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Meta-Analysis
. 2021 Jul;54(1):103-112.
doi: 10.1002/jmri.27546. Epub 2021 Feb 11.

Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

Kye Jin Park  1 , Sang Hyun Choi  1 , Mi-Hyun Kim  1 , Jeong Kon Kim  1 , In Gab Jeong  2
Affiliations
Meta-Analysis

Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

Kye Jin Park et al. J Magn Reson Imaging. 2021 Jul.

Abstract

Background: The Prostate Imaging Reporting and Data System (PI-RADS) was introduced in 2012 and updated to version 2.1 (v2.1) in early 2019 to improve diagnostic performance and interreader reliability.

Purpose: To evaluate the diagnostic performance of PI-RADS v2.1 in comparison with v2.

Methods: A systematic review and meta-analysis of the literature was performed using MEDLINE, EMBASE, and Cochrane databases to identify studies evaluating the diagnostic performance of PI-RADS v2.1 for diagnosing clinically significant prostate cancer (csPCa).

Study type: Systematic review and meta-analysis.

Subject: One thousand two hundred forty-eight patients with 1406 lesions from 10 eligible articles.

Field strength/sequence: Conventional MR sequences at 1.5 T and 3 T.

Assessment: Two reviewers independently identified and reviewed the original articles reporting diagnostic performance of PI-RADS v2.1.

Statistical tests: Meta-analytic summary sensitivity and specificity were calculated using a bivariate random effects model. Meta-analytic sensitivity and specificity between PI-RADS v2 and v2.1 were compared.

Results: The pooled sensitivity and specificity of PI-RADS v2.1 were 87% (95% confidence intervals, 82-91%) and 74% (63-82%), respectively. In five studies available for a head-to-head comparison between PI-RADS v2.1 and v2, there were no significant differences in either sensitivity (90% [86-94%] vs. 88% [83-93%], respectively) or specificity (76% [59-93%] vs. 61% [39-83%], respectively; P = 0.37). The sensitivity and specificity were 81% (73-87%) and 82% (68-91%), respectively, for a PI-RADS score cutoff of ≥4, and 94% (88-97%) and 56% (35-97%) for ≥3. Regarding the zonal location, the sensitivity and specificity for the transitional zone only were 90% (84-96%) and 76% (62-90%) respectively, whereas for the whole gland they were 85% (79-91%) and 71% (57-85%).

Data conclusion: PI-RADS v2.1 demonstrated good overall performance for the diagnosis of csPCa. PI-RADS v2.1 tended to show higher specificity than v2, but the difference lacked statistical significance.

Level of evidence: 3 TECHNICAL EFFICACY STAGE: 3.

Keywords: PI-RADS; diagnostic performance; prostate; version 2.1.

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References

    1. Padhani AR, Barentsz J, Villeirs G, et al. PI-RADS Steering Committee: The PI-RADS multiparametric MRI and MRI-directed biopsy pathway. Radiology 2019;292:464-474.
    1. EAU Guidelines. Prostate Cancer. Accessed on November 04, 2020. Available from https://uroweb.org/guideline/prostate-cancer/
    1. Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018;378:1767-1777.
    1. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Diagnostic performance of prostate imaging reporting and data system version 2 for detection of prostate cancer: A systematic review and diagnostic meta-analysis. Eur Urol 2017;72:177-188.
    1. Park KJ, Choi SH, Lee JS, Kim JK, Kim MH. Interreader agreement with prostate imaging reporting and data system version 2 for prostate cancer detection: A systematic review and meta-analysis. J Urol 2020;204:661-670.

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