Does including histological outcomes in a multiparametric MRI report improve prostate biopsy decision making?

Abstract

Objectives: To see if inserting audited histological outcome data for each Likert score into prostate mpMRI reports was helpful for clinicians counselling patients and influenced prostate biopsy uptake. Methods: A single radiologist reported 791 mpMRI scans for query prostate cancer between 2017 and 2019. A structured template which included histological outcome data from this cohort was devised and included in 207 mpMRI reports between January and June 2021. The outcomes of the new cohort were compared with the historical cohort, and with 160 contemporaneous reports without histological outcome data from the four other radiologists in the department. The opinion of this template was sought from referring clinicians who counselled patients. Results: The proportion of patients biopsied fell from 58.0 to 32.9% overall between the n = 791 cohort and the n = 207 cohort. This was most noticeable in those scoring Likert 3, where the proportion biopsied fell from 78.4 to 42.9%. This reduction was also seen when comparing the biopsy rates of patients scored Likert 3 by other reporters in a contemporaneous n = 160 cohort without the audit information (65.2%) with the n = 207 cohort (42.9%). 100% of counselling clinicians were in favour and 66.7% said it gave them greater confidence to advise the patient when they did not need a biopsy. Conclusion: Fewer low-risk patients choose unnecessary biopsies when audited histological outcomes for the radiologist’s Likert scores are included in mpMRI reports. Advances in knowledge: Clinicians welcome reporter-specific audit information in mpMRI reports which could result in fewer biopsies.