What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel

Paul C. Moldovan, Thomas Van den Broeck, Richard Sylvester, Lorenzo Marconi, Joaquim Bellmunt, Roderick C.N. van den Bergh, Michel Bolla, Erik Briers, Marcus G. Cumberbatch, Nicola Fossati, Tobias Gross, Ann M. Henry, Steven Joniau, Theo H. van der Kwast, Vsevolod Matveev, Henk G. van der Poel, Maria De Santis, Ivo G. Schoots, Thomas Wiegel, Cathy Yuan & 4 others Phil Cornford, Nicolas Mottet, Thomas B Lam, Olivier Rouvière

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Abstract

Context: It remains unclear whether patients with suspicion of prostate cancer (PCa) and negative multiparametric magnetic resonance imaging (mpMRI) can safely obviate prostate biopsy. Objective: To systematically review the literature assessing the negative predictive value (NPV) of mpMRI in patients with suspicion of PCa. Evidence acquisition: The Embase, Medline and Cochrane databases were searched up to February 2016. Studies reporting pre-biopsy mpMRI results using transrectal or transperineal biopsy as reference standard were included. We further selected for meta-analysis studies with at least 10-core biopsies as reference standard, mpMRI comprising at least T2-weighted and diffusion-weighted imaging, positive mpMRI defined as a PI-RADS/Likert score of ≥3/5 or ≥4/5, results reported at patient level for detection of overall PCa or clinically significant PCa (csPCa) defined as Gleason ≥7 cancer. Evidence synthesis: 48 studies (9613 patients) were eligible for inclusion. At patient level, median prevalence was 50.4% (IQR, 36.4-57.7%) for overall cancer and 32.9% (IQR, 28.1-37.2%) for csPCa. Median mpMRI NPV was 82.4% (IQR, 69.0-92.4%) for overall cancer and 88.1% (IQR, 85.7-92.3) for csPCa. NPV significantly decreased when cancer prevalence increased, for overall cancer (r=-0.64, p<0.0001) and csPCa (r=-0.75, p=0.032). Eight studies fulfilled the inclusion criteria for meta-analysis. Seven reported results for overall PCa. When the overall PCa prevalence increased from 30% to 60%, the combined NPV estimates decreased from 88% (95% confidence interval (95% CI), 77–99%) to 67% (95% CI, 56–79%) for a cut-off score of 3/5. Only one study selected for meta-analysis reported results for Gleason ≥7 cancers, with a positive biopsy rate of 29.3%. The corresponding NPV for a cut-off score of ≥3/5 was 87.9%. Conclusion: mpMRI NPV varied greatly depending on study design, cancer prevalence, and definitions of positive mpMRI and csPCa. Because cancer prevalence was highly variable among series, risk stratification of patients should be the initial step before considering prebiopsy mpMRI and defining those in whom biopsy may be omited when the mpMRI is negative. Patient summary: This systematic review examined if multiparametric MRI scan can be used to reliably predict the absence of prostate cancer in patients suspected of having prostate cancer, thereby avoiding a prostate biopsy. The results suggest that whilst it is a promising tool, it is not accurate enough to replace prostate biopsy in such patients, mainly because its accuracy is variable and influenced by the prostate cancer risk. However, its performance can be enhanced if there were more accurate ways of determining the risk of having prostate cancer. When such tools are available, it should then be possible to use MRI scan to avoid biopsy in patients at low risk of prostate cancer.
Original languageEnglish
Pages (from-to)250-266
Number of pages17
JournalEuropean Urology
Volume72
Issue number2
Early online date21 Mar 2017
DOIs
Publication statusPublished - Aug 2017

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Meta-Analysis
Prostatic Neoplasms
Magnetic Resonance Imaging
Guidelines
Biopsy
Neoplasms
Prostate
Confidence Intervals
Databases

Keywords

  • prostate cancer
  • multiparametric magnetic resonance imaging
  • prostate biopsy
  • risk stratification

Cite this

What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. / Moldovan, Paul C. ; Van den Broeck, Thomas ; Sylvester, Richard; Marconi, Lorenzo; Bellmunt, Joaquim; van den Bergh, Roderick C.N. ; Bolla, Michel; Briers, Erik; Cumberbatch, Marcus G. ; Fossati, Nicola ; Gross, Tobias ; Henry, Ann M. ; Joniau, Steven; van der Kwast, Theo H.; Matveev, Vsevolod; van der Poel, Henk G.; De Santis, Maria; Schoots, Ivo G. ; Wiegel, Thomas; Yuan , Cathy ; Cornford, Phil; Mottet, Nicolas; Lam, Thomas B; Rouvière, Olivier (Corresponding Author).

