Affiliation:
1. Medical Education, Faculty of Medicine and Health University of New South Wales Kensington New South Wales 2052 Australia
2. School of Biomedical Sciences, Faculty of Medicine and Health University of New South Wales Kensington New South Wales 2052 Australia
3. Graduate School of Biomedical Engineering, Faculty of Engineering University of New South Wales Kensington New South Wales 2052 Australia
4. Prince of Wales Hospital Sydney New South Wales 2031 Australia
Abstract
BackgroundLocal staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE).PurposeTo assess the performance of quantitative MRI markers for detecting ECE.Study TypeSystematic review and meta‐analysis.Subjects4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta‐analysis. Patients from 46 studies were included for systematic review.Field Strength/SequenceDiffusion‐weighted, T2‐weighted, and dynamic contrast‐enhanced MRI at 1.5 T or 3 T.AssessmentPubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC‐mean) were pooled for meta‐analysis, but not for other quantitative markers including radiomics due to low number of studies available.Statistical TestsHierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC‐mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta‐regression. Results were significant if P ≤ 0.05.ResultsAt the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71–0.81] and 0.68 [95% CI 0.63–0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53–0.83] and 0.74 [95% CI 0.60–0.84] respectively. The area under the HSROC curves for TCL and ADC‐mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy.Data ConclusionBoth 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC‐mean may be superior to TCL at higher sensitivities.Level of Evidence3Technical Efficacy Stage2
Subject
Radiology, Nuclear Medicine and imaging