Context

Magnetic resonance imaging (MRI), with or without MRI-targeted biopsy (MRI pathway), is an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of having prostate cancer. At present, evidence on which test to use is insufficient to inform detailed evidence-based decision making.

Objective

To determine the diagnostic accuracy of the index tests MRI only, MRI-targeted biopsy, MRI pathway, and systematic biopsy, as compared with template-guided biopsy (reference standard), in detecting clinically significant prostate cancer, defined as International Society of Urological Pathology grade 2 or higher, in biopsy-naive men or those with a prior-negative biopsy (or mix of both).

Evidence acquisition

We systematically searched the literature and considered for inclusion any cross-sectional study if it investigated (1) one or more index tests verified by the reference standard, and (2) paired testing of the MRI pathway with systematic biopsy. Quality and certainty of evidence were assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Grading of Recommendations Assessment, Development and Evaluation, respectively.

Evidence synthesis

Accuracy analyses: Using a baseline cancer prevalence of 30%, MRI pathway (sensitivity 0.72 [95% confidence interval {CI}: 0.60–0.82]; specificity 0.96 [0.94–0.98]; eight studies) may result in 216 (180–246) true positives, 28 (14–42) false positives, 672 (658–686) true negatives, and 84 (54–120) false negatives per 1000 men. Systematic biopsy (sensitivity 0.63 [0.19–0.93]; specificity 1.00 [0.91–1.00]; four studies) may result in 189 (57–279) true positives, 0 (0–63) false positives, 700 (637–700) true negatives, and 111 (21–243) false negatives per 1000 men. Agreement analyses: With a direct comparison of the MRI pathway with systematic biopsy concerning significant disease, we found pooled detection ratios of 1.05 (95% CI: 0.95–1.16; 20 studies) in biopsy-naive men and 1.44 (1.19–1.75; 10 studies) in men with a prior-negative biopsy. Concerning insignificant disease, we found detection ratios of 0.63 (95% CI: 0.54–0.74), and 0.62 (95% CI: 0.44–0.88), respectively.

Conclusions

MRI pathway had the most favourable outcome in significant and insignificant prostate cancer detection compared with systematic biopsy. The certainty in our findings was reduced by study limitations.

Patient summary

We reviewed recent advances in prostate biopsy by magnetic resonance imaging (MRI) guidance and targeting for prostate cancer detection in comparison with standard diagnosis by systematic biopsies. The findings of this Cochrane review suggest that MRI pathway is better than systematic biopsies in making a correct diagnosis of clinically important prostate cancer and reducing redundant biopsies and the detection of unimportant cancers substantially. However, MRI pathway still misses some men with important prostate cancer. Therefore, further research in this area is important.

中文翻译：

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前列腺磁共振成像，有或没有以磁共振成像为目标的活检以及用于检查前列腺癌的系统活检：Cochrane系统评价和荟萃分析。

语境

在怀疑患有前列腺癌的男性中，进行或不进行MRI靶向活检（MRI通路）的磁共振成像（MRI）是系统经直肠超声引导下活检的另一种测试方法。目前，关于使用哪种测试的证据不足以为基于证据的详细决策提供依据。

客观的

为了确定仅通过MRI，针对MRI的活检，MRI通路和系统活检与模板引导的活检（参考标准）相比，指标测试在诊断临床上有意义的前列腺癌中的诊断准确性，定义为国际泌尿外科病理学学会初次活检或先前活检阴性（或两者兼有）的男性达到2级或更高级别。

取证

我们系统地检索了文献，并考虑是否包括任何横断面研究，如果它调查了（1）一种或多种通过参考标准验证的指标测试，以及（2）MRI通路与系统活检的配对测试。分别通过诊断准确性研究的质量评估（QUADAS-2）和建议评估，发展和评估的等级来评估证据的质量和确定性。

证据综合

准确性分析：使用30％的基线癌症患病率，MRI通路（敏感性0.72 [95％置信区间{CI}：0.60-0.82]；特异性0.96 [0.94-0.98]；八项研究）可能会导致216（180-246） ）每1000名男性中有正阳性，28（14-42）个假阳性，672（658-686）个真阴性和84（54-120）个假阴性。系统活检（敏感性0.63 [0.19-0.93]；特异性1.00 [0.91-1.00]；四项研究）可能会导致189（57-279）个真实阳性，0（0-63）个假阳性，700（637-700）个真实底片和每1000名男性中有111（21–243）个假底片。协议分析：通过将MRI通路与针对重大疾病的系统活检进行直接比较，我们发现未进行活检的男性合并检出率为1.05（95％CI：0.95-1.16； 20个研究），而合并检出率为1.44（1.19-1.75； 10个研究）。活检阴性的男性。关于微不足道的疾病，我们发现检出率分别为0.63（95％CI：0.54-0.74）和0.62（95％CI：0.44-0.88）。

结论

与系统活检相比，MRI通路在前列腺癌的显着和微不足道的检测中具有最有利的结果。研究局限性降低了我们发现的确定性。

病人总结

我们回顾了通过磁共振成像（MRI）指导和靶向前列腺癌检测的前列腺穿刺活检的最新进展，以及通过系统活检的标准诊断。这项Cochrane综述的结果表明，在正确诊断临床上重要的前列腺癌，减少重复的活检和实质上不重要的癌症的检测方面，MRI通路优于系统的活检。但是，MRI通路仍然错过了一些患有重要前列腺癌的男性。因此，在这一领域的进一步研究很重要。