Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology

Purpose: We evaluated the accuracy of magnetic resonance imaging in determining the size and shape of localized prostate cancer. Materials and Methods: The subjects were 114 men who underwent multiparametric magnetic resonance imaging before radical prostatectomy with patient specific mold processing of the specimen from 2013 to 2015. T2‐weighted images were used to contour the prostate capsule and cancer suspicious regions of interest. The contours were used to design and print 3‐dimensional custom molds, which permitted alignment of excised prostates with magnetic resonance imaging scans. Tumors were reconstructed in 3 dimensions from digitized whole mount sections. Tumors were then matched with regions of interest and the relative geometries were compared. Results: Of the 222 tumors evident on whole mount sections 118 had been identified on magnetic resonance imaging. For the 118 regions of interest mean volume was 0.8 cc and the longest 3‐dimensional diameter was 17 mm. However, for matched pathological tumors, of which most were Gleason score 3 + 4 or greater, mean volume was 2.5 cc and the longest 3‐dimensional diameter was 28 mm. The median tumor had a 13.5 mm maximal extent beyond the magnetic resonance imaging contour and 80% of cancer volume from matched tumors was outside region of interest boundaries. Size estimation was most accurate in the axial plane and least accurate along the base‐apex axis. Conclusions: Magnetic resonance imaging consistently underestimates the size and extent of prostate tumors. Prostate cancer foci had an average diameter 11 mm longer and a volume 3 times greater than T2‐weighted magnetic resonance imaging segmentations. These results may have important implications for the assessment and treatment of prostate cancer.

[1]  S. Mendrinos,et al.  Prostate cancer foci detected on multiparametric magnetic resonance imaging are histologically distinct from those not detected. , 2012, The Journal of urology.

[2]  D. Margolis,et al.  PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. , 2016, European urology.

[3]  Henry Rusinek,et al.  Prostate tumour volumes: evaluation of the agreement between magnetic resonance imaging and histology using novel co‐registration software , 2014, BJU international.

[4]  Marco van Vulpen,et al.  Validation of functional imaging with pathology for tumor delineation in the prostate. , 2009, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[5]  Henry Rusinek,et al.  Image Guided Focal Therapy for Magnetic Resonance Imaging Visible Prostate Cancer: Defining a 3-Dimensional Treatment Margin Based on Magnetic Resonance Imaging Histology Co-Registration Analysis. , 2015, The Journal of urology.

[6]  Aaron Fenster,et al.  3D prostate histology image reconstruction: Quantifying the impact of tissue deformation and histology section location , 2013, Journal of pathology informatics.

[7]  Piotr Kozlowski,et al.  Device for sectioning prostatectomy specimens to facilitate comparison between histology and in vivo MRI , 2010, Journal of magnetic resonance imaging : JMRI.

[8]  F. Beuvon,et al.  Tumor target volume for focal therapy of prostate cancer-does multiparametric magnetic resonance imaging allow for a reliable estimation? , 2014, The Journal of urology.

[9]  A. Evans,et al.  Prostate cancer detection with multi‐parametric MRI: Logistic regression analysis of quantitative T2, diffusion‐weighted imaging, and dynamic contrast‐enhanced MRI , 2009, Journal of magnetic resonance imaging : JMRI.

[10]  Ashish Chandra,et al.  A Workflow to Improve the Alignment of Prostate Imaging with Whole-mount Histopathology. , 2014, Academic radiology.

[11]  Cheng Soon Ong,et al.  Development of a registration framework to validate MRI with histology for prostate focal therapy. , 2015, Medical physics.

[12]  Aaron Fenster,et al.  Clinical application of a 3D ultrasound-guided prostate biopsy system. , 2011, Urologic oncology.

[13]  透 松ヶ角 Prostate Cancer Volume Estimation by Combining Magnetic Resonance Imaging and Targeted Biopsy Proven Cancer Core Length: Correlation with Cancer Volume. , 2018 .

[14]  Jason A Koutcher,et al.  Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume. , 2009, Radiology.

[15]  Yipeng Hu,et al.  Characterizing clinically significant prostate cancer using template prostate mapping biopsy. , 2011, The Journal of urology.

[16]  David Y. Lu,et al.  Characteristics of Detected and Missed Prostate Cancer Foci on 3-T Multiparametric MRI Using an Endorectal Coil Correlated With Whole-Mount Thin-Section Histopathology. , 2015, AJR. American journal of roentgenology.

[17]  A. Prando Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume , 2009 .

[18]  Baris Turkbey,et al.  Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. , 2011, The Journal of urology.

[19]  H Rusinek,et al.  Assessment of change in prostate volume and shape following surgical resection through co-registration of in-vivo MRI and fresh specimen ex-vivo MRI. , 2014, Clinical radiology.

[20]  P. Walsh,et al.  Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. , 1994, JAMA.

[21]  Dimitris N. Metaxas,et al.  Automated detection of prostatic adenocarcinoma from high-resolution ex vivo MRI , 2005, IEEE Transactions on Medical Imaging.

[22]  R. Lenkinski,et al.  Elastic registration of multimodal prostate MRI and histology via multiattribute combined mutual information. , 2011, Medical physics.

[23]  Hyunjin Park,et al.  Registration methodology for histological sections and in vivo imaging of human prostate. , 2008, Academic radiology.

[24]  T. Stamey,et al.  Assessment of morphometric measurements of prostate carcinoma volume , 2000, Cancer.

[25]  Shyam Natarajan,et al.  A system for evaluating magnetic resonance imaging of prostate cancer using patient-specific 3D printed molds. , 2014, American journal of clinical and experimental urology.

[26]  A. Fenster,et al.  Registration of prostate histology images to ex vivo MR images via strand‐shaped fiducials , 2012, Journal of magnetic resonance imaging : JMRI.

[27]  S. Crouzet,et al.  How accurate is multiparametric MR imaging in evaluation of prostate cancer volume? , 2015, Radiology.

[28]  S. Kaleci,et al.  Lesion volume predicts prostate cancer risk and aggressiveness: validation of its value alone and matched with prostate imaging reporting and data system score , 2017, BJU international.

[29]  Lars Egevad,et al.  International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume , 2011, Modern Pathology.

[30]  Jean Pouliot,et al.  Expandable and rigid endorectal coils for prostate MRI: impact on prostate distortion and rigid image registration. , 2005, Medical physics.

[31]  H Rusinek,et al.  Preliminary experience with a novel method of three-dimensional co-registration of prostate cancer digital histology and in vivo multiparametric MRI. , 2013, Clinical radiology.

[32]  T. Stamey,et al.  Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. , 2002, Urology.

[33]  Choon Hua Thng,et al.  Optimum slicing of radical prostatectomy specimens for correlation between histopathology and medical images , 2010, International Journal of Computer Assisted Radiology and Surgery.

[34]  A S Whittemore,et al.  Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer , 1993, Cancer.

[35]  J R Thornbury,et al.  Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. , 1996, AJR. American journal of roentgenology.

[36]  Bing Ma,et al.  Challenges in accurate registration of 3-D medical imaging and histopathology in primary prostate cancer , 2013, European Journal of Nuclear Medicine and Molecular Imaging.

[37]  Stephan E Maier,et al.  Multiparametric MRI of prostate cancer: An update on state‐of‐the‐art techniques and their performance in detecting and localizing prostate cancer , 2013, Journal of magnetic resonance imaging : JMRI.

[38]  Baris Turkbey,et al.  Correlation of magnetic resonance imaging tumor volume with histopathology. , 2012, The Journal of urology.