背景用于检测有临床意义的前列腺癌(csPCa)的前列腺MRI是由前列腺成像报告和数据系统(PI-RADS)标准化的。目前在2.1版本中。建立了具有12个月更新周期的系统回顾和荟萃分析基础设施,以评估PI-RADS随时间的诊断性能。目的提供PI-RADS2.1类前列腺MRI诊断准确性和癌症检出率(CDR)的估计,这是进一步的循证患者管理所必需的。材料与方法PubMed的系统搜索,Embase,科克伦图书馆,并进行了多项试验登记(2019年3月1日至2022年8月30日发表的英语研究).纳入了以csPCa为主要结果的PI-RADS2.1版的诊断准确性或CDR数据的研究。对于荟萃分析,敏感性的汇总估计,特异性,和CDRs来自病变水平和患者水平的提取数据。研究了PI-RADS大于或等于3和PI-RADS大于或等于4被认为是测试阳性的敏感性和特异性。除了单个PI-RADS类别1-5外,子类别的亚组分析(即,进行2+1、3+0)。结果共70项研究(11686个病灶,包括13330名患者)。在患者层面,PI-RADS大于或等于3时认为是阳性,荟萃分析发现,总敏感度为96%(95%CI:95,98),特异性为43%(95%CI:33,54),总受试者工作特征(SROC)曲线下面积为0.86(95%CI:0.75,0.93)。对于PI-RADS大于或等于4,荟萃分析发现,敏感性为89%(95%CI:85,92)和特异性为66%(95%CI:58,74)。SROC曲线下面积为0.89(95%CI:0.85,0.92)。CDR如下:PI-RADS1,6%;PI-RADS2,5%;PI-RADS3,19%;PI-RADS4,54%;和PI-RADS5,84%。过渡区2+1病变的CDR为12%(95%CI:7,19),3+0病变的CDR为19%(95%CI:12,29)(P=.12)。结论PI-RADS2.1类的诊断准确性和CDR估计可用于质量基准测试,并指导进一步的循证患者管理。©RSNA,2024补充材料可用于本文。另见本期Tammisetti和Jacobs的社论。
Background Prostate MRI for the detection of clinically significant prostate cancer (csPCa) is standardized by the Prostate Imaging Reporting and Data System (PI-RADS), currently in version 2.1. A systematic review and meta-analysis infrastructure with a 12-month update cycle was established to evaluate the diagnostic performance of PI-RADS over time. Purpose To provide estimates of diagnostic accuracy and cancer detection rates (CDRs) of PI-RADS version 2.1 categories for prostate MRI, which is required for further evidence-based patient management. Materials and Methods A systematic search of PubMed, Embase, Cochrane Library, and multiple trial registers (English-language studies published from March 1, 2019, to August 30, 2022) was performed. Studies that reported data on diagnostic accuracy or CDRs of PI-RADS version 2.1 with csPCa as the primary outcome were included. For the meta-analysis, pooled estimates for sensitivity, specificity, and CDRs were derived from extracted data at the lesion level and patient level. Sensitivity and specificity for PI-RADS greater than or equal to 3 and PI-RADS greater than or equal to 4 considered as test positive were investigated. In addition to individual PI-RADS categories 1-5, subgroup analyses of subcategories (ie, 2+1, 3+0) were performed. Results A total of 70 studies (11 686 lesions, 13 330 patients) were included. At the patient level, with PI-RADS greater than or equal to 3 considered positive, meta-analysis found a 96% summary sensitivity (95% CI: 95, 98) and 43% specificity (95% CI: 33, 54), with an area under the summary receiver operating characteristic (SROC) curve of 0.86 (95% CI: 0.75, 0.93). For PI-RADS greater than or equal to 4, meta-analysis found an 89% sensitivity (95% CI: 85, 92) and 66% specificity (95% CI: 58, 74), with an area under the SROC curve of 0.89 (95% CI: 0.85, 0.92). CDRs were as follows: PI-RADS 1, 6%; PI-RADS 2, 5%; PI-RADS 3, 19%; PI-RADS 4, 54%; and PI-RADS 5, 84%. The CDR was 12% (95% CI: 7, 19) for transition zone 2+1 lesions and 19% (95% CI: 12, 29) for 3+0 lesions (P = .12). Conclusion Estimates of diagnostic accuracy and CDRs for PI-RADS version 2.1 categories are provided for quality
benchmarking and to guide further evidence-based patient management. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Tammisetti and Jacobs in this issue.