Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

Abstract

Objective To perform a diagnostic test accuracy (DTA) systematic review and meta‐analysis comparing multiparametric (diffusion‐weighted imaging [DWI], T2‐weighted imaging [T2WI], and dynamic contrast‐enhanced [DCE] imaging) magnetic resonance imaging (mpMRI) and biparametric (DWI and T2WI) MRI (bpMRI) in detecting prostate cancer in treatment‐naïve patients. Methods The Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE) were searched to identify relevant studies published after 1 January 2012. Articles underwent title, abstract, and full‐text screening. Inclusion criteria consisted of patients with suspected prostate cancer, bpMRI and/or mpMRI as the index test(s), histopathology as the reference standard, and a DTA outcome measure. Methodological and DTA data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)‐2 tool. DTA metrics were pooled using bivariate random‐effects meta‐analysis. Subgroup analysis was conducted to assess for heterogeneity. Results From an initial 3502 studies, 31 studies reporting on 9480 patients (4296 with prostate cancer) met the inclusion criteria for the meta‐analysis; 25 studies reported on mpMRI (7000 patients, 2954 with prostate cancer) and 12 studies reported on bpMRI DTA (2716 patients, 1477 with prostate cancer). Pooled summary statistics demonstrated no significant difference for sensitivity (mpMRI: 86%, 95% confidence interval [CI] 81–90; bpMRI: 90%, 95% CI 83–94) or specificity (mpMRI: 73%, 95% CI 64–81; bpMRI: 70%, 95% CI 42–83). The summary receiver operating characteristic curves were comparable for mpMRI (0.87) and bpMRI (0.90). Conclusions No significant difference in DTA was found between mpMRI and bpMRI in diagnosing prostate cancer in treatment‐naïve patients. Study heterogeneity warrants cautious interpretation of the results. With replication of our findings in dedicated validation studies, bpMRI may serve as a faster, cheaper, gadolinium‐free alternative to mpMRI.

Added value of diffusion‐weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial

“…This approach is supported by recent systematic reviews and meta-analyses comparing standard mpMRI with biparametric MRI (bpMRI), the latter consisting of T2W and DWI sequences without DCE. In a meta-analysis by Alabousi et al [8] the pooled summary statistics had no significant difference in sensitivity (mpMRI: 86%, 95% CI 81-90; bpMRI: 90%, 95% CI 83-94) or specificity (mpMRI: 73%, 95% CI 64-81; bpMRI: 70%, 95% CI 42-83) with the summary AUROC values being comparable for mpMRI (0.87) and bpMRI (0.90) [8]. Subsequent to this, van der Leest et al [10] showed that sensitivity for high-grade prostate cancer of both bpMRI and mpMRI was 95% (95% CI 91-97), with a specificity of 69% (95% CI 64-73).…”

“…It also recommends dominant sequences based on zonal anatomy so that DWI is dominant in the peripheral zone and T2W is dominant in the transition zone. Recent systematic reviews have indicated that DCE may not be necessary [8,9]; this is supported by results from paired-cohort studies from expert centres [10,11].…”

Fifteen‐year analysis of prostate biopsies in Western Australia including recent impact of multiparametric magnetic resonance imaging

“…The identification of significant prostate cancer (PCa) has been limited by the absence of a dependable screening test able to accurately detect and localize the tumour . Case identification combines clinical features including family history, clinical assessment (digital rectal examination (DRE)) together with laboratory tests (prostate‐specific antigen (PSA)) . Ultrasound guided prostate biopsy is currently the gold standard in PCa diagnosis, but large‐scale international studies report a wide range of positive biopsy rates, anywhere from 24% to 48% .…”

“…1 Case identification combines clinical features including family history, clinical assessment (digital rectal examination (DRE)) together with laboratory tests (prostate-specific antigen (PSA)). 2 Ultrasound guided prostate biopsy is currently the gold standard in PCa diagnosis, but largescale international studies report a wide range of positive biopsy rates, anywhere from 24% to 48%. 3,4 A significant challenge in the diagnosis of PCa is that it remains one of the few cancers to be diagnosed with non-targeted tissue sampling.…”

Dropping the GAD – just a fad? The case for a simpler, quicker, safer and cheaper prostate magnetic resonance imaging

“…The systematic review in this issue of the BJUI by Alabousi et al. explores, via the process of systematic review, whether the omission of the T1‐GAD sequence results in any clinically important reduction in test performance when compared with the full sequence scan comprising traditionally of T2, diffusion, and T1‐GAD sequences. It did not.…”