PI-RADS version 2: Preoperative role in the detection of normal-sized pelvic lymph node metastasis in prostate cancer

Objectives: To analyze whether Prostate Imaging Reporting and Data System (PI-RADSv2) scores are associated with a risk of normal-sized pelvic lymph node metastasis (PLNM) in prostate cancer (PCa). Materials and methods: A consecutive series of 221 patients who underwent magnetic resonance imaging and radical prostatectomy with pelvic lymph node dissection (PLND) for PCa were retrospectively analyzed under the approval of institutional review board in our institution. No patients had enlarged (>= 0.8 cm in short-axis diameter) lymph nodes. Clinical parameters [prostate-specific antigen (PSA), greatest percentage of biopsy core, and percentage of positive cores], and PI-RADSv2 score from two independent readers were analyzed with multivariate logistic regression and receiver operating-characteristic curve for PLNM. Diagnostic performance of PI-RADSv2 and Briganti nomogram was compared. Weighted kappa was investigated regarding PI-RADSv2 scoring. Results: Normal-sized PLNM was found in 9.5% (21/221) of patients. In multivariate analysis, PI-RADSv2 (reader 1, p= 0.009; reader 2, p = 0.026) and PSA (reader 1, p = 0.008; reader 2, p= 0.037) were predictive of normal-sized PLNM. Threshold of PI-RADSv2 was a score of 5, where PI-RADSv2 was associated with high sensitivity (reader 1, 95.2% [20/21]; reader 2, 90.5% [19/21]) and negative predictive value (reader 1, 99.2% [124/125]; reader 2, 98.6% [136/138]). However, diagnostic performance of PI-RADSv2 (AUC = 0.786-0.788) was significantly lower than that of Briganti nomogram (AUC = 0.890) for normal-sized PLNM (p < 0.05). The inter-reader agreement was excellent for PI-RADSv2 of 5 or not (weighted kappa = 0.804). Conclusion: PI-RADSv2 scores may be associated with the risk of normal-sized PLNM in PCa.