Introduction: Systematic sampling helps to avoid clinically significant prostate cancer misdiagnosis and leads to more accurate prostate mapping. However, the ideal pathway differs by scenario (biopsy naïve vs repeat biopsy). Therefore, our aim was to compare the accuracy of clinically significant prostate cancer diagnosis by magnetic resonance imaging–targeted biopsy vs systematic biopsy in men suspected of having prostate cancer because of elevated prostate-specific antigen or abnormal digital rectal examination in both scenarios independently.
Methods: Searches were conducted on primary bases MedLine, Cochrane Central, Embase, Web of Science, Scopus and Lilacs through the Biblioteca Virtual em Saúde (BVS). We included comparative studies with a single arm, retrospective or prospective paired cohorts, and randomized clinical trials that included one arm that met the eligibility criteria—paired comparison among patients with a suspicious lesion on magnetic resonance imaging scan where they themselves are their control. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) score was applied to evaluate the quality of evidence. The area under curve difference significance of both groups (summary receiver operating characteristic/SROC curves) was calculated in a two-tailed method. Finally, the positive predictive value (PPV) of the best single method based on SROC curves (TB-MRI or SB) as well as of the CB were calculated and compared.
Results: We included 45 studies with 8,560 patients in the final analysis. In the biopsy-naïve scenario, pooled sensitivity for the magnetic resonance imaging–targeted biopsy and systematic biopsy groups was 0.88 (95% CI, 0.86-0.89; I²=88.9%; P<.001) and 0.76 (95% CI, 0.74-0.78; I²=79.9%; P<.001), respectively. The area under the summary receiver operating characteristic curve for the 2 groups was 0.998 × 0.987 (P<.001). In the repeat biopsy scenario, pooled sensitivity for the groups was 0.84 (95% CI, 0.81-0.86; I²=77%; P<.001) and 0.67 (95% CI, 0.65-0.70; I²=80.5%; P<.001), respectively. The area under the SROC curve for the 2 groups was 0.991 × 0.972 (P<.001).
Conclusions: Magnetic resonance imaging–targeted biopsy found more clinically significant disease than systematic biopsy in patients with suspected prostate cancer in both scenarios. Source of
