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Meta-Analysis
. 2022 Dec 23;101(51):e32404.
doi: 10.1097/MD.0000000000032404.

Contrast-enhanced ultrasound targeted versus conventional ultrasound guided systematic prostate biopsy for the accurate diagnosis of prostate cancer: A meta-analysis

Ming Zhang  1 , Qingsong Meng  1 , Lulu Feng  2 , Dongbin Wang  1 , Changbao Qu  1 , Hui Tian  3 , Jianghua Jia  1 , Qinglu Gao  1 , Xin Wang  1
Affiliations
Meta-Analysis

Contrast-enhanced ultrasound targeted versus conventional ultrasound guided systematic prostate biopsy for the accurate diagnosis of prostate cancer: A meta-analysis

Ming Zhang et al. Medicine (Baltimore). .

Abstract

Background: Conventional transrectal ultrasonography (TRUS) guided prostate biopsy is the standard method for accurate diagnosis of prostate cancer (PCa). However, the limitations of this technique in terms of missed diagnosis cannot be ignored. Based on previous studies, contrast-enhanced ultrasound (CEUS) may be able to more distinctly detect malignant lesions with increased microvessels. Therefore, to evaluate the diagnostic efficiency and clinical application prospects of CEUS-guided prostate biopsy for patients with suspected PCa, we performed a meta-analysis comparing CEUS-targeted with TRUS-guided systematic biopsy.

Methods: A systematic search of PubMed, Web of Science, Embase and CNKI was performed up to March, 2022 for the relevant published studies. After data extraction and quality assessment, meta-analysis was performed using the RevMan 5.3 software.

Results: The results showed that the overall sensitivity was higher for CEUS targeted biopsy than systematic biopsy (P = .03), so was the accuracy (P = .03). However, significant heterogeneity and inconsistent results from certain subgroup analyses challenged the validity of the results. Meanwhile, CEUS yielded a much higher sensitivity in patients with prostate specific antigen (PSA) level of 4 to 10 ng/mL (P = .007). On the other hand, the positive rate of each core (P < .001) and the detection rate of clinically significant PCa (P = .006) were significantly improved using CEUS.

Conclusion: CEUS showed the advantage of a higher detection rate of clinically significant PCa, which might provide more specific indications for subsequent treatment. More feasible, real-time data are required to confirm our findings.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flowchart showing the selection of studies for meta-analysis.
Figure 2.
Figure 2.
Forest plot and meta-analysis of diagnostic sensitivity comparing CEUS targeted with TRUS guided systematic biopsy. CEUS = contrast-enhanced ultrasound, TRUS = transrectal ultrasonography.
Figure 3.
Figure 3.
Forest plot and meta-analysis of diagnostic sensitivity comparing CEUS targeted with TRUS guided systematic biopsy at different PSA levels. CEUS = contrast-enhanced ultrasound, PSA = prostate specific antigen, TRUS = transrectal ultrasonography.
Figure 4.
Figure 4.
Forest plot and meta-analysis of positive rate of each core comparing CEUS targeted with TRUS guided systematic biopsy. CEUS = contrast-enhanced ultrasound, TRUS = transrectal ultrasonography.
Figure 5.
Figure 5.
Forest plot and meta-analysis of diagnostic specificity comparing CEUS targeted with TRUS guided systematic biopsy. CEUS = contrast-enhanced ultrasound, TRUS = transrectal ultrasonography.
Figure 6.
Figure 6.
Forest plot and meta-analysis of diagnostic accuracy comparing CEUS targeted with TRUS guided systematic biopsy. CEUS = contrast-enhanced ultrasound, TRUS = transrectal ultrasonography.
Figure 7.
Figure 7.
Forest plot and meta-analysis of detection rate of clinical significant PCa comparing CEUS targeted with TRUS guided systematic biopsy. CEUS = contrast-enhanced ultrasound, PCa = prostate cancer, TRUS = transrectal ultrasonography.
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