MP24-18 SYSTEMATIC REVIEW AND META-ANALYSIS OF SIGNIFICANT CANCER DETECTION BY MRI-TARGETED BIOPSY COMPARED TO SYSTEMATIC BIOPSY

Abstract

INTRODUCTION AND OBJECTIVES: MRI-targeted biopsy (MRI-TB) is a diagnostic test strategy that serves as an alternative to systematic prostate biopsy. This systematic review aimed to assess the detection rates of clinically significant (CSC) and clinically insignificant cancer (CIC) by MRI-targeted biopsy compared to systematic biopsy in men with suspected prostate cancer. METHODS: A literature search was carried out using Embase, PubMed, Web of Science, Cochrane library and Clinicaltrials.gov databases using search terms including: “biopsy”, “MRI” and “prostate” and variations of these. For inclusion, each paper needed to specify cancer detection rates from the biopsies taken only from MRI suspicious areas. Systematic biopsy included 10 to 12 core ultrasound guided transrectal (TRUS) or transperineal template mapping (TPM) biopsy. The methodological quality of included studies was assessed using a modified QUADAS-2 checklist. CSC was defined as Gleason score 3+4 or greater and CIC as Gleason score 3+3, unless otherwise specified by the study. A detection ratio (DR) was calculated as the proportion of men with the target condition in the MRI-TB arm divided by the proportion in the systematic biopsy arm. A DR > 1 indicated that MRI-TB detected the target condition more frequently than systematic biopsy. For each target condition, DRs were pooled using random effects meta-analysis. Differences between subgroups were formally assessed with univariate meta-regression. RESULTS: More than 7000 studies were screened. For CSC detection, 73 studies (5906 patients) were included. MRI-TB had a higher detection rate for CSC than systematic biopsy (DR, 1.12 [95% CI 1.07-1.18], p <0.001), though meta-regression showed that this depended on the type of systematic biopsy (p=0.053), with MRI-TB performing slightly better compared to TRUS biopsy than compared to TPM biopsy. MRI-TB had higher detection rates irrespective of prior biopsy status (p=0.91) and type of MRI (cognitive versus fusion biopsy, p=0.70). Of the 73 studies, 61 studies (2917 patients) were included for CIC detection. MRI-TB had a lower detection rate of CIC than systematic biopsy (DR, 0.66 [95% CI 0.59- 0.74], p <0.001). The methodological quality of the included studies was moderate. CONCLUSIONS: This study provides evidence supporting the use of MRI-TB over TRUS biopsy as a diagnostic test for men with suspected prostate cancer.