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Eur Urol. 2017 Apr;71(4):517-531. doi: 10.1016/j.eururo.2016.07.041. Epub 2016 Aug 25.

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?

Author information

1
Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands. Electronic address: o.wegelin@antoniusziekenhuis.nl.
2
Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.
3
Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
4
Department of Urology, University Medical Centre Utrecht, The Netherlands.
5
Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
6
Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands.
7
Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.

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.

KEYWORDS:

Diagnosis; Image guided biopsy; MRI; Meta-analysis; Prostate cancer; Systematic review

PMID:
27568655
DOI:
10.1016/j.eururo.2016.07.041
[Indexed for MEDLINE]

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