Interobserver Agreement and Accuracy in Interpreting mpMRI of the Prostate: a Systematic Review

Arvind Annamalai; Judy N Fustok; Jesus Beltran-Perez; Ahmed T Rashad; Louis S Krane; Benjamin L Triche

doi:10.1007/s11934-022-01084-y

Interobserver Agreement and Accuracy in Interpreting mpMRI of the Prostate: a Systematic Review

Curr Urol Rep. 2022 Jan;23(1):1-10. doi: 10.1007/s11934-022-01084-y. Epub 2022 Feb 28.

Authors

Arvind Annamalai¹, Judy N Fustok¹, Jesus Beltran-Perez², Ahmed T Rashad², Louis S Krane³, Benjamin L Triche⁴

Affiliations

¹ Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
² Department of Radiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
³ Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
⁴ Department of Radiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA. btriche1@tulane.edu.

PMID: 35226257
DOI: 10.1007/s11934-022-01084-y

Abstract

Purpose of review: To present the latest evidence related to interobserver agreement and accuracy; evaluate the strengths, weaknesses, and implications of use; and outline opportunities for improvement and future development of the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) for detection of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI).

Recent findings: Our review of currently available evidence suggests that recent improvements to the PI-RADS system with PI-RADS v2.1 slightly improved interobserver agreement, with generally high sensitivity and moderate specificity for the detection of clinically significant PCa. Recent evidence additionally demonstrates substantial improvement in diagnostic specificity with PI-RADS v2.1 compared with PI-RADS v2. However, results of studies examining the comparative performance of v2.1 are limited by small sample sizes and retrospective cohorts, potentially introducing selection bias. Some studies suggest a substantial improvement between v2.1 and v2, while others report no statistically significant difference. Additionally, in PI-RADS v2.1, the interpretation and reporting of certain findings remain subjective, particularly for category 2 lesions, and reader experience continues to vary significantly. These factors further contribute to a remaining degree of interobserver variability and findings of improved performance among more experienced readers. PI-RADS v2.1 appears to show at least minimal improvement in interobserver agreement, diagnostic performance, and both sensitivity and specificity, with greater improvements seen among more experienced readers. However, given the decrescent nature of these improvements and the limited power of all studies examined, the clinical impact of this progress may be marginal. Despite improvements in PI-RADS v2.1, practitioner experience in interpreting mpMRI of the prostate remains the most important factor in prostate cancer detection.

Keywords: Accuracy; Cancer; Imaging; Interobserver agreement; PI-RADS v2; PI-RADS v2.1; Prostate; Prostate Imaging Reporting and Data System.

Publication types

Review
Systematic Review

MeSH terms

Humans
Magnetic Resonance Imaging / methods
Male
Multiparametric Magnetic Resonance Imaging*
Observer Variation
Prostate / diagnostic imaging
Prostate / pathology
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology
Reproducibility of Results
Retrospective Studies