Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Urology Section, Department of Surgery, University of Catania, Catania, Italy.
Prostate Cancer Prostatic Dis. 2019 May;22(2):206-220. doi: 10.1038/s41391-018-0113-2. Epub 2018 Nov 28.
The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS.
A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification.
In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83.
Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
在主动监测（AS）患者中使用多参数磁共振成像（mpMRI）具有广阔的前景。在本系统评价中，我们旨在分析 mpMRI 在 AS 患者中的作用。
我们使用 Medline、Scopus 和 Web of Science 数据库对近期发表的英文原始和综述文献进行了全面的文献检索，检索时间截至 2017 年 10 月 30 日。我们使用了以下 MeSH 术语：“主动监测”、“前列腺癌”、“多参数磁共振成像”。我们对 3.0TmpMRI 预测疾病再分类的诊断进行了荟萃分析。
经过检索和重复项去除，共选择了 226 项研究。在分析纳入标准后，确定了 43 项符合本系统评价标准的研究，共纳入 6605 例患者。AS 随访期间 MRI 的时间因所有研究而异，就像纳入 AS 方案的标准一样。总体而言，所有研究的偏倚风险较低。1.5T 磁共振成像的诊断荟萃分析显示，其敏感性为 0.60，阴性预测值（NPV）为 0.75，分层综合接收操作曲线（HSROC）为 0.74；而 3.0T mpMRI 的敏感性为 0.81，NPV 为 0.78，HSROC 为 0.83。
总体而言，现有证据表明，1.5 或 3.0TmpMRI 均是监测 AS 随访中进展的有效工具，在检测 PCa 再分类方面具有良好的准确性。然而，必须进一步评估哪种模态能更好地定义 mpMRI 上的“疾病进展”。
