Prostate multiparametric magnetic resonance imaging (MRI) shows high sensitivity for International Society of Urological Pathology grade group (GG) ≥2 cancers. Many artificial intelligence algorithms have shown promising results in diagnosing clinically significant prostate cancer on MRI. To assess a region-of-interest-based machine-learning algorithm aimed at characterising GG ≥2 prostate cancer on multiparametric MRI.
The lesions targeted at biopsy in the MRI-FIRST dataset were retrospectively delineated and assessed using a previously developed algorithm. The Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) score assigned prospectively before biopsy and the algorithm score calculated retrospectively in the regions of interest were compared for diagnosing GG ≥2 cancer, using the areas under the curve (AUCs), and sensitivities and specificities calculated with predefined thresholds (PIRADSv2 scores ≥3 and ≥4; algorithm scores yielding 90% sensitivity in the training database). Ten predefined biopsy strategies were assessed retrospectively.
After excluding 19 patients, we analysed 232 patients imaged on 16 different scanners; 85 had GG ≥2 cancer at biopsy. At patient level, AUCs of the algorithm and PI-RADSv2 were 77% (95% confidence interval [CI]: 70-82) and 80% (CI: 74-85; p = 0.36), respectively. The algorithm's sensitivity and specificity were 86% (CI: 76-93) and 65% (CI: 54-73), respectively. PI-RADSv2 sensitivities and specificities were 95% (CI: 89-100) and 38% (CI: 26-47), and 89% (CI: 79-96) and 47% (CI: 35-57) for thresholds of ≥3 and ≥4, respectively. Using the PI-RADSv2 score to trigger a biopsy would have avoided 26-34% of biopsies while missing 5-11% of GG ≥2 cancers. Combining prostate-specific antigen density, the PI-RADSv2 and algorithm's scores would have avoided 44-47% of biopsies while missing 6-9% of GG ≥2 cancers. Limitations include the retrospective nature of the study and a lack of PI-RADS version 2.1 assessment.
The algorithm provided robust results in the multicentre multiscanner MRI-FIRST database and could help select patients for biopsy.
An artificial intelligence-based algorithm aimed at diagnosing aggressive cancers on prostate magnetic resonance imaging showed results similar to expert human assessment in a prospectively acquired multicentre test database.
European urology oncology. 2024 Mar 15 [Epub ahead of print]
Thibaut Couchoux, Tristan Jaouen, Christelle Melodelima-Gonindard, Pierre Baseilhac, Arthur Branchu, Nicolas Arfi, Richard Aziza, Nicolas Barry Delongchamps, Franck Bladou, Flavie Bratan, Serge Brunelle, Pierre Colin, Jean-Michel Correas, François Cornud, Jean-Luc Descotes, Pascal Eschwege, Gaelle Fiard, Bénédicte Guillaume, Rémi Grange, Nicolas Grenier, Hervé Lang, Frédéric Lefèvre, Bernard Malavaud, Clément Marcelin, Paul C Moldovan, Nicolas Mottet, Pierre Mozer, Eric Potiron, Daniel Portalez, Philippe Puech, Raphaele Renard-Penna, Matthieu Roumiguié, Catherine Roy, Marc-Olivier Timsit, Thibault Tricard, Arnauld Villers, Jochen Walz, Sabine Debeer, Adeline Mansuy, Florence Mège-Lechevallier, Myriam Decaussin-Petrucci, Lionel Badet, Marc Colombel, Alain Ruffion, Sébastien Crouzet, Muriel Rabilloud, Rémi Souchon, Olivier Rouvière
Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France., LabTau, INSERM Unit 1032, Lyon, France., Laboratoire d'écologie Alpine, CNRS, UMR 5553, Grenoble, France; Université Grenoble Alpes, Grenoble, France., Department of Urology, Hôpital Saint Joseph Saint Luc, Lyon, France., Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France., Department of Urology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France., Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Department of Diagnostic and Interventional Imaging, Hôpital Saint Joseph Saint Luc, Lyon, France., Department of Radiology and Medical Imaging, Institut Paoli-Calmettes Cancer Center, Marseille, France., Department of Urology, Hôpital privé La Louvrière, Lille, France., Department of Radiology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France., Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France., Université Grenoble Alpes, Grenoble, France; Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France., Department of Urology, Centre Hospitalier Régional et Universitaire de Nancy, Vandoeuvre, France., Department of Radiology, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Apes, Grenoble, France., Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France., Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Bordeaux, France., Department of Urology, Centre Hospitalier Universitaire de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France., Department of Radiology, Centre Hospitalier Régional et Universitaire de Nancy, Vandoeuvre, France., Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France., Department of Urology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France., Department of Urology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France., Clinique Urologique de Nantes, Saint-Herblain, France., Department of Radiology, Centre Hospitalier Régional et Universitaire de Lille, Lille, France., Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; GRC no 5, ONCOTYPE-URO, Sorbonne Universités, Paris, France., Department of Urology, Toulouse-Rangueil University Hospital, Toulouse France., Department of Radiology B, Centre Hospitalier Universitaire de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France., Department of Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France., Department of Urology, Univ. Lille, CHU Lille, Lille, France., Department of Urology, Institut Paoli-Calmettes Cancer Center, Marseille, France., Department of Pathology, Hospices Civils de Lyon, Pierre-Bénite, France., Department of Urology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France; Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France., Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France., Université Lyon 1, Université de Lyon, Lyon, France; Department of Urology, Centre Hospitalier Lyon Sud, Hospices Cibvils de Lyon, Pierre-Bénite, France., LabTau, INSERM Unit 1032, Lyon, France; Department of Urology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France., Université Lyon 1, Université de Lyon, Lyon, France; Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France., Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; LabTau, INSERM Unit 1032, Lyon, France; Université Lyon 1, Université de Lyon, Lyon, France. Electronic address: .