In: European Urology, Vol. 72, No. 2, 08.2017, p. 250-266.

Research output: Contribution to journalArticle

Moldovan, PC, Van den Broeck, T, Sylvester, R, Marconi, L, Bellmunt, J, van den Bergh, RCN, Bolla, M, Briers, E, Cumberbatch, MG, Fossati, N, Gross, T, Henry, AM, Joniau, S, van der Kwast, TH, Matveev, V, van der Poel, HG, De Santis, M, Schoots, IG, Wiegel, T, Yuan , C, Cornford, P, Mottet, N, Lam, TB & Rouvière, O 2017, 'What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel' European Urology, vol. 72, no. 2, pp. 250-266. https://doi.org/10.1016/j.eururo.2017.02.026
Moldovan, Paul C. ; Van den Broeck, Thomas ; Sylvester, Richard ; Marconi, Lorenzo ; Bellmunt, Joaquim ; van den Bergh, Roderick C.N. ; Bolla, Michel ; Briers, Erik ; Cumberbatch, Marcus G. ; Fossati, Nicola ; Gross, Tobias ; Henry, Ann M. ; Joniau, Steven ; van der Kwast, Theo H. ; Matveev, Vsevolod ; van der Poel, Henk G. ; De Santis, Maria ; Schoots, Ivo G. ; Wiegel, Thomas ; Yuan , Cathy ; Cornford, Phil ; Mottet, Nicolas ; Lam, Thomas B ; Rouvière, Olivier. / What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. In: European Urology. 2017 ; Vol. 72, No. 2. pp. 250-266.
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title = "What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel",
abstract = "Context: It remains unclear whether patients with suspicion of prostate cancer (PCa) and negative multiparametric magnetic resonance imaging (mpMRI) can safely obviate prostate biopsy. Objective: To systematically review the literature assessing the negative predictive value (NPV) of mpMRI in patients with suspicion of PCa. Evidence acquisition: The Embase, Medline and Cochrane databases were searched up to February 2016. Studies reporting pre-biopsy mpMRI results using transrectal or transperineal biopsy as reference standard were included. We further selected for meta-analysis studies with at least 10-core biopsies as reference standard, mpMRI comprising at least T2-weighted and diffusion-weighted imaging, positive mpMRI defined as a PI-RADS/Likert score of ≥3/5 or ≥4/5, results reported at patient level for detection of overall PCa or clinically significant PCa (csPCa) defined as Gleason ≥7 cancer. Evidence synthesis: 48 studies (9613 patients) were eligible for inclusion. At patient level, median prevalence was 50.4{\%} (IQR, 36.4-57.7{\%}) for overall cancer and 32.9{\%} (IQR, 28.1-37.2{\%}) for csPCa. Median mpMRI NPV was 82.4{\%} (IQR, 69.0-92.4{\%}) for overall cancer and 88.1{\%} (IQR, 85.7-92.3) for csPCa. NPV significantly decreased when cancer prevalence increased, for overall cancer (r=-0.64, p<0.0001) and csPCa (r=-0.75, p=0.032). Eight studies fulfilled the inclusion criteria for meta-analysis. Seven reported results for overall PCa. When the overall PCa prevalence increased from 30{\%} to 60{\%}, the combined NPV estimates decreased from 88{\%} (95{\%} confidence interval (95{\%} CI), 77–99{\%}) to 67{\%} (95{\%} CI, 56–79{\%}) for a cut-off score of 3/5. Only one study selected for meta-analysis reported results for Gleason ≥7 cancers, with a positive biopsy rate of 29.3{\%}. The corresponding NPV for a cut-off score of ≥3/5 was 87.9{\%}. Conclusion: mpMRI NPV varied greatly depending on study design, cancer prevalence, and definitions of positive mpMRI and csPCa. Because cancer prevalence was highly variable among series, risk stratification of patients should be the initial step before considering prebiopsy mpMRI and defining those in whom biopsy may be omited when the mpMRI is negative. Patient summary: This systematic review examined if multiparametric MRI scan can be used to reliably predict the absence of prostate cancer in patients suspected of having prostate cancer, thereby avoiding a prostate biopsy. The results suggest that whilst it is a promising tool, it is not accurate enough to replace prostate biopsy in such patients, mainly because its accuracy is variable and influenced by the prostate cancer risk. However, its performance can be enhanced if there were more accurate ways of determining the risk of having prostate cancer. When such tools are available, it should then be possible to use MRI scan to avoid biopsy in patients at low risk of prostate cancer.",
keywords = "prostate cancer, multiparametric magnetic resonance imaging, prostate biopsy, risk stratification",
author = "Moldovan, {Paul C.} and {Van den Broeck}, Thomas and Richard Sylvester and Lorenzo Marconi and Joaquim Bellmunt and {van den Bergh}, {Roderick C.N.} and Michel Bolla and Erik Briers and Cumberbatch, {Marcus G.} and Nicola Fossati and Tobias Gross and Henry, {Ann M.} and Steven Joniau and {van der Kwast}, {Theo H.} and Vsevolod Matveev and {van der Poel}, {Henk G.} and {De Santis}, Maria and Schoots, {Ivo G.} and Thomas Wiegel and Cathy Yuan and Phil Cornford and Nicolas Mottet and Lam, {Thomas B} and Olivier Rouvi{\`e}re",
year = "2017",
month = "8",
doi = "10.1016/j.eururo.2017.02.026",
language = "English",
volume = "72",
pages = "250--266",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "2",

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TY - JOUR

T1 - What Is the Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in Excluding Prostate Cancer at Biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel

AU - Moldovan, Paul C.

AU - Van den Broeck, Thomas

AU - Sylvester, Richard

AU - Marconi, Lorenzo

AU - Bellmunt, Joaquim

AU - van den Bergh, Roderick C.N.

AU - Bolla, Michel

AU - Briers, Erik

AU - Cumberbatch, Marcus G.

AU - Fossati, Nicola

AU - Gross, Tobias

AU - Henry, Ann M.

AU - Joniau, Steven

AU - van der Kwast, Theo H.

AU - Matveev, Vsevolod

AU - van der Poel, Henk G.

AU - De Santis, Maria

AU - Schoots, Ivo G.

AU - Wiegel, Thomas

AU - Yuan , Cathy

AU - Cornford, Phil

AU - Mottet, Nicolas

AU - Lam, Thomas B

AU - Rouvière, Olivier

PY - 2017/8

Y1 - 2017/8

N2 - Context: It remains unclear whether patients with suspicion of prostate cancer (PCa) and negative multiparametric magnetic resonance imaging (mpMRI) can safely obviate prostate biopsy. Objective: To systematically review the literature assessing the negative predictive value (NPV) of mpMRI in patients with suspicion of PCa. Evidence acquisition: The Embase, Medline and Cochrane databases were searched up to February 2016. Studies reporting pre-biopsy mpMRI results using transrectal or transperineal biopsy as reference standard were included. We further selected for meta-analysis studies with at least 10-core biopsies as reference standard, mpMRI comprising at least T2-weighted and diffusion-weighted imaging, positive mpMRI defined as a PI-RADS/Likert score of ≥3/5 or ≥4/5, results reported at patient level for detection of overall PCa or clinically significant PCa (csPCa) defined as Gleason ≥7 cancer. Evidence synthesis: 48 studies (9613 patients) were eligible for inclusion. At patient level, median prevalence was 50.4% (IQR, 36.4-57.7%) for overall cancer and 32.9% (IQR, 28.1-37.2%) for csPCa. Median mpMRI NPV was 82.4% (IQR, 69.0-92.4%) for overall cancer and 88.1% (IQR, 85.7-92.3) for csPCa. NPV significantly decreased when cancer prevalence increased, for overall cancer (r=-0.64, p<0.0001) and csPCa (r=-0.75, p=0.032). Eight studies fulfilled the inclusion criteria for meta-analysis. Seven reported results for overall PCa. When the overall PCa prevalence increased from 30% to 60%, the combined NPV estimates decreased from 88% (95% confidence interval (95% CI), 77–99%) to 67% (95% CI, 56–79%) for a cut-off score of 3/5. Only one study selected for meta-analysis reported results for Gleason ≥7 cancers, with a positive biopsy rate of 29.3%. The corresponding NPV for a cut-off score of ≥3/5 was 87.9%. Conclusion: mpMRI NPV varied greatly depending on study design, cancer prevalence, and definitions of positive mpMRI and csPCa. Because cancer prevalence was highly variable among series, risk stratification of patients should be the initial step before considering prebiopsy mpMRI and defining those in whom biopsy may be omited when the mpMRI is negative. Patient summary: This systematic review examined if multiparametric MRI scan can be used to reliably predict the absence of prostate cancer in patients suspected of having prostate cancer, thereby avoiding a prostate biopsy. The results suggest that whilst it is a promising tool, it is not accurate enough to replace prostate biopsy in such patients, mainly because its accuracy is variable and influenced by the prostate cancer risk. However, its performance can be enhanced if there were more accurate ways of determining the risk of having prostate cancer. When such tools are available, it should then be possible to use MRI scan to avoid biopsy in patients at low risk of prostate cancer.

AB - Context: It remains unclear whether patients with suspicion of prostate cancer (PCa) and negative multiparametric magnetic resonance imaging (mpMRI) can safely obviate prostate biopsy. Objective: To systematically review the literature assessing the negative predictive value (NPV) of mpMRI in patients with suspicion of PCa. Evidence acquisition: The Embase, Medline and Cochrane databases were searched up to February 2016. Studies reporting pre-biopsy mpMRI results using transrectal or transperineal biopsy as reference standard were included. We further selected for meta-analysis studies with at least 10-core biopsies as reference standard, mpMRI comprising at least T2-weighted and diffusion-weighted imaging, positive mpMRI defined as a PI-RADS/Likert score of ≥3/5 or ≥4/5, results reported at patient level for detection of overall PCa or clinically significant PCa (csPCa) defined as Gleason ≥7 cancer. Evidence synthesis: 48 studies (9613 patients) were eligible for inclusion. At patient level, median prevalence was 50.4% (IQR, 36.4-57.7%) for overall cancer and 32.9% (IQR, 28.1-37.2%) for csPCa. Median mpMRI NPV was 82.4% (IQR, 69.0-92.4%) for overall cancer and 88.1% (IQR, 85.7-92.3) for csPCa. NPV significantly decreased when cancer prevalence increased, for overall cancer (r=-0.64, p<0.0001) and csPCa (r=-0.75, p=0.032). Eight studies fulfilled the inclusion criteria for meta-analysis. Seven reported results for overall PCa. When the overall PCa prevalence increased from 30% to 60%, the combined NPV estimates decreased from 88% (95% confidence interval (95% CI), 77–99%) to 67% (95% CI, 56–79%) for a cut-off score of 3/5. Only one study selected for meta-analysis reported results for Gleason ≥7 cancers, with a positive biopsy rate of 29.3%. The corresponding NPV for a cut-off score of ≥3/5 was 87.9%. Conclusion: mpMRI NPV varied greatly depending on study design, cancer prevalence, and definitions of positive mpMRI and csPCa. Because cancer prevalence was highly variable among series, risk stratification of patients should be the initial step before considering prebiopsy mpMRI and defining those in whom biopsy may be omited when the mpMRI is negative. Patient summary: This systematic review examined if multiparametric MRI scan can be used to reliably predict the absence of prostate cancer in patients suspected of having prostate cancer, thereby avoiding a prostate biopsy. The results suggest that whilst it is a promising tool, it is not accurate enough to replace prostate biopsy in such patients, mainly because its accuracy is variable and influenced by the prostate cancer risk. However, its performance can be enhanced if there were more accurate ways of determining the risk of having prostate cancer. When such tools are available, it should then be possible to use MRI scan to avoid biopsy in patients at low risk of prostate cancer.

KW - prostate cancer

KW - multiparametric magnetic resonance imaging

KW - prostate biopsy

KW - risk stratification

U2 - 10.1016/j.eururo.2017.02.026

DO - 10.1016/j.eururo.2017.02.026

M3 - Article

VL - 72

SP - 250

EP - 266

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 2

ER -