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Reply by Gattinoni et al. to Hedenstierna et al. , to Maley et al. , to Fowler et al. , to Bhatia and Mohammed, to Bos, to Koumbourlis and Motoyama, and to Haouzi et al.
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Variability of segmented prostate volume on MRI: impact on PSA density for prostate cancer diagnosis
Full text linkPurpose PSA density (PSAd), based on prostate volume (PV), is a decision-making parameter for prostate cancer (PCa) diagnosis and risk stratification. We assessed variability in prostate manual segmentation on MRI and its impact on PV and PSAd. Materials and Methods We retrospectively analyzed 68 treatment-na & iuml;ve patients, aged 66.2 +/- 6.9 years, with increased PSA and/or positive digital endorectal examination who underwent MRI, with available biopsy/follow-up. Three radiologists (R1, R2, R3) manually segmented the gland on T2-weighted images slice-by-slice. Dice similarity coefficient (DSC), Welch's t-test, and 95% confidence intervals (CIs) were used. Results Of 68 patients with a PSA of 7.59 +/- 4.80 ng/mL, 38 had biopsy-confirmed PCa, and the remaining 30 were negative on biopsy/follow-up. The segmentation time per patient ranged from 4 to 7 min. Pairs R1-R2, R1-R3, and R2-R3 showed a different number of segmented slices (p= 0.15 ng/mL/mL, variations in segmented PV impacted PSAd-based classification, resulting in 1 false negative for R1 and another false negative for R2 (false-negative rate for both 1/38, 2.63%, 95% CI 0.10-13.8%).Conclusion Segmentation of PV is a time-intensive task. Inter-reader variability can impact PSAd-based diagnosis of PCa. Automated prostate segmentation methods are welcome
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