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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Magnetic resonance image in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer: a systematic review of literature and meta-analysis

RC Silva, AD Sasse, WE Matheus, and U Ferreira.

Review published: 2013.

Link to full article: [Journal publisher]

CRD summary

This review concluded that there were very few good studies evaluating magnetic resonance imaging, using 1.5 tesla conventional images, in patients with prostate cancer due to receive radical prostatectomy, and there was significant variation across studies. The review had several reporting limitations, but its cautious conclusions are likely to be appropriate.

Authors' objectives

To evaluate magnetic resonance imaging (MRI) with endorectal coil for diagnosing prostate cancer, and for evaluating extra-prostatic extension and involvement of seminal vesicles.

Searching

EMBASE, LILACS, PubMed and The Cochrane Library were searched, with no language restrictions, for studies published after 2008; a search strategy was reported.

Study selection

Studies of patients diagnosed with prostate cancer following biopsy, and with an indication for radical prostatectomy (with no previous treatment) were eligible. All patients had to receive MRI (with conventional 1.5 tesla images) before radical prostatectomy. Histopathology after prostatectomy had to be the reference standard, and sufficient data had to be reported to calculate sensitivity and specificity.

In most studies patients received open radical prostatectomy; in one study they received robot-assisted surgery. Where reported, the patients' prostate-specific antigen levels ranged from 5.3 to 10.8 nanograms per decilitre. Mean patient age ranged from 59 to 66 years. All but one of the studies were published between 2010 and 2011. No study was set in the UK; the locations varied.

Two reviewers independently selected studies.

Assessment of study quality

Study quality was assessed using QUADAS. The authors did not state how many reviewers performed the assessments.

Data extraction

The data were extracted to calculate the sensitivity, specificity and diagnostic odds ratios, with 95% confidence intervals. Two reviewers independently extracted the data, with disagreements resolved by a third reviewer.

Methods of synthesis

Sensitivity, specificity and diagnostic odds ratios were pooled separately using meta-analysis; the type of model used was not always stated. Heterogeneity was evaluated using Cochran's Q and Ι². Summary receiver operating characteristic curves were generated; the methods were not stated.

The authors stated that publication bias was assessed in funnel plots, but it seems that forest plots were used.

Results of the review

Seven studies (603 patients; range 23 to 190) were included. Only two studies were conducted prospectively. Few results of the QUADAS were presented; in some studies the histopathology assessments were made with prior knowledge of the MRI results.

For diagnosing prostate cancer (six studies) the pooled sensitivity was 65% (95% CI 61 to 68; Ι²=86%) and the specificity was 58% (95% CI 51 to 64; Ι²=80%). The area under the summary receiver operating characteristic curve was 0.71.

For extra-prostatic extension (three studies) the pooled sensitivity was 49% (95% CI 40 to 58; Ι²=88%) and the specificity was 82% (95% CI 77 to 86; Ι²=0). The area under the curve was 0.93.

For invasion of seminal vesicles (three studies) the pooled sensitivity was 45% (95% CI 31 to 60; Ι²=80%) and the specificity was 96% (95% CI 93 to 98; Ι²=78%). The area under the curve was 0.92.

Authors' conclusions

There were very few good studies, with significant variation. MRI had low sensitivity and specificity for the diagnosis and staging of prostate cancer. The best results were for the specificity for involvement of seminal vesicles.

CRD commentary

The review addressed a clear question, and was supported by reproducible eligibility criteria. Several relevant databases were searched for studies in any language, but some relevant studies may have been missed since unpublished studies were not sought. No reason was given for seeking studies published after 2008. Duplicate processes were used to reduce the risk of reviewer error and bias, except they were not reported for the assessment of study quality.

Study quality was evaluated using the QUADAS, but very few results were reported, meaning it was not possible to evaluate the likely reliability of each study's results. The results were pooled in meta-analyses, but separate pooling of sensitivity and specificity is not generally recommended, and the results from the summary receiver operating characteristic curves may be more reliable. Not all the methods were clearly reported. Possible sources of variation were discussed.

The review had several reporting limitations, but its cautious conclusions are likely to be appropriate.

Implications of the review for practice and research

Practice: The authors stated that 1.5T MRI should not be routinely used for all patients with prostate cancer. It should be used as a complementary method for diagnosis and staging for specific patients.

Research: The authors stated that more studies evaluating new technologies, such as 3T MRI, and multiple parameters (diffusion, perfusion and spectroscopy) were needed before recommending the routine use of MRI.

Funding

Not stated.

Bibliographic details

Silva RC, Sasse AD, Matheus WE, Ferreira U. Magnetic resonance image in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer: a systematic review of literature and meta-analysis. International Brazilian Journal of Urology 2013; 39(2): 155-166. [PubMed: 23683681]

Indexing Status

Subject indexing assigned by NLM

MeSH

Humans; Magnetic Resonance Imaging /methods; Male; Prostate /pathology; Prostatectomy; Prostatic Neoplasms /pathology /surgery; Seminal Vesicles /pathology; Sensitivity and Specificity

AccessionNumber

12013029203

Database entry date

03/01/2014

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 23683681

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