Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis.
Author(s): Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG
Publication: Eur Urol, 2015, Vol. 68, Page 438-50
PubMed ID: 25480312 PubMed Review Paper? No
Purpose of Paper
This paper reviewed 16 reports comparing the sensitivity of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS)-guided biopsies for prostate cancer diagnosis and investigated the effects of prior biopsy and MRI-navigation method.
Conclusion of Paper
Although MRI and TRUS-guided biopsies had comparable sensitivity for prostate cancer, MRI-guided biopsies had a significantly greater sensitivity for high-risk prostate cancer and lower sensitivity for insignificant prostate cancer. When only men with a previous negative biopsy were considered, MRI-guided biopsies became more sensitive than TRUS-guided biopsies for prostate cancer diagnosis. The method of MRI navigation had no effect on the detection of prostate cancer. MRI-in bore and MRI-fusion but not MRI-visual demonstrated higher sensitivity for diagnosis of high-risk prostate cancer than TRUS; however, the sensitivity of the various MRI-guided methods was similar and the sensitivity of TRUS was high in the studies using visual navigation of the MRI.
Studies
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Study Purpose
This study reviewed 16 reports comparing the sensitivity of MRI- and TRUS- guided prostate biopsies for prostate cancer and investigated the effects of prior biopsy and MRI-navigation method. The authors included 16 studies comparing results of matched MRI-guided and TRUS-guided (without MRI input) biopsies obtained from both lobes. Data from a total of 1926 patients were included of whom 59% had prostate cancer.
Summary of Findings:
MRI and TRUS-guided biopsies had comparable sensitivity for prostate cancer (85% and 81%, respectively); however, MRI-guided biopsies had a significantly greater sensitivity for high-risk prostate cancers (91% versus 76%) but lower sensitivity for insignificant prostate cancer (44% versus 83%). The overall rate of concordance of MRI and TRUS-guided biopsies was 65% for a prostate cancer diagnosis and 66% for a high-risk cancer diagnosis, but only 35% for insignificant prostate cancer. In men with a previously negative biopsy, MRI-guided biopsies were more sensitive than TRUS-guided biopsies for prostate cancer (88% versus 54%) or high-risk prostate cancer (87% versus 56%) but not insignificant prostate cancer (32% versus 68%). There was no effect of MRI navigation method on the detection of prostate cancer, but detection of significant cancer was only higher in MRI-fusion (89% versus 67%) or MRI-in-bore (90% versus 72%) biopsies and not MRI-visual biopsies (95% versus 91%) compared to matched TRUS-guided biopsies. It is interesting to note that the difference in findings between MRI-navigation methods wre a result of differences in the sensitivity of TRUS and not a difference in the sensitivity of the navigation methods.
Biospecimens
Preservative Types
- Formalin
Diagnoses:
- Neoplastic - Benign
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform Morphology Light microscopy Morphology H-and-E microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Preaquisition Prognostic factor First biopsy
Prior negative biopsy
Biospecimen Acquisition Method of tissue acquisition Magnetic resonance imaging-guided biopsy
Ultrasound-guided biopsy
Multiple targeting methods compared