Micro-Ultrasound-guided Versus Multiparametric Magnetic Resonance Imaging-Targeted Biopsy in the Detection of Prostate Cancer: A Systematic Review and Meta-Analysis
Menée à partir d'une revue systématique de la littérature (18 études), cette méta-analyse compare la performance, du point de vue du taux de détection des cancers de la prostate, de deux techniques de biopsie, l'une guidée par micro-ultrasons et l'autre ciblée par IRM multiparamétrique
Purpose: Micro-ultrasound is a novel, high-resolution, ultrasound technology, aiming to improve prostate imaging and, consequently, the diagnostic accuracy of ultrasound-guided prostate biopsy (PB). Micro-ultrasound-guided PB may present comparable detection rates to, the standard of care, multiparametric magnetic resonance imaging (mpMRI)-targeted PB for the diagnosis of clinically significant prostate cancer (PCa). We aimed to compare the detection rate of micro-ultrasound versus mpMRI-targeted PB for PCa diagnosis.
Materials and Methods: We performed a systematic review and meta-analysis of diagnostic accuracy studies comparing micro-ultrasound-guided PB to mpMRI-targeted PB as a reference standard test (PROSPERO ID: CRD42020198326). Records were identified by searching in PubMed, Scopus and Cochrane Library databases, as well as in potential sources of grey literature until November 30th, 2020.
Results: We included 18 studies in the qualitative and 13 in the quantitative synthesis. In the quantitative synthesis, 1125 participants received micro-ultrasound-guided, followed by mpMRI-targeted and systematic PB. Micro-ultrasound and mpMRI-targeted PBs displayed similar detection rates across all PCa grades. The pooled detection ratio for ISUP Grade Group (GG)
≥
2 PCa was 1.05 (95%CI: 0.93–1.19, I2=0%), 1.25 (95%CI: 0.95–1.64, I2=0%) for GG
≥
3 and 0.94 (95%CI: 0.73–1.22, I2=0%) for clinically insignificant (GG=1) PCa. The overall detection ratio for PCa was 0.99 (95%CI: 0.89–1.11, I2=0%).
Conclusions: Micro-ultrasound-guided PB provides comparable detection rates for PCa diagnosis with the mpMRI-guided PB. Therefore, it could be considered as an attractive alternative to mpMRI-targeted PB. Nevertheless, high quality randomized trials are warranted to corroborate our findings.
Journal of Urology , article en libre accès, 2020