Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment-naive patients: a diagnostic test accuracy systematic review and meta-analysis

Objective To perform a diagnostic test accuracy (DTA) systematic review and meta-analysis comparing multiparametric (diffusion-weighted imaging [DWI], T2-weighted imaging [T2WI], and dynamic contrast-enhanced [DCE] imaging) magnetic resonance imaging (mpMRI) and biparametric (DWI and T2WI) MRI (bpMRI) in detecting prostate cancer in treatment-naive patients. Methods The Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE) were searched to identify relevant studies published after 1 January 2012. Articles underwent title, abstract, and full-text screening. Inclusion criteria consisted of patients with suspected prostate cancer, bpMRI and/or mpMRI as the index test(s), histopathology as the reference standard, and a DTA outcome measure. Methodological and DTA data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. DTA metrics were pooled using bivariate random-effects meta-analysis. Subgroup analysis was conducted to assess for heterogeneity. Results From an initial 3502 studies, 31 studies reporting on 9480 patients (4296 with prostate cancer) met the inclusion criteria for the meta-analysis; 25 studies reported on mpMRI (7000 patients, 2954 with prostate cancer) and 12 studies reported on bpMRI DTA (2716 patients, 1477 with prostate cancer). Pooled summary statistics demonstrated no significant difference for sensitivity (mpMRI: 86%, 95% confidence interval [CI] 81-90; bpMRI: 90%, 95% CI 83-94) or specificity (mpMRI: 73%, 95% CI 64-81; bpMRI: 70%, 95% CI 42-83). The summary receiver operating characteristic curves were comparable for mpMRI (0.87) and bpMRI (0.90). Conclusions No significant difference in DTA was found between mpMRI and bpMRI in diagnosing prostate cancer in treatment-naive patients. Study heterogeneity warrants cautious interpretation of the results. With replication of our findings in dedicated validation studies, bpMRI may serve as a faster, cheaper, gadolinium-free alternative to mpMRI.