RESUMO
PURPOSE: To investigate the impact of Prostate Imaging Quality (PI-QUAL) scores on the diagnostic performance of multiparametric MRI (mpMRI) in a targeted biopsy cohort. PATIENTS AND METHODS: 300 patients who underwent both mpMRI and biopsy were included. PI-QUAL scores were retrospectively assigned by two radiologists in consensus and were correlated to pre-biopsy PI-RADS scores and biopsy outcomes. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥ 2. RESULTS: Image quality was optimal (PI-QUAL ≥ 4) in 249/300 (83%) and suboptimal (PI-QUAL < 4) in 51/300 (17%). The proportion of PI-RADS 3 scores referred for biopsy was higher in scans of suboptimal vs optimal quality (51% vs 33%). For PI-QUAL < 4 scans, the positive predictive value (PPV) was lower compared to PI-QUAL ≥ 4 (35% [95%CI: 22, 48] vs 48% [95%CI: 41, 55]; difference -13% [95%CI: -27, 2]; p 0.090), as was the detection rate of csPCa in both PI-RADS 3 and PI-RADS 4-5 (15% vs 23% and 56 vs 63%, respectively). The overall MRI quality increased over time. CONCLUSIONS: Scan quality may affect the diagnostic performance of prostate mpMRI in patients undergoing MRI-guided biopsy. Scans of suboptimal quality (PI-QUAL < 4) were associated with lower PPV for csPCa.
Assuntos
Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/patologia , Próstata/diagnóstico por imagem , Próstata/patologia , Imageamento por Ressonância Magnética/métodos , Estudos Retrospectivos , Biópsia , Biópsia Guiada por Imagem/métodosRESUMO
Leiomyosarcoma of the rectum is an uncommon malignancy; it accounts for less than 0.1% of all malignancies of the colon and rectum and only one case has been reported long-term following pelvic radiotherapy. We report a second case of leiomyosarcoma of the rectum after radiotherapy in an elderly women who received external radiation therapy eighteen years before, for endometrial carcinoma. We confirm that leiomyosarcoma may be a late uncommon effect of pelvic irradiation and suggest that close and long-term surveillance of irradiated patients is highly recommended.