Agrotis Georgios, Pooch Eduardo Pais, Marsitopoulos Kostas, Vlychou Marianna, Benndorf Matthias, Beets-Tan Regina G H, Schoots Ivo G
Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
Eur Radiol. 2025 Apr 27. doi: 10.1007/s00330-025-11618-w.
To evaluate and compare cancer detection rates (CDRs) of transition zone (TZ) lesions upgraded from PI-RADSv2.1 score 2 to 3 ("2 + 1") or from 3 to 4 ("3 + 1") using DWI and assess their clinical impact.
A systematic literature search was performed in Embase, Medline, and Web of Science for studies assessing TZ lesions with DWI in PI-RADSv2.1, with histology-confirmed grade group ≥ 2 cancer (GG ≥ 2) as the primary outcome. Risk of bias was evaluated using QUADAS-2. Pooled sensitivity, specificity, CDRs, and odds ratios (ORs) were estimated at the lesion level using a bivariate binomial random-effects model.
Eight studies with 1535 TZ lesions were included. GG ≥ 2 CDRs for PI-RADS scores of 1, 2, 2 + 1, 3, 3 + 1, 4, and 5 were 2% (95%CI: 0%-12%), 6% (4%-10%), 13% (6%-23%), 19% (15%-25%), 37% (24%-52%), 49% (32%-67%), and 73% (66%-79%), respectively. Scores of 2 + 1 had higher GG ≥ 2 CDRs than 2 (OR 3.37 (1.53-7.44), p = 0.003) but were similar to 3 (OR 0.80 (0.44-1.45), p = 0.46). Scores of 3 + 1 had higher GG ≥ 2 CDRs than 3 (OR 2.67 (1.27-5.59), p = 0.009) but were similar to 4 (OR 0.68 (0.33-1.44), p = 0.32). False-positive rates remained substantial (≥ 2 + 1: 69% (55%-80%); ≥ 3: 54% (46%-62%)).
The risk of having significant prostate cancer in "2 + 1" and "3 + 1" TZ lesions, with an upgrading based on DWI images, is appropriately categorized within the PI-RADS v2.1 scoring system, as shown by this meta-analysis.
Question PI-RADS v2.1 incorporates rules allowing scores of some transition zone (TZ) lesions to be increased. Literature on the clinical impact of these rules is scarce. Findings For TZ lesions upgraded with DWI: "2 + 1" lesions show a cancer detection rate (CDR) of 13%, and "3 + 1" lesions show a CDR of 37%. Clinical relevance Upgraded TZ lesions may impact individualized biopsy-decisions, especially as "3 + 1" lesions harbor significant disease in 2-out-of-5 patients. Still, the high rate of grade group = 1 and benign findings in these sub-categories emphasizes the need for strategies to minimize overdiagnosis.
评估并比较使用扩散加权成像（DWI）将移行区（TZ）病变从PI-RADSv2.1评分2升级为3（“2+1”）或从3升级为4（“3+1”）后的癌症检出率（CDR），并评估其临床影响。
在Embase、Medline和Web of Science中进行系统文献检索，以查找在PI-RADSv2.1中使用DWI评估TZ病变的研究，以组织学证实的≥2级组癌症（GG≥2）作为主要结局。使用QUADAS-2评估偏倚风险。使用双变量二项式随机效应模型在病变水平估计合并敏感性、特异性、CDR和比值比（OR）。
纳入8项研究，共1535个TZ病变。PI-RADS评分为1、2、2+1、3、3+1、4和5时，GG≥2的CDR分别为2%（95%CI：0%-12%）、6%（4%-10%）、13%（6%-23%）、19%（15%-25%）、37%（24%-52%）、49%（32%-67%）和73%（66%-79%）。2+1评分的GG≥2的CDR高于2（OR 3.37（1.53-7.44），p=0.003），但与3相似（OR 0.80（0.44-1.45），p=0.46）。3+1评分的GG≥2的CDR高于3（OR 2.67（1.27-5.59），p=0.009），但与4相似（OR 0.68（0.33-1.44），p=0.32）。假阳性率仍然很高（≥2+1：69%（55%-80%）；≥3：54%（46%-62%））。
如本荟萃分析所示，基于DWI图像升级的“2+1”和“3+1”TZ病变中存在显著前列腺癌的风险，在PI-RADS v2.1评分系统中得到了适当分类。
问题PI-RADS v2.1纳入了允许提高一些移行区（TZ）病变评分的规则。关于这些规则临床影响的文献很少。发现对于经DWI升级的TZ病变：“2+1”病变的癌症检出率（CDR）为13%，“3+1”病变的CDR为37%。临床相关性升级的TZ病变可能会影响个体化活检决策，特别是因为“3+1”病变在五分之二的患者中存在显著疾病。尽管如此，这些亚组中1级组和良性结果的高发生率强调了需要采取策略以尽量减少过度诊断。
