Implementation of MDT evaluating multi-parametric prostate MRI: Is double reporting needed?
BAUS ePoster online library. Noureldin M. 06/25/19; 259470; P10-2 Disclosure(s): Nothing to disclose
Mr. Mohamed Noureldin
Mr. Mohamed Noureldin
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Abstract
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Introduction and Objectives

MDTs are under increasing pressure in terms of workload volume and complexity. Our diagnostic pathway was initially set up with prospective double reporting of mpMRI scans via a dedicated MDT. We aimed to determine the impact of this process.

Materials and methods

Of 580 biopsy-naïve patients who underwent pre-biopsy mpMRI, 273 had a second report carried out (April/2017-October/2018). Both reporters were expert uro-radiologists each with over 5 years' experience in mpMRI prostate reporting.

A second mpMRI review 1-2 weeks after the initial report occurred within a MDT as a quality control measure. Men were recalled for a targeted and systematic biopsy if MRI scores were changed from non-suspicious to suspicious (4 or 5 or score 3 with PSA-Density >0.12).

RESULTS

Mean PSA 7.4 (SD±4.8) ng/ml and PSA-density 0.18 (SD±0.16).

MRI Likert scores were concordant in 248/273 (90%) and 25/273 (9.1%) were discordant. 8/25 (32%) discordant reports were 'down-scored' and 7/25 (28%) were 'up-scored'.

Of the discordant cases, only 4/273 (1.4%) required a change in management from 'no biopsy advised' to 'biopsy advised' and were recalled. Two of these had no cancer on subsequent biopsy whilst one had 2mm Gleason 3+3=6. One patient had 3mm 3+4=7 subsequently managed with active surveillance.

CONCLUSION

We have shown that variability between expert uro-radiologists for mpMRI is low. The MDT double reporting had minimal clinical impact on biopsy rates and significant cancer detection rates. Shifting to single reporting would save 60 minutes of MDT time per month estimated at £30,303 per annum.
Introduction and Objectives

MDTs are under increasing pressure in terms of workload volume and complexity. Our diagnostic pathway was initially set up with prospective double reporting of mpMRI scans via a dedicated MDT. We aimed to determine the impact of this process.

Materials and methods

Of 580 biopsy-naïve patients who underwent pre-biopsy mpMRI, 273 had a second report carried out (April/2017-October/2018). Both reporters were expert uro-radiologists each with over 5 years' experience in mpMRI prostate reporting.

A second mpMRI review 1-2 weeks after the initial report occurred within a MDT as a quality control measure. Men were recalled for a targeted and systematic biopsy if MRI scores were changed from non-suspicious to suspicious (4 or 5 or score 3 with PSA-Density >0.12).

RESULTS

Mean PSA 7.4 (SD±4.8) ng/ml and PSA-density 0.18 (SD±0.16).

MRI Likert scores were concordant in 248/273 (90%) and 25/273 (9.1%) were discordant. 8/25 (32%) discordant reports were 'down-scored' and 7/25 (28%) were 'up-scored'.

Of the discordant cases, only 4/273 (1.4%) required a change in management from 'no biopsy advised' to 'biopsy advised' and were recalled. Two of these had no cancer on subsequent biopsy whilst one had 2mm Gleason 3+3=6. One patient had 3mm 3+4=7 subsequently managed with active surveillance.

CONCLUSION

We have shown that variability between expert uro-radiologists for mpMRI is low. The MDT double reporting had minimal clinical impact on biopsy rates and significant cancer detection rates. Shifting to single reporting would save 60 minutes of MDT time per month estimated at £30,303 per annum.
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