Garcia-Becerra Carlos A, Arias-Gallardo Maria I, Juarez-Garcia Jesus E, Soltero-Molinar Veronica, Rivera-Rocha Mariabelen I, Parra-Camaño Luis F, Garcia-Becerra Natalia, García-Gutiérrez Carlos M
Research Department, Urovallarta Medical Center, Puerto Vallarta, Mexico.
Basic Science Institute, School of Medicine, Autonomous University of Guadalajara, Guadalajara, México.
Prostate Cancer Prostatic Dis. 2025 Jul 22. doi: 10.1038/s41391-025-00999-0.
Prostate Cancer (PCa) is a leading cause of cancer-related mortality globally. Clinically significant PCa (CsPCa) is associated with more aggressive disease, making accurate diagnosis crucial. Multiparametric Magnetic Resonance Imaging (Mp-MRI) is a well-established tool for PCa detection, but the dynamic contrast-enhanced (DCE) sequence raises concerns due to cost, risks, and patient experience. Biparametric MRI (Bp-MRI) has emerged as an alternative, but its diagnostic performance compared to Mp-MRI has not been thoroughly examined through a systematic review and meta-analysis in recent years.
A systematic review and meta-analysis were conducted to compare the diagnostic accuracy of Bp-MRI and Mp-MRI for detecting CsPCa by assessing the databases MEDLINE/PubMed, CENTRAL Cochrane, and ClinicalTrials.gov. Studies published between 2012 and 2024 that compared Bp-MRI and Mp-MRI using histopathological analysis as the reference standard were included. Data were extracted to obtain diagnostic test accuracy measurements (sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) and study characteristics. Statistical analysis involved two bivariate random-effects models, a summary Receiver Operating Characteristic (sROC) curve, and meta-regression models assessing the comparison of both diagnostic test accuracies and the interaction of different study-level covariates.
Nineteen studies involving 5,173 patients were included. Mp-MRI demonstrated a pooled sensitivity of 0.90 (95% CI: 0.87-0.93) and a specificity of 0.64 (95% CI: 0.50-0.76), while Bp-MRI showed a pooled sensitivity of 0.89 (95% CI: 0.85-0.92) and a specificity of 0.73 (95% CI: 0.62-0.82). Both modalities showed similar diagnostic performance with overlapping sROC curves. Meta-regression revealed no statistically significant difference between the two tools, and the study-level covariates did not influence the results.
Bp-MRI is a viable alternative to Mp-MRI for detecting CsPCa, with comparable diagnostic accuracy, especially when contrast agents are a concern. Further prospective randomized studies are needed to confirm these findings.
PROSPERO (CRD42024552125).
前列腺癌（PCa）是全球癌症相关死亡的主要原因。具有临床意义的前列腺癌（CsPCa）与更具侵袭性的疾病相关，因此准确诊断至关重要。多参数磁共振成像（Mp-MRI）是一种成熟的前列腺癌检测工具，但动态对比增强（DCE）序列由于成本、风险和患者体验等问题而引发关注。双参数MRI（Bp-MRI）已成为一种替代方法，但近年来其与Mp-MRI相比的诊断性能尚未通过系统评价和荟萃分析进行全面研究。
通过评估MEDLINE/PubMed、CENTRAL Cochrane和ClinicalTrials.gov数据库，进行了一项系统评价和荟萃分析，以比较Bp-MRI和Mp-MRI检测CsPCa的诊断准确性。纳入2012年至2024年间发表的以组织病理学分析为参考标准比较Bp-MRI和Mp-MRI的研究。提取数据以获得诊断试验准确性测量值（敏感性、特异性、诊断比值比、阳性和阴性似然比）及研究特征。统计分析涉及两个双变量随机效应模型、一条汇总的受试者工作特征（sROC）曲线以及评估两种诊断试验准确性比较和不同研究水平协变量相互作用的荟萃回归模型。
纳入了19项涉及5173例患者的研究。Mp-MRI的合并敏感性为0.90（95%CI：0.87-0.93），特异性为0.64（95%CI：0.50-0.76），而Bp-MRI的合并敏感性为0.89（95%CI：0.85-0.92），特异性为0.73（95%CI：0.62-0.82）。两种检查方式显示出相似的诊断性能，sROC曲线重叠。荟萃回归显示两种工具之间无统计学显著差异，且研究水平协变量不影响结果。
对于检测CsPCa，Bp-MRI是Mp-MRI的一种可行替代方法，具有相当的诊断准确性，尤其是在对比剂存在问题时。需要进一步的前瞻性随机研究来证实这些发现。
PROSPERO（CRD42024552125）
