Department of Advanced Biomedical Sciences, University of Naples "Federico II," Via Pansini 5, Naples 80131, Italy.
Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy.
AJR Am J Roentgenol. 2021 Mar;216(3):608-621. doi: 10.2214/AJR.20.23219. Epub 2021 Jan 27.
The purpose of this study was to perform a systematic review and a meta-analysis of diagnostic accuracy studies that used biparametric MRI (bpMRI) for the detection of clinically significant prostate cancer (csPCa). Multiple medical databases were systematically searched to identify articles using bpMRI for csPCa detection. Sensitivity, specificity, PPV, and NPV were calculated for each study after enough data were extracted to create a 2 × 2 contingency table. Risk of bias was assessed using the QUADAS-2 tool. Meta-analyses based on bivariate random-effects methods were used to calculate pooled sensitivity, specificity, and summary ROC (SROC) curves. A meta-regression analysis was performed to assess heterogeneity sources. A total of 17 studies (3964 patients) that adopted PI-RADS or other scoring systems were included. Sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio of bpMRI in the detection of csPCa were 0.83 (95% CI, 0.76-0.88), 0.71 (95% CI, 0.63-0.79), 2.9 (95% CI, 2.3-3.7), 0.24 (95% CI, 0.17-0.33), and 12 (95% CI, 8-19), respectively, with an area under the SROC curve of 0.84 (95% CI, 0.81-0.87). The overall quality of the included studies was heterogeneous. Our results confirm the feasibility of bpMRI for the detection of csPCa and for reducing acquisition time, patient discomfort, and costs. Nevertheless, the available studies proved to be heterogeneous, indicating a need for a more robust validation of this imaging protocol and a standardization of prostate bpMRI acquisition and reporting.
本研究旨在对使用双参数 MRI（bpMRI）检测临床显著前列腺癌（csPCa）的诊断准确性研究进行系统评价和荟萃分析。通过系统搜索多个医学数据库，确定了使用 bpMRI 检测 csPCa 的文章。在提取足够的数据以创建 2×2 列联表后，计算了每个研究的敏感性、特异性、PPV 和 NPV。使用 QUADAS-2 工具评估偏倚风险。使用基于双变量随机效应方法的荟萃分析计算了汇总敏感性、特异性和汇总 ROC（SROC）曲线。进行了荟萃回归分析以评估异质性来源。共纳入了 17 项研究（3964 例患者），采用 PI-RADS 或其他评分系统。bpMRI 检测 csPCa 的敏感性、特异性、阳性似然比（LR）、阴性 LR 和诊断比值比分别为 0.83（95%CI，0.76-0.88）、0.71（95%CI，0.63-0.79）、2.9（95%CI，2.3-3.7）、0.24（95%CI，0.17-0.33）和 12（95%CI，8-19），SROC 曲线下面积为 0.84（95%CI，0.81-0.87）。纳入研究的总体质量存在异质性。我们的结果证实了 bpMRI 检测 csPCa 以及减少采集时间、患者不适和成本的可行性。然而，现有研究证明存在异质性，这表明需要更有力地验证该成像方案，并标准化前列腺 bpMRI 的采集和报告。
