磁共振成像靶向活检可能比标准经直肠超声引导活检更能提高显著前列腺癌检测的诊断准确性：系统评价和荟萃分析。

Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis.

机构信息

Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.

出版信息

Eur Urol. 2015 Sep;68(3):438-50. doi: 10.1016/j.eururo.2014.11.037. Epub 2014 Dec 3.

DOI:10.1016/j.eururo.2014.11.037

PMID:25480312

Abstract

CONTEXT

Multiparametric magnetic resonance imaging (MRI) of the prostate may improve the diagnostic accuracy of prostate cancer detection in MRI-targeted biopsy (MRI-TBx) in comparison to transrectal ultrasound-guided biopsy (TRUS-Bx).

OBJECTIVE

Systematic review and meta-analysis of evidence regarding the diagnostic benefits of MRI-TBx versus TRUS-Bx in detection of overall prostate cancer (primary objective) and significant/insignificant prostate cancer (secondary objective).

EVIDENCE ACQUISITION

A systematic review of Embase, Medline, Web of Science, Scopus, PubMed, Cinahl, and the Cochrane library was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Identified reports were critically appraised according to the Quality Assessment of Diagnostic Accuracy Studies criteria. Only men with a positive MRI were included.

EVIDENCE SYNTHESIS

The reports we included (16 studies) used both MRI-TBx and TRUS-Bx for prostate cancer detection. A cumulative total of 1926 men with positive MRI were included, with prostate cancer prevalence of 59%. MRI-TBx and TRUS-Bx did not significantly differ in overall prostate cancer detection (sensitivity 0.85, 95% confidence interval [CI] 0.80-0.89, and 0.81, 95% CI 0.70-0.88, respectively). MRI-TBx had a higher rate of detection of significant prostate cancer compared to TRUS-Bx (sensitivity 0.91, 95% CI 0.87-0.94 vs 0.76, 95% CI 0.64-0.84) and a lower rate of detection of insignificant prostate cancer (sensitivity 0.44, 95% CI 0.26-0.64 vs 0.83, 95% confidence interval 0.77-0.87). Subgroup analysis revealed an improvement in significant prostate cancer detection by MRI-TBx in men with previous negative biopsy, rather than in men with initial biopsy (relative sensitivity 1.54, 95% CI 1.05-2.57 vs 1.10, 95% CI 1.00-1.22). Because of underlying methodological flaws of MRI-TBx, the comparison of MRI-TBx and TRUS-Bx needs to be regarded with caution.

CONCLUSIONS

In men with clinical suspicion of prostate cancer and a subsequent positive MRI, MRI-TBx and TRUS-Bx did not differ in overall prostate cancer detection. However, MRI-TBx had a higher rate of detection of significant prostate cancer and a lower rate of detection of insignificant prostate cancer compared with TRUS-Bx.

PATIENT SUMMARY

We reviewed recent advances in magnetic resonance imaging (MRI) for guidance and targeting of prostate biopsy for prostate cancer detection. We found evidence to suggest that MRI-guided targeted biopsy benefits the diagnosis of prostate cancer.

摘要

背景

与经直肠超声引导活检（TRUS-Bx）相比，前列腺磁共振成像（MRI）的多参数成像可能提高前列腺癌检测的诊断准确性，适用于 MRI 靶向活检（MRI-TBx）。

目的

系统评价和荟萃分析 MRI-TBx 与 TRUS-Bx 在检测总体前列腺癌（主要目标）和有意义/无意义前列腺癌（次要目标）方面的诊断优势的证据。

证据获取

根据系统评价和荟萃分析的首选报告项目声明，对 Embase、Medline、Web of Science、Scopus、PubMed、Cinahl 和 Cochrane 图书馆进行了系统评价。根据诊断准确性研究质量评估标准对确定的报告进行了严格评估。仅纳入 MRI 阳性的男性。

证据综合

我们纳入的报告（16 项研究）均使用 MRI-TBx 和 TRUS-Bx 检测前列腺癌。共纳入 1926 名 MRI 阳性男性，前列腺癌患病率为 59%。MRI-TBx 和 TRUS-Bx 在总体前列腺癌检测方面无显著差异（敏感性分别为 0.85[95%置信区间（CI）0.80-0.89]和 0.81[95%CI 0.70-0.88]）。与 TRUS-Bx 相比，MRI-TBx 检测有意义前列腺癌的比例更高（敏感性分别为 0.91[95%CI 0.87-0.94]和 0.76[95%CI 0.64-0.84]），而检测无意义前列腺癌的比例更低（敏感性分别为 0.44[95%CI 0.26-0.64]和 0.83[95%CI 0.77-0.87]）。亚组分析显示，MRI-TBx 对既往阴性活检的男性中显著提高了前列腺癌的检出率，而非初始活检的男性（相对敏感性分别为 1.54[95%CI 1.05-2.57]和 1.10[95%CI 1.00-1.22]）。由于 MRI-TBx 存在潜在的方法学缺陷，因此需要谨慎比较 MRI-TBx 和 TRUS-Bx。