Limitation
- The small sample group, and lack of equal numbers of lesions according
to pathologic diagnosis and zones. Increasing the number of patients
in the study may provide better results and beneficial statistical
data for the literature.
- As the study was prospectively designed, there were 9/106 lesions in
PI-RADS<3 group, so we could not evaluate the sensitivity
and specificity of PI-RADS-3, especially in TZ.
- The main disadvantage of TRUS-guided CF-Bx is that the success of the
procedure is depending on the operator’s experience and lack of
standardization.38
- Measuring interobserver agreement between radiologists before and
after PI-RADS training may reveal the difference between experience
and training in terms of MpMRI.
PI-RADSv2.1 was observed to be very effective for detecting lesions, for
determining patient selection for biopsy, identifying risk level for
patients with prostate cancer suspicion, and follow-up strategies
according to risk level. When the PI-RADS≥3 cut-off value is increased
to PI-RADS≥4, the significant increase in the specificity, PPV and
interobserver agreement suggests that the PI-RADS3 criteria will be
revised in new versions of the PI-RADS.
When lesions with DCE positivity and DWI score 3 upgrading PI-RADS 3 to
4 and PI-RADS 4 lesions with DWI score 4 are compared, we identified
significant differences between ISUP grades. For this reason, we suggest
there should be differences in the scoring of these groups.
PI-RADSv2.1 is created to increase interobserver agreement within the
framework of v2 and also provides additional explanations for certain
criteria. We believe that, as more data to be obtained with further
studies, PI-RADS guidelines will be more accurate.