TY - JOUR
T1 - Magnetic resonance imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer
T2 - a systematic review and meta-analysis
AU - Kasivisvanathan, Veeru
AU - Stabile, Armando
AU - Neves, Joana B.
AU - Giganti, Francesco
AU - Valerio, Massimo
AU - Shanmugabavan, Yaalini
AU - Clement, Keiran D.
AU - Sarkar, Debashis
AU - Philippou, Yiannis
AU - Thurtle, David
AU - Deeks, Jonathan
AU - Emberton, Mark
AU - Takwoingi, Yemisi
AU - Moore, Caroline M.
PY - 2019/9
Y1 - 2019/9
N2 - Context: Magnetic resonance imaging (MRI)-targeted prostate biopsy (MRI-TB) may be an alternative to systematic biopsy for diagnosing prostate cancer. Objective: The primary aims of this systematic review and meta-analysis were to compare the detection rates of clinically significant and clinically insignificant cancer by MRI-TB with those by systematic biopsy in men undergoing prostate biopsy to identify prostate cancer. Evidence acquisition: A literature search was conducted using the PubMed, Embase, Web of Science, Cochrane library, and Clinicaltrials.gov databases. We included prospective and retrospective paired studies where the index test was MRI-TB and the comparator test was systematic biopsy. We also included randomised controlled trials (RCTs) if one arm included MRI-TB and another arm included systematic biopsy. The risk of bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 checklist. In addition, the Cochrane risk of bias 2.0 tool was used for RCTs. Evidence synthesis: We included 68 studies with a paired design and eight RCTs, comprising a total of 14 709 men who either received both MRI-TB and systematic biopsy, or were randomised to receive one of the tests. MRI-TB detected more men with clinically significant cancer than systematic biopsy (detection ratio [DR] 1.16 [95% confidence interval {CI} 1.09–1.24], p < 0.0001) and fewer men with clinically insignificant cancer than systematic biopsy (DR 0.66 [95% CI 0.57–0.76], p < 0.0001). The proportion of cores positive for cancer was greater for MRI-TB than for systematic biopsy (relative risk 3.17 [95% CI 2.82–3.56], p < 0.0001). Conclusions: MRI-TB is an attractive alternative diagnostic strategy to systematic biopsy. Patient summary: We evaluated the published literature, comparing two methods of diagnosing prostate cancer. We found that biopsies targeted to suspicious areas on magnetic resonance imaging were better at detecting prostate cancer that needs to be treated and avoiding the diagnosis of disease that does not need treatment than the traditional systematic biopsy.
AB - Context: Magnetic resonance imaging (MRI)-targeted prostate biopsy (MRI-TB) may be an alternative to systematic biopsy for diagnosing prostate cancer. Objective: The primary aims of this systematic review and meta-analysis were to compare the detection rates of clinically significant and clinically insignificant cancer by MRI-TB with those by systematic biopsy in men undergoing prostate biopsy to identify prostate cancer. Evidence acquisition: A literature search was conducted using the PubMed, Embase, Web of Science, Cochrane library, and Clinicaltrials.gov databases. We included prospective and retrospective paired studies where the index test was MRI-TB and the comparator test was systematic biopsy. We also included randomised controlled trials (RCTs) if one arm included MRI-TB and another arm included systematic biopsy. The risk of bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 checklist. In addition, the Cochrane risk of bias 2.0 tool was used for RCTs. Evidence synthesis: We included 68 studies with a paired design and eight RCTs, comprising a total of 14 709 men who either received both MRI-TB and systematic biopsy, or were randomised to receive one of the tests. MRI-TB detected more men with clinically significant cancer than systematic biopsy (detection ratio [DR] 1.16 [95% confidence interval {CI} 1.09–1.24], p < 0.0001) and fewer men with clinically insignificant cancer than systematic biopsy (DR 0.66 [95% CI 0.57–0.76], p < 0.0001). The proportion of cores positive for cancer was greater for MRI-TB than for systematic biopsy (relative risk 3.17 [95% CI 2.82–3.56], p < 0.0001). Conclusions: MRI-TB is an attractive alternative diagnostic strategy to systematic biopsy. Patient summary: We evaluated the published literature, comparing two methods of diagnosing prostate cancer. We found that biopsies targeted to suspicious areas on magnetic resonance imaging were better at detecting prostate cancer that needs to be treated and avoiding the diagnosis of disease that does not need treatment than the traditional systematic biopsy.
KW - MRI-targeted biopsy
KW - systematic biopsy
KW - prostate cancer
KW - diagnosis
KW - clinically significant
KW - clinically insignificant
KW - meta-analysis
KW - systematic review
KW - Systematic review
KW - Clinically insignificant
KW - Systematic biopsy
KW - Meta-analysis
KW - Clinically significant
KW - Magnetic resonance imaging-targeted biopsy
KW - Diagnosis
KW - Prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85065969999&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2019.04.043
DO - 10.1016/j.eururo.2019.04.043
M3 - Article
SN - 0302-2838
VL - 76
SP - 284
EP - 303
JO - European urology
JF - European urology
IS - 3
ER -
