QUALITYIMPROVEMENT:ISTHEBIOPSYPATHOLOGY

REFLECTIVEOFDISEASEGRADE?

RajanT.Gupta,M.D.

SitharthanSekar,B.S.

SARProstateDFP–TeachingCaseoftheWeek5/21/18

�  56yearoldM�  PSA-4.4ng/mL�  PSADensity-0.20ng/mL2

�  NegaJvepriorTRUS-guidedbiopsy�  PresentstoDukeformpMRIand

evaluaJonofpossibleprostatecancer

History

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

T2W ADC

b1400 CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

�  AxialT2W-lesioninrightanteriorPZatlevelofthemid-gland/apex�  Lesionmeasured1.6cminmaximalaxialdimension

�  CorrespondingareaofmarkedrestricJondiffusiononADCandb1400images

MRIInterpretaJon

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

�  OverallPI-RADSCategory5�  Thelesionwasupgradedfroma4to5,duetoitssizegreaterthan1.5cm.

MRIInterpretaJon

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

�  TargetedMRI-USfusionbiopsyàG3+3=6PCa�  MulJdisciplinaryteammettoreviewresults�  Lowgradetumorfelttobediscordantwith

imagingfindings�  PaJentunderwentradicalprostatectomydue

tohighsuspicionofclinicallysignificantcanceranddiscordancewithfusionbiopsy�  FinalsurgicalpathologyrevealedG3+4=7PCa

FollowUp

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

�  PI-RADS5lesionshaveveryhighlikelihoodofclinicallysignificantcancer

�  Discordantbiopsyresultsrequirefollowup�  Inthiscase,mulJdisciplinaryteamshould

(Radiology,Urology,andPathology)reviewpathologyanddetermineconcordance/discordanceandnextstepsinmanagement

TeachingPoints

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

THANKYOU

RajanT.Gupta,M.D.AssociateProfessorofRadiology

AssistantProfessorofSurgeryDirector,AbdominalImagingFellowshipProgram

DukeUniversityMedicalCenter&DukeCancerInsItuterajan.gupta@duke.edu

@RajanTGuptaMD

SARProstateDFP–TeachingCaseoftheWeek5/21/18