Elsevier

European Urology

Volume 67, Issue 6, June 2015, Pages 1112-1121
European Urology

Review – Prostate Cancer
Use of the Prostate Imaging Reporting and Data System (PI-RADS) for Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: A Diagnostic Meta-analysis

https://doi.org/10.1016/j.eururo.2014.10.033Get rights and content

Abstract

Context

In 2012, an expert panel of the European Society of Urogenital Radiology (ESUR) published the Prostate Imaging Reporting and Data System (PI-RADS) for prostate cancer (PC) detection with multiparametric magnetic resonance imaging (mp-MRI). Since then, many centers have reported their experiences.

Purpose

To review the diagnostic accuracy of PI-RADS for PC detection with mp-MRI.

Evidence acquisition

We searched Medline and Embase up to March 20, 2014. We included diagnostic accuracy studies since 2012 that used PI-RADS with mp-MRI for PC detection in men, using prostatectomy or biopsy as the reference standard. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool by two independent reviewers. Data necessary to complete 2 × 2 contingency tables were obtained from the included studies, and test characteristics including sensitivity and specificity were calculated. Results were pooled and plotted in a summary receiver operating characteristics plot.

Evidence synthesis

Fourteen studies (1785 patients) could be analyzed. The pooled data showed sensitivity of 0.78 (95% confidence interval [CI] 0.70–0.84) and specificity of 0.79 (95% CI 0.68–0.86) for PC detection, with negative predictive values ranging from 0.58 to 0.95. Sensitivity analysis revealed pooled sensitivity of 0.82 (95% CI 0.72–0.89) and specificity of 0.82 (95% CI 0.67–0.92) in studies with correct use of PI-RADS (ie, clear description in the methodology and no adjustment of criteria). For studies with a less strict or adjusted use of PI-RADS criteria, or unclear description of the methodology, had pooled sensitivity of 0.73 (95% CI 0.62–0.82) and specificity of 0.75 (95% CI 0.61–0.84).

Conclusions

In patients for whom PC is suspected, PI-RADS appears to have good diagnostic accuracy in PC detection, but no recommendation regarding the best threshold can be provided because of heterogeneity.

Patient summary

Pooling of results from all previous studies that used a relatively new 5-point scoring system for prostate magnetic resonance imaging showed that this scoring system appears to be able to detect prostate cancer accurately.

Introduction

Prostate cancer (PC) is the most common noncutaneous malignancy in men in Western countries; in 2011, 903 500 new cases and 258 400 deaths were recorded worldwide [1]. Multiparametric magnetic resonance imaging (mp-MRI) is increasingly being used for PC diagnosis because of its growing availability, advances that combine anatomic and functional data, and the increasing number of studies confirming its diagnostic reliability for PC detection [2], [3], [4], [5], [6], [7]. However, mp-MRI is not utilized in daily clinical practice everywhere. Widespread acceptance of mp-MRI of the prostate was hampered by a lack of standard diagnostic criteria for reporting of results. This lack of a standardized reporting method led to substantial variability in interpretation. Radiologists used different types of Likert scale to characterize their level of suspicion of the presence of PC, which was generally based on the overall impression of the radiologist [8]. To standardize the evaluation and reporting of prostate MRI, the European Society of Urogenital Radiology (ESUR) published guidelines based on expert consensus in 2012, termed the Prostate Imaging Reporting and Data System (PI-RADS) [9]. These guidelines provide explicit criteria for single-modality scores (Supplementary Table 1) and are the first attempt to standardize prostate MRI. Since then, several studies using PI-RADS with mp-MRI have been published. However, the accuracy of this scoring system has not been studied systematically. Our aim was therefore to assess the diagnostic accuracy of mp-MRI using PI-RADS as a reporting system for PC detection in men, using prostatectomy or biopsy as the reference standard.

Section snippets

Literature search

We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception up to March 20, 2014 for studies evaluating the diagnostic value of PI-RADS in diagnosing PC. The search query combined synonyms for prostate cancer with synonyms for magnetic resonance imaging and synonyms for PI-RADS or scoring system (see Appendix A for the complete search strategy). We also performed a reference and related article search. Duplicate articles were manually

Literature search and study selection

Our search yielded 1498 unique publications (Fig. 1). Of these publications, 192 full-text articles were reviewed for eligibility, of which 178 were excluded. Studies were excluded because they only reported on PC staging (n = 52), were review articles (n = 7), or were irrelevant to the review question (n = 4). In addition, 109 articles on PC detection did not use the PI-RADS classification, and six studies using PI-RADS did not report on diagnostic accuracy or provided insufficient data for 2 × 2

Conclusions

Pooled data from all included studies that used the PI-RADS with mp-MRI showed sensitivity of 0.78 and specificity of 0.79 for PC detection. Therefore, it can be concluded that PI-RADS appears to have good diagnostic accuracy in PC detection. However, no recommendations can be made regarding the use of a threshold because of study heterogeneity.

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