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Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique?

Abstract

Context

The introduction of magnetic resonance imaging-guided biopsies (MRI-GB) has changed the paradigm concerning prostate biopsies. Three techniques of MRI-GB are available: (1) in-bore MRI target biopsy (MRI-TB), (2) MRI-transrectal ultrasound fusion (FUS-TB), and (3) cognitive registration (COG-TB).

Objective

To evaluate whether MRI-GB has increased detection rates of (clinically significant) prostate cancer (PCa) compared with transrectal ultrasound-guided biopsy (TRUS-GB) in patients at risk for PCa, and which technique of MRI-GB has the highest detection rate of (clinically significant) PCa.

Evidence acquisition

We performed a literature search in PubMed, Embase, and CENTRAL databases. Studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 checklist and START recommendations. The initial search identified 2562 studies and 43 were included in the meta-analysis.

Evidence synthesis

Among the included studies 11 used MRI-TB, 17 used FUS-TB, 11 used COG-TB, and four used a combination of techniques. In 34 studies concurrent TRUS-GB was performed. There was no significant difference between MRI-GB (all techniques combined) and TRUS-GB for overall PCa detection (relative risk [RR] 0.97 [0.90–1.07]). MRI-GB had higher detection rates of clinically significant PCa (csPCa) compared with TRUS-GB (RR 1.16 [1.02–1.32]), and a lower yield of insignificant PCa (RR 0.47 [0.35–0.63]). There was a significant advantage (p = 0.02) of MRI-TB compared with COG-TB for overall PCa detection. For overall PCa detection there was no significant advantage of MRI-TB compared with FUS-TB (p = 0.13), and neither for FUS-TB compared with COG-TB (p = 0.11). For csPCa detection there was no significant advantage of any one technique of MRI-GB. The impact of lesion characteristics such as size and localisation could not be assessed.

Conclusions

MRI-GB had similar overall PCa detection rates compared with TRUS-GB, increased rates of csPCa, and decreased rates of insignificant PCa. MRI-TB has a superior overall PCa detection compared with COG-TB. FUS-TB and MRI-TB appear to have similar detection rates. Head-to-head comparisons of MRI-GB techniques are limited and are needed to confirm our findings.

Patient summary

Our review shows that magnetic resonance imaging-guided biopsy detects more clinically significant prostate cancer (PCa) and less insignificant PCa compared with systematic biopsy in men at risk for PCa.

Take Home Message

Based on this comprehensive review of the literature magnetic resonance imaging (MRI)-guided biopsy had similar overall prostate cancer detection rates compared with transrectal ultrasound-guided biopsy, increased rates of clinically significant cancer, and decreased rates of clinically insignificant cancer. In-bore MRI target biopsy has a superior overall prostate cancer detection compared with cognitively registered target biopsy. MRI-transrectal ultrasound fusion target biopsy and in-bore MRI target biopsy have similar detection rates. The impact of lesion characteristics such as size and localisation could not be assessed.

Keywords: Diagnosis, Image guided biopsy, Meta-analysis, MRI, Prostate cancer, Systematic review.

Footnotes

a Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands

b Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands

c Department of Urology, University Medical Centre Utrecht, The Netherlands

d Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands

e Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands

f Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

Corresponding author. St. Antonius Hospital, Department of Urology, Koekoekslaan 1, Post Office Box 2500, 3430 EM Nieuwegein, The Netherlands. Tel. +31-(0)-88-3202554; Fax: +31-(0)-30-6092680.