Discrimination between clinical significant and insignificant prostate cancer with Apparent diffusion coefficient – A systematic review and meta analysis

Abstract

Background Multiparametric MRI has become a corner stone in diagnosis of prostate cancer (PC). Diffusion weighted imaging and the apparent diffusion coefficient (ADC) can be used to reflect tumor microstructure. The present analysis sought to compare ADC values of clinically insignificant with clinical significant PC based upon a large patient sample. Methods MEDLINE library and SCOPUS databases were screened for the associations between ADC and Gleason score in PC up to May 2019. The primary endpoint of the systematic review was the ADC value of PC groups according to Gleason score. In total 27 studies were suitable for the analysis and included into the present study. The included studies comprised a total of 1633 lesions. Results Clinically relevant PCs (Gleason score 7 and higher) were diagnosed in 1078 cases (66.0%) and insignificant PCs (Gleason score 5 and 6) in 555 cases (34.0%). The pooled mean ADC value of the clinically significant PC was 0.86x10-3 mm2/s [95% CI 0.83-0.90] and the pooled mean value of insignificant PC was 1.1 x10-3 mm2/s [95% CI 1.03-1.18]. Clinical significant PC showed lower ADC values compared to non-significant PC. The pooled ADC values of clinically insignificant PCs were no lower than 0.75 ×10-3 mm2/s. This value may be proposed as a threshold for distinguishing clinically significant from insignificant PCs. Conclusions We evaluated the published literature comparing clinical insignificant with clinically prostate cancer in regard of the Apparent diffusion coefficient values derived from magnetic resonance imaging. We identified that the clinically insignificant prostate cancer have lower ADC values than clinically significant, which may aid in tumor noninvasive tumor characterization in clinical routine.