The value of magnetic resonance imaging and ultrasonography (MRI/US)‐fusion biopsy platforms in prostate cancer detection: a systematic review
- 28 August 2015
- journal article
- review article
- Published by Wiley in BJU International
- Vol. 117 (3), 392-400
- https://doi.org/10.1111/bju.13247
Abstract
Despite limitations considering the presence, staging and aggressiveness of prostate cancer, ultrasonography (US)-guided systematic biopsies (SBs) are still the 'gold standard' for the diagnosis of prostate cancer. Recently, promising results have been published for targeted prostate biopsies (TBs) using magnetic resonance imaging (MRI) and ultrasonography (MRI/US)-fusion platforms. Different platforms are USA Food and Drug Administration registered and have, mostly subjective, strengths and weaknesses. To our knowledge, no systematic review exists that objectively compares prostate cancer detection rates between the different platforms available. To assess the value of the different MRI/US-fusion platforms in prostate cancer detection, we compared platform-guided TB with SB, and other ways of MRI TB (cognitive fusion or in-bore MR fusion). We performed a systematic review of well-designed prospective randomised and non-randomised trials in the English language published between 1 January 2004 and 17 February 2015, using PubMed, Embase and Cochrane Library databases. Search terms included: 'prostate cancer', 'MR/ultrasound(US) fusion' and 'targeted biopsies'. Extraction of articles was performed by two authors (M.G. and A.A.) and were evaluated by the other authors. Randomised and non-randomised prospective clinical trials comparing TB using MRI/US-fusion platforms and SB, or other ways of TB (cognitive fusion or MR in-bore fusion) were included. In all, 11 of 1865 studies met the inclusion criteria, involving seven different fusion platforms and 2626 patients: 1119 biopsy naïve, 1433 with prior negative biopsy, 50 not mentioned (either biopsy naïve or with prior negative biopsy) and 24 on active surveillance (who were disregarded). The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of included articles. No clear advantage of MRI/US fusion-guided TBs was seen for cancer detection rates (CDRs) of all prostate cancers. However, MRI/US fusion-guided TBs tended to give higher CDRs for clinically significant prostate cancers in our analysis. Important limitations of the present systematic review include: the limited number of included studies, lack of a general definition of 'clinically significant' prostate cancer, the heterogeneous study population, and a reference test with low sensitivity and specificity. Today, a limited number of prospective studies have reported the CDRs of fusion platforms. Although MRI/US-fusion TB has proved its value in men with prior negative biopsies, general use of this technique in diagnosing prostate cancer should only be performed after critical consideration. Before bringing MRI/US fusion-guided TB in to general practice, there is a need for more prospective studies on prostate cancer diagnosiKeywords
Funding Information
- Astellas Pharma US
This publication has 35 references indexed in Scilit:
- Critical Evaluation of Magnetic Resonance Imaging Targeted, Transrectal Ultrasound Guided Transperineal Fusion Biopsy for Detection of Prostate CancerJournal of Urology, 2013
- Targeted MRI-guided Prostate Biopsies for the Detection of Prostate Cancer: Initial Clinical Experience With Real-time 3-Dimensional Transrectal Ultrasound Guidance and Magnetic Resonance/Transrectal Ultrasound Image FusionUrology, 2013
- ESUR prostate MR guidelines 2012European Radiology, 2012
- Combined Multiparametric MRI and Targeted Biopsies Improve Anterior Prostate Cancer Detection, Staging, and GradingUrology, 2011
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- The Epstein Criteria Predict for Organ-Confined But Not Insignificant Disease and a High Likelihood of Cure at Radical ProstatectomyEuropean Urology, 2010
- Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?Journal of Urology, 2010
- Magnetic Resonance Imaging Guided Prostate Biopsy in Men With Repeat Negative Biopsies and Increased Prostate Specific AntigenJournal of Urology, 2009
- Serial Biopsy Results in Prostate Cancer Screening StudyJournal of Urology, 2002
- PROSPECTIVE EVALUATION OF PROSTATE CANCER DETECTED ON BIOPSIES 1, 2, 3 AND 4: WHEN SHOULD WE STOP?Journal of Urology, 2001