Abbreviated Biparametric Versus Standard Multiparametric MRI for Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

Kang, Zhuang; Min, Xiangde; Weinreb, Jeffrey C.; Li, Qiubai; Feng, Zhaoyan; Wang, Liang

doi:10.2214/ajr.18.20103

Cited by 91 publications

(70 citation statements)

References 33 publications

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“…Hence, it makes sense for us to compare these results with studies regarding diagnostic accuracy for PCa detection performed using PI-RADS v2. For the detection of PCa, regardless of GS, the observed sensitivity and specificity values fall within the ranges indicated in a diagnostic test accuracy meta-analysis by Kang et al [30], including 10 studies with population characteristics that were similar to those considered in our study and using a per-lesion approach, and verifying that bpMRI and mpMRI had similar diagnostic performances for PCa detection.…”

Section: Discussionsupporting

confidence: 87%

Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility

et al. 2020

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The role of dynamic contrast-enhanced-MRI (DCE-MRI) for Prostate Imaging-Reporting and Data System (PI-RADS) scoring is a controversial topic. In this retrospective study, we aimed to measure the added value of DCE-MRI in combination with T2-weighted (T2W) and diffusion-weighted imaging (DWI) using PI-RADS v2.1, in terms of reproducibility and diagnostic accuracy, for detection of prostate cancer (PCa) and clinically significant PCa (CS-PCa, for Gleason Score ≥ 7). 117 lesions in 111 patients were identified as suspicion by multiparametric MRI (mpMRI) and addressed for biopsy. Three experienced readers independently assessed PI-RADS score, first using biparametric MRI (bpMRI, including DWI and T2W), and then multiparametric MRI (also including DCE). The inter-rater and inter-method agreement (bpMRI- vs. mpMRI-based scores) were assessed by Cohen’s kappa (κ). Receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic accuracy for PCa and CS-PCa detection among the two scores. Inter-rater agreement was excellent for the three pairs of readers (κ ≥ 0.83), while the inter-method agreement was good (κ ≥ 0.73). Areas under the ROC curve (AUC) showed similar high-values (0.8 ≤ AUC ≤ 0.85). The reproducibility of PI-RADS v2.1 scoring was comparable and high among readers, without relevant differences, depending on the MRI protocol used. The inclusion of DCE did not influence the diagnostic accuracy.

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Section: Discussionsupporting

confidence: 87%

Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility

et al. 2020

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“…About 1/3 of these MRI:s were performed early in the study before the main site adopted mpMRI according to ESUR recommendations. There is a controversy regarding the diagnostic accuracy of bi-parametric prostate MRI (without DCE) in two recent meta-analyses reporting a slight advantage for multi-parametric MRI and no advantage, respectively [27,28]. However, the heterogeneity of the MRI population may be a strength since many hospitals in Scandinavia are not using DCE which brings this study closer to clinical routine.…”

Section: Discussionmentioning

confidence: 95%

Performance and inter-observer variability of prostate MRI (PI-RADS version 2) outside high-volume centres

Kohestani

Wallström

Dehlfors

et al. 2019

Scandinavian Journal of Urology

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Objective: Despite the growing trend to embrace pre-biopsy MRI in the diagnostic pathway for prostate cancer (PC), its performance and inter-observer variability outside high-volume centres remains unknown. This study aims to evaluate sensitivity of and variability between readers of prostate MRI outside specialized units with radical prostatectomy (RP) specimen as the reference standard. Materials and methods: Retrospective study comprising a consecutive cohort of all 97 men who underwent MRI and subsequent RP between January 2012 and December 2014 at a private hospital in Sweden. Three readers, blinded to clinical data, reviewed all images (including 11 extra prostate MRI to reduce bias). A tumour was considered detected if the overall PI-RADS v2 score was 3-5 and there was an approximate match (same or neighbouring sector) of tumour sector according to a 24 sector system used for both MRI and whole mount sections. Results: Detection rate for the index tumour ranged from 67 to 76%, if PI-RADS 3-5 lesions were considered positive and 54-66% if only PI-RADS score 4-5 tumours were included. Detection rate for aggressive tumours (GS ! 4 þ 3) was higher; 83.1% for PI-RADS 3-5 and 79.2% for PI-RADS 4-5. The agreement between readers showed average j values of 0.41 for PI-RADS score 3-5 and 0.51 for PI-RADS score 4-5. Conclusions: Prostate MRI evidenced a moderate detection rate for clinically significant PC with a rather large variability between readers. Clinics outside specialized units must have knowledge of their performance of prostate MRI before considering omitting biopsies in men with negative MRI.

