sequences for the initial read, may improve the PPV and benefit-to-harm ratio of MRI-based screening by reducing unnecessary biopsies. Prospective evaluation is needed to confirm these findings in real-world screening settings.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Diagnostic accuracy of a ‘stage-gated’ approach for reporting prostate screening MRI: “Is less more?”
- Date Crossref
- 19/02/2026
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University College London Hospitals NHS Foundation Trust Centre for Medical Imaging pays non établi dans la noticeÉtablissement de santé
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University College London Department of Radiology pays non établi dans la noticeUniversité ou école supérieure
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Vita-Salute San Raffaele University pays non établi dans la noticeUniversité ou école supérieure
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Istituti di Ricovero e Cura a Carattere Scientifico pays non établi dans la noticeÉtablissement de santé
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Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele pays non établi dans la noticeÉtablissement de santé
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University of Cambridge Department of Radiology pays non établi dans la noticeUniversité ou école supérieure
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Addenbrooke's Hospital pays non établi dans la noticeÉtablissement de santé
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Imperial College Healthcare NHS Trust Imperial Urology pays non établi dans la noticeÉtablissement de santé
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Imperial College London Division of Surgery pays non établi dans la noticeUniversité ou école supérieure
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Hillingdon Hospitals NHS Foundation Trust Department of Radiology pays non établi dans la noticeÉtablissement de santé
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Mount Vernon Hospital Paul Strickland Scanner Centre pays non établi dans la noticeÉtablissement de santé
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Clinical and Experimental Radiology Unit pays non établi dans la noticeÉtablissement de santé
Centre for Medical Imaging — University College London Hospitals NHS Foundation Trust, Department of Radiology — University College London et Vita-Salute San Raffaele University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.