ArticleFrontiers in oncology2026
Diagnostic value of whole-tumor ADC histogram parameters combined with ISUP grade and MRI-EPE score for predicting extracapsular extension in PI-RADS 4-5 prostate cancer.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To investigate the incremental value of whole-tumor apparent diffusion coefficient (ADC) histogram parameters, when combined with clinical pathological variables for predicting extracapsular extension (EPE) in patients with PI-RADS 4-5 prostate cancer. Methods: This retrospective study included 102 patients with pathologically confirmed prostate cancer following surgery, comprising 51 patients with EPE and 51 without EPE as the training cohort, plus an independent temporal validation cohort of 34 patients. All patients underwent preoperative multiparametric magnetic resonance imaging (mpMRI). Tumor regions and 1-3 mm peritumoral regions of interest (ROIs) were manually segmented on ADC maps using 3D Slicer software, followed by the extraction of histogram parameters. Histogram features were selected using forward stepwise logistic regression based on the likelihood ratio test. Clinical, histogram, and combined predictive models were established using logistic regression analysis. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Internal validation was performed with 1000 bootstrap resamples to evaluate model stability and optimism. Calibration and decision curve analyses were further applied to assess model accuracy and clinical utility. To specifically quantify incremental value beyond the established clinical model, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were defined as core secondary endpoints and calculated in the temporal validation cohort. Results: Multivariate Firth-corrected logistic regression analysis identified the International Society of Urological Pathology (ISUP) grade (OR = 2.701, Conclusion: Integration of ISUP grade, MRI-EPE score, and peritumoral ADC histogram features (peri1_Minimum and peri3_Minimum) enables robust prediction of EPE in PI-RADS 4-5 prostate cancer. While the combined model's overall discriminatory performance was comparable to that of the clinical model based on AUC, the significant continuous NRI suggests incremental value in refining risk stratification. However, given the non-significant AUC difference and borderline IDI, these findings warrant validation in larger, multicenter cohorts before informing individualized surgical planning for high-risk patients.
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