University of Melbourne, Department of Surgery, Urology Unit and Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Victoria, Australia.
Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
Prostate Cancer Prostatic Dis. 2019 Mar;22(1):39-48. doi: 10.1038/s41391-018-0075-4. Epub 2018 Aug 14.
Although magnetic resonance imaging and subsequent targeted biopsy ('MRI pathway') have been widely adopted in routine clinical practice, it is still a common practice to perform systematic biopsy concurrently, because the accuracy of the MRI pathway is yet to be fully defined. This systematic review of the literature assessed the sensitivity of the MRI pathway for detecting clinically significant prostate cancer.
Multiple databases were searched up to May 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement for studies assessing the accuracy of MR-guided biopsy (MRGB) compared to a reference standard which consisted of both MRGB and systematic biopsy with at least 20-cores. The primary outcome was the sensitivity of detecting clinically significant prostate cancer defined as Gleason ≥7 disease.
A total of 15 studies met the predefined inclusion criteria. Overall, studies were assessed to be of low quality with inadequate blinding of personnel, which could introduce performance and detection bias. The calculated summary sensitivity of the MRI pathway was 78.3% [95%CI 75.0-81.4%]. There was moderate heterogeneity between the included studies (I = 36%). Subgroup analysis was performed based on clinical setting, the strength of MRI magnet and mode of image fusion as factors but no interaction was identified between any of the subgroups. No publication bias was identified.
The MRI pathway cannot yet be solely relied upon to diagnose clinically significant disease and hence additional systematic sampling should still be performed during the biopsy procedure.
尽管磁共振成像和随后的靶向活检（“MRI 路径”）已在常规临床实践中广泛采用，但同时进行系统活检仍然是一种常见做法，因为 MRI 路径的准确性尚未完全确定。本系统评价文献评估了 MRI 路径检测临床显着前列腺癌的敏感性。
根据系统评价和荟萃分析（PRISMA）声明，我们对评估 MR 引导活检（MRGB）与参考标准（包括 MRGB 和至少 20 核系统活检）准确性的研究进行了多数据库搜索，截至 2017 年 5 月。主要结局是检测定义为 Gleason≥7 疾病的临床显着前列腺癌的敏感性。
共有 15 项研究符合预先确定的纳入标准。总体而言，研究质量较低，人员的盲目性不足，这可能会引入表现和检测偏倚。MRI 路径的计算汇总敏感性为 78.3%[95%CI 75.0-81.4%]。纳入的研究存在中度异质性（I=36%）。根据临床环境、MRI 磁铁的强度和图像融合方式进行了亚组分析，但没有发现任何亚组之间存在相互作用。未发现发表偏倚。
MRI 路径尚不能单独用于诊断临床显着疾病，因此在活检过程中仍应进行额外的系统采样。
