PI-RADS 1: clinically significant cancer is highly unlikely to be present; PI-RADS 2: clinically significant cancer is unlikely to be present, PI-RADS 3: intermediate the presence of clinically significant cancer is equivocal; PI-RADS 4: clinically significant cancer is likely to be present; PI-RADS 5: clinically ...
PI-RADS category 3 lesions are characterized as focal mildly to moderately hypointense on ADC, and isointense to mildly hyperintense on high b-value DWI. This is in combination with heterogeneous signal intensity or non-circumscribed, rounded, and moderate hypointensity on T2w images.
Lesions scored 4 or 5 are considered to indicate that clinically significant cancer is likely to be present. PIRADS 3 lesions are equivocal for the presence of prostate cancer and pose a significant clinical management challenge.
Conclusions: PIRADS 3 lesion indicates an equivocal likelihood of significant prostate cancer. In our series the overall PCa detection rate was 26.8% and 14.6% for clinically significant cancer in PIRADS 3 lesions.
The latest PI-RADS version assesses the likelihood (probability) of clinically significant prostate cancer on a 5-point scale for each lesion as follows: PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)
Radiologists use the Prostate Imaging Reporting and Data System (PI-RADS) to report how likely it is that a suspicious area is a clinically significant cancer. PI-RADS scores range from 1 (most likely not cancer) to 5 (very suspicious).
The present study attempted to determine what percentage of T1c prostate cancer patients have clinically significant disease, as defined as having a cause-specific mortality of greater than 50% or a greater than 50% risk of tumor recurrence after radical prostatectomy.
The best cutoff for differentiating low-risk PCa from csPCa was PI-RADS category 4. The pooled sensitivity, specificity, and accuracy among all readers were 84.8%, 90.9%, and 89.9% for PI-RADS v2. 1 compared with 81.4%, 89.9%, and 88.5% for PI-RADS v2.
Conclusions: These data indicate that clinically significant prostate cancer in lesions less than 0.65 cm and greater than 1.70 cm may be characterized with a single targeted biopsy core, sparing 33.5% of lesions (21% patients) a double core targeted biopsy.
Therefore, seeking a second opinion or review may be a reasonable first approach to a PI-RADS-3 finding if there is elevated clinical suspicion for prostate cancer. PI-RADS-3 lesions should be considered together with other factors, including prostate-specific antigen density (PSAD) and possibly size of lesion >14 mm.
For the transition zone, the PI-RADS assessment is primarily determined by the T2W score and sometimes modified by the DWI score. For the peripheral zone, the PI-RADS assessment is primarily determined by the DWI score and sometimes modified by the presence of dynamic contrast enhancement.
One study comparing prostate MRI to biopsy found MRI scans to correctly diagnose 93% of tumors, whereas biopsy correctly diagnosed only 48%. Identifying non-threatening forms of prostate cancer helps decrease the risk of overdiagnosis and overtreatment.
As a reminder, effective October 1, 2017, the 2018 ICD-10-CM updates are in effect (October 1, 2017 through September 30, 2018). Providers should be coding to the highest level of specificity per the 2018 ICD-10-CM updates.
Effective October 1, 2016. Medicare ICD-10 flexibilities have expired. Providers should be coding to the highest level of specificity and also avoiding the use of unspecified ICD-10 codes whenever the clinical documentation supports a more detailed code.