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“…This is particularly relevant as mpMRI is now a mandatory prerequisite step before prostate biopsy and hence an essential diagnostic cost [5]. Bi-parametric instead of multiparametric MRI may be cheaper but their comparative effectiveness remains debated [36,37]. The cost of biomarkers also remains controversial with different studies showing varying results [38][39][40].…”

Section: Discussionmentioning

confidence: 99%

Clinical utility and cost modelling of the phi test to triage referrals into image-based diagnostic services for suspected prostate cancer: the PRIM (Phi to RefIne Mri) study

Kim

Boxall

George

et al. 2020

BMC Med

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Background: The clinical pathway to detect and diagnose prostate cancer has been revolutionised by the use of multiparametric MRI (mpMRI pre-biopsy). mpMRI however remains a resource-intensive test and is highly operator dependent with variable effectiveness with regard to its negative predictive value. Here we tested the use of the phi assay in standard clinical practice to pre-select men at the highest risk of harbouring significant cancer and hence refine the use of mpMRI and biopsies. Methods: A prospective five-centre study recruited men being investigated through an mpMRI-based prostate cancer diagnostic pathway. Test statistics for PSA, PSA density (PSAd) and phi were assessed for detecting significant cancers using 2 definitions: ≥ Grade Group (GG2) and ≥ Cambridge Prognostic Groups (CPG) 3. Cost modelling and decision curve analysis (DCA) was simultaneously performed. Results: A total of 545 men were recruited and studied with a median age, PSA and phi of 66 years, 8.0 ng/ml and 44 respectively. Overall, ≥ GG2 and ≥ CPG3 cancer detection rates were 64% (349/545), 47% (256/545) and 32% (174/545) respectively. There was no difference across centres for patient demographics or cancer detection rates. The overall area under the curve (AUC) for predicting ≥ GG2 cancers was 0.70 for PSA and 0.82 for phi. AUCs for ≥ CPG3 cancers were 0.81 and 0.87 for PSA and phi respectively. AUC values for phi did not differ between centres suggesting reliability of the test in different diagnostic settings. Pre-referral phi cutoffs between 20 and 30 had NPVs of 0.85-0.90 for ≥ GG2 cancers and 0.94-1.0 for ≥ CPG3 cancers. A strategy of mpMRI in all and biopsy only positive lesions reduced unnecessary biopsies by 35% but missed 9% of ≥ GG2 and 5% of ≥ CPG3 cancers. Using PH ≥ 30 to rule out referrals missed 8% and 5% of ≥ GG2 and ≥ CPG3 cancers (and reduced unnecessary biopsies by 40%). This was achieved however with 25% fewer mpMRI. Pathways incorporating PSAd missed fewer cancers but necessitated more unnecessary biopsies. The phi strategy had the lowest mean costs with DCA demonstrating net clinical benefit over a range of thresholds. Conclusion: phi as a triaging test may be an effective way to reduce mpMRI and biopsies without compromising detection of significant prostate cancers.

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Abbreviated Biparametric Versus Standard Multiparametric MRI for Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

Cited by 91 publications

References 33 publications

Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility

Assessment of DCE Utility for PCa Diagnosis Using PI-RADS v2.1: Effects on Diagnostic Accuracy and Reproducibility

Performance and inter-observer variability of prostate MRI (PI-RADS version 2) outside high-volume centres

Clinical utility and cost modelling of the phi test to triage referrals into image-based diagnostic services for suspected prostate cancer: the PRIM (Phi to RefIne Mri) study

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