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A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk

Prostate Cancer and Prostatic Diseases volume 24, pages 596–611 (2021)Cite this article

Subjects

Abstract

Introduction

Multiparametric magnetic resonance imaging (mpMRI), the use of three multiple imaging sequences, typically T2-weighted, diffusion weighted (DWI) and dynamic contrast enhanced (DCE) images, has a high sensitivity and specificity for detecting significant cancer. Current guidance now recommends its use prior to biopsy. However, the impact of DCE is currently under debate regarding test accuracy. Biparametric MRI (bpMRI), using only T2 and DWI has been proposed as a viable alternative. We conducted a contemporary systematic review and meta-analysis to further examine the diagnostic performance of bpMRI in the diagnosis of any and clinically significant prostate cancer.

Methods

A systematic review of the literature from 01/01/2017 to 06/07/2019 was performed by two independent reviewers using predefined search criteria. The index test was biparametric MRI and the reference standard whole-mount prostatectomy or prostate biopsy. Quality of included studies was assessed by the QUADAS-2 tool. Statistical analysis included pooled diagnostic performance (sensitivity; specificity; AUC), meta-regression of possible covariates and head-to-head comparisons of bpMRI and mpMRI where both were performed in the same study.

Results

Forty-four articles were included in the analysis. The pooled sensitivity for any cancer detection was 0.84 (95% CI, 0.80–0.88), specificity 0.75 (95% CI, 0.68–0.81) for bpMRI. The summary ROC curve yielded a high AUC value (AUC = 0.86). The pooled sensitivity for clinically significant prostate cancer was 0.87 (95% CI, 0.78–0.93), specificity 0.72 (95% CI, 0.56–0.84) and the AUC value was 0.87. Meta-regression analysis revealed no difference in the pooled diagnostic estimates between bpMRI and mpMRI.

Conclusions

This meta-analysis on contemporary studies shows that bpMRI offers comparable test accuracies to mpMRI in detecting prostate cancer. These data are broadly supportive of the bpMRI approach but heterogeneity does not allow definitive recommendations to be made. There is a need for prospective multicentre studies of bpMRI in biopsy naïve men.

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Fig. 1: Study selection.
Fig. 2: Study bias assessment.
Fig. 3: Sensitivity of Biparametric MRI for detecting all prostate cancer.
Fig. 4: Specificity of Biparametric MRI for detecting all prostate cancer.
Fig. 5: Diagnostic test accuracy of BpMRI for detecting all PCa.
Fig. 6: Diagnostic test accuracy of BpMRI for detecting csPCa.
Fig. 7: Summary ROC curve (bivariate model) for diagnostic test accuracy of all PCa for.

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Code availability

Example R code used for this analysis is found in a statistical methodology paper by Shim et al. [81].

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Funding

Wellcome Trust Senior Clinical Research Fellowship. Grant code:204998/Z/16/Z.

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Authors and Affiliations

  1. Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK

    E. J. Bass, M. Connor, H. Tam, M. Winkler & H. U. Ahmed

  2. Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK

    E. J. Bass, M. Connor, M. Winkler & H. U. Ahmed

  3. Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, Belgrade, Serbia

    A. Pantovic

  4. Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK

    R. Gabe

  5. Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, UK

    A. R. Padhani & H. Sokhi

  6. Division of Cancer, Department of Surgery and Cancer,Faculty of Medicine, Imperial College London, London, UK

    A. Rockall

  7. Department of Radiology, Hillingdon Hospitals NHS Foundation Trust, London, UK

    H. Sokhi

  8. Department of Radiology, Imperial College Healthcare NHS Trust, London, UK

    H. Tam

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Conflict of interest

HUA’s research is supported by core funding from the United Kingdom’s National Institute of Health Research (NIHR) Imperial Biomedical Research Centre. HUA currently receives funding from the Wellcome Trust, Medical Research Council (UK), Cancer Research UK, Prostate Cancer UK, The Urology Foundation, BMA Foundation, Imperial Health Charity, NIHR Imperial BRC, Sonacare Inc., Trod Medical and Sophiris Biocorp for trials in prostate cancer. HUA was a paid medical consultant for Sophiris Biocorp in the previous 3 years.

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Bass, E.J., Pantovic, A., Connor, M. et al. A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk. Prostate Cancer Prostatic Dis 24, 596–611 (2021). https://doi.org/10.1038/s41391-020-00298-w

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  • DOI: https://doi.org/10.1038/s41391-020-00298-w

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