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MRI-GUIDED PROSTATE BIOPSY HAS IMPROVED ACCURACY COMPARED WITH RANDOM SAMPLING FOR PATIENTS WITH A SUSPICIOUS MPMRI UNDERGOING ACTIVE SURVEILLANCE OF PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Introdução, Material, Método, Resultados, Discussão e Conclusões
Purpose: This meta-analysis interposes the accuracy of upgrading to clinically significant prostate cancer by multiparametric magnetic resonance imaging–targeted biopsy and systematic biopsy, then compares the results with the combined method during active surveillance.
Materials and Methods: We searched Medline, Embase, Cochrane CENTRAL, Web of Science, Scopus, and LILACS to July 2019 for single-arm comparative, retrospective/prospective paired cohort, and randomized clinical trials with paired comparisons. The target population was those low-risk prostate cancer cases in active surveillance with at least 1 index lesion on imaging. We applied the Quality Assessment of Diagnostic Accuracy Studies-2 score to evaluate the quality of evidence. We measured the area under the curve difference between groups in a 2-tailed method. Finally, we compared and determined the positive predictive value of the best single method and of the combined biopsy.
Results: Seven studies with 814 patients were included in the meta-analysis. The pooled sensitivity for the 2 groups was 0.79 (95% CI, 0.74-0.83; I²=75%; P=.001) and 0.67 (95% CI, 0.65-0.70; I² = 80.5%; P< .001), respectively. The area under the curve for the 2 groups was 0.99 × 0.919 (P<.001). Both groups presented a 98.3% positive predictive value (detection rate: 36.9% × 44.5%; positive likelihood ratio: 98.781 × 73.01, respectively).
Conclusions: Evidence suggests that patients with low-risk prostate cancer on active surveillance can undergo multiparametric magnetic resonance imaging–targeted biopsy alone with better results compared with systematic sampling alone.
prostate cancer; diagnosis; target biopsy; systematic biopsy; upgrading
Câncer de Próstata Localizado
FACULDADE DE MEDICINA DO ABC - Sao Paulo - Brasil, INSTITUT MUTUALISTE MONTSOURIS - - França
WILLY BACCAGLINI, FELIPE PLACCO ARAÚJO GLINA, CRISTIANO LINCK PAZETO, LUIS GUILLERMO MEDINA, FERNANDO KORKES, WANDERLEY MARQUES BERNARDO, RENE SOTELO, XAVIER CATHELINEAU, RAFAEL SANCHEZ SALAS, SIDNEY GLINA