Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis.

CONTEXT Correct assessment of tumour stage is crucial for prostate cancer (PCa) management. OBJECTIVE To