Ahn Hyungwoo, Hwang Sung Il, Lee Hak Jong, Kim Sang Youn, Cho Jeong Yeon, Lee Hakmin, Hong Sung Kyu, Byun Seok-Soo, Kim Taek Min
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Prostate Int. 2023 Jun;11(2):59-68. doi: 10.1016/j.prnil.2022.12.004. Epub 2022 Dec 24.
This article aims to evaluate the pooled diagnostic performance control MRI for prediction of recurrent prostate cancer (PCa) after high-intensity focused ultrasound (HIFU).
MEDLINE, EMBASE, and Cochrane library databases up to December 31, 2021, were searched. We included studies providing 2×2 contingency table for diagnostic performance of MRI in predicting recurrent PCa after HIFU, using control biopsy as reference standard. The quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Sensitivity and specificity were pooled and displayed in a summary receiver operating characteristics (SROC) plot. Meta-regression analysis using clinically relevant covariates was performed for the causes of heterogeneity.
Nineteen studies (703 patients) were included. All included studies satisfied at least four of the seven QUADAS-2 domains. Pooled sensitivity was 0.81 (95% CI 0.72-0.90) with specificity of 0.91 (95% CI 0.86-0.96), with area under the SROC curve of 0.81. Larger studies including more than 50 patients showed relatively poor sensitivity (0.68 vs. 0.84) and specificity (0.75 vs. 0.93). The diagnostic performance of studies reporting higher nadir serum prostate-specific antigen levels (>1 ng/mL) after HIFU was inferior, and differed significantly in sensitivity (0.54 vs. 0.78) rather than specificity (0.85 vs. 0.91).
Although MRI showed adequate diagnostic performance in predicting PCa recurrence after HIFU, these results may have been exaggerated.
本文旨在评估对照磁共振成像（MRI）对高强度聚焦超声（HIFU）治疗后复发性前列腺癌（PCa）的预测的汇总诊断性能。
检索截至2021年12月31日的MEDLINE、EMBASE和Cochrane图书馆数据库。我们纳入了提供2×2列联表的研究，这些研究以对照活检作为参考标准，用于评估MRI在预测HIFU后复发性PCa的诊断性能。使用诊断准确性研究质量评估-2（QUADAS-2）对纳入研究的质量进行评估。汇总敏感性和特异性，并绘制在汇总受试者工作特征（SROC）图中。使用临床相关协变量进行meta回归分析以探讨异质性原因。
纳入19项研究（703例患者）。所有纳入研究至少满足QUADAS-2七个领域中的四个。汇总敏感性为0.81（95%CI 0.72-0.90），特异性为0.91（95%CI 0.86-0.96），SROC曲线下面积为0.81。纳入患者超过50例的较大规模研究显示敏感性（0.68对0.84）和特异性（0.75对0.93）相对较差。报告HIFU后最低血清前列腺特异性抗原水平较高（>1 ng/mL）的研究的诊断性能较差，敏感性差异显著（0.54对0.78），而非特异性差异（0.85对0.91）。
尽管MRI在预测HIFU后PCa复发方面显示出足够的诊断性能，但这些结果可能被夸大了。
