Investig Clin Urol.  2019 Sep;60(5):388-395. 10.4111/icu.2019.60.5.388.

Inflammation appears as high Prostate Imaging–Reporting and Data System scores on prostate magnetic resonance imaging (MRI) leading to false positive MRI fusion biopsy

• Rourke E
• Sunnapwar
• Mais D
• Kukkar V
• DiGiovanni J
• Kaushik D
• Liss MA

• KMID: 2455967
• DOI: http://doi.org/10.4111/icu.2019.60.5.388

Abstract

PURPOSE
To investigate if inflammation as a potential cause of false-positive lesions from recent UroNav magnetic resonance imaging (MRI) fusion prostate biopsy patients.
MATERIALS AND METHODS
We retrospectively identified 43 men with 61 MRI lesions noted on prostate MRI before MRI ultrasound-guided fusion prostate biopsy. Men underwent MRI with 3T Siemens TIM Trio MRI system (Siemens AG, Germany), and lesions were identified and marked in DynaCAD system (Invivo Corporation, USA) with subsequent biopsy with MRI fusion with UroNav. We obtained targeted and standard 12-core needle biopsies. We retrospectively reviewed pathology reports for inflammation.
RESULTS
We noted a total of 43 (70.5%) false-positive lesions with 28 having no cancer on any cores, and 15 lesions with cancer noted on systematic biopsy but not in the target region. Of the men with cancer, 6 of the false positive lesions had inflammation in the location of the targeted region of interest (40.0%, 6/15). However, when we examine the 21/28 lesions with an identified lesion on MRI with no cancer in all cores, 54.5% had inflammation on prostate biopsy pathology (12/22, p=0.024). We noted the highest proportion of inflammation.
CONCLUSIONS
Inflammation can confound the interpretation of MRI by mimicking prostate cancer. We suggested focused efforts to differentiate inflammation and cancer on prostate MRI.

Keyword

Inflammation; Magnetic resonance imaging; Prostatic neoplasms; Prostatitis

MeSH Terms

Biopsy*
Biopsy, Needle
Humans
Inflammation*
Information Systems*
Magnetic Resonance Imaging*
Male
Pathology
Prostate*
Prostatic Neoplasms
Prostatitis
Retrospective Studies

Figure

• 

  Fig. 1 (A) Proportion of false positives (no cancer identified) based on location. (B) Proportion of inflammation of false positives (FP−, no cancer identified) based on prostate biopsy location. R, right; L, left.

• 

  Fig. 2 Proportion of false positives (FP+, negative target with or without cancer on systematic prostate biopsy) based on prostate biopsy location. R, right; L, left.

• 

  Fig. 3 Example of true-positive lesions and false positive caused by inflammation. We present the course of action of a 67-year-old man who presented with elevated prostate specific antigen (PSA) and a previous biopsy with high-grade (HG) PIN in one core of a 12-core biopsy. His magnetic resonance imaging (MRI), which originally was read as Prostate Imaging–Reporting and Data System (PI-RADS) 4, was downgraded to a PI-RADS 3 on re-review. He underwent MRI fusion with UroNav, and the biopsy is displayed. Only inflammation was noted in the pathology specimens displayed on the right side (hematoxylin and eosin stain, top down magnification is 4×, 10×, and 20×). DWI, diffusion-weighted imaging; DCE, dynamic contrast-enhanced.

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