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