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Meta-Analysis
. 2021 Feb 1;94(1118):20191050.
doi: 10.1259/bjr.20191050. Epub 2020 Oct 22.

Impact of PI-RADS Category 3 lesions on the diagnostic accuracy of MRI for detecting prostate cancer and the prevalence of prostate cancer within each PI-RADS category: A systematic review and meta-analysis

Akshay Wadera  1 , Mostafa Alabousi  1 , Alex Pozdnyakov  2 , Mohammed Kashif Al-Ghita  3 , Ali Jafri  4 , Matthew Df McInnes  5   6 , Nicola Schieda  6 , Christian B van der Pol  7 , Jean-Paul Salameh  8 , Lucy Samoilov  1 , Kaela Gusenbauer, Abdullah Alabousi  9
Affiliations
Meta-Analysis

Impact of PI-RADS Category 3 lesions on the diagnostic accuracy of MRI for detecting prostate cancer and the prevalence of prostate cancer within each PI-RADS category: A systematic review and meta-analysis

Akshay Wadera et al. Br J Radiol. .

Abstract

Objective: To evaluate Prostate Imaging Reporting and Data System (PI-RADS) category 3 lesions' impact on the diagnostic test accuracy (DTA) of MRI for prostate cancer (PC) and to derive the prevalence of PC within each PI-RADS category.

Methods: MEDLINE and Embase were searched until April 10, 2020 for studies reporting on the DTA of MRI by PI-RADS category. Accuracy metrics were calculated using a bivariate random-effects meta-analysis with PI-RADS three lesions treated as a positive test, negative test, and excluded from the analysis. Differences in DTA were assessed utilizing meta-regression. PC prevalence within each PI-RADS category was estimated with a proportional meta-analysis.

Results: In total, 26 studies reporting on 12,913 patients (4,853 with PC) were included. Sensitivities for PC in the positive, negative, and excluded test groups were 96% (95% confidence interval [CI] 92-98), 82% (CI 75-87), and 95% (CI 91-97), respectively. Specificities for the positive, negative, and excluded test groups were 33% (CI 23-44), 71% (CI 62-79), and 52% (CI 37-66), respectively. Meta-regression demonstrated higher sensitivity (p < 0.001) and lower specificity (p < 0.001) in the positive test group compared to the negative group. Clinically significant PC prevalences were 5.9% (CI 0-17.1), 11.4% (CI 6.5-17.3), 24.9% (CI 18.4-32.0), 55.7% (CI 47.8-63.5), and 81.4% (CI 75.9-86.4) for PI-RADS categories 1, 2, 3, 4 and 5, respectively.

Conclusion: PI-RADS category 3 lesions can significantly impact the DTA of MRI for PC detection. A low prevalence of clinically significant PC is noted in PI-RADS category 1 and 2 cases.

Advances in knowledge: Inclusion or exclusion of PI-RADS category 3 lesions impacts the DTA of MRI for PC detection.

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Conflict of interest statement

Competing interests: None to declare

Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Forest plots of the pooled sensitivity (i) and specificity (ii) in using PI-RADS Categoryto predict PC. Forest plots demonstrating PI-RADS three threshold as (A) positive, (B) negative, and (C) excluded. PI-RADS, Prostate Imaging Reporting and Data System.
Figure 3.
Figure 3.
SROC curves for the diagnostic performance of PI-RADS using PI-RADS 3 threshold as (A) positive, (B) negative, and (C) excluded. PT: positive test; NT: negative test; ET: excluded test. PI-RADS, Prostate Imaging Reporting and Data System; SROC, summary receiver operating characteristic
Figure 4.
Figure 4.
Forest plots and estimates of PC prevalence for the following categories: (A) PI-RADS 1; (B) PI-RADS 2; (C) combined PI-RADS 1 and 2; (D) PI-RADS 3; (E) PI-RADS 4; and (F) PI-RADS 5. PC, prostate cancer; Pi-RADS, Prostate Imaging Reporting and Data System.
Figure 5.
Figure 5.
Flow diagram with stratification of patients/lesions by PI-RADS category. mpMRI: multiparametric MRI; PC: prostate cancer; PI-RADS: Prostate Imaging Reporting and Data System.
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References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;. ; 68: 394–424 2018. doi: 10.3322/caac.21492 - DOI - PubMed
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;. ; 66: 7–30 2007. doi: 10.3322/caac.21332 - DOI - PubMed
    1. Heijnsdijk EAM, Bangma CH, Borràs JM, de Carvalho TM, Castells X, Eklund M, et al. . Summary statement on screening for prostate cancer in Europe. Int J Cancer 2018; 142: 741–6. doi: 10.1002/ijc.31102 - DOI - PubMed
    1. Mulhem E, Beaumont W, Heights S, Fulbright MN, Hospital P, Lyon S, et al. . Prostate cancer screening. 2015;.
    1. Gleason DF. Histologic grading of prostate cancer: a perspective. Hum Pathol 1992; 23: 273–9. doi: 10.1016/0046-8177(92)90108-F - DOI - PubMed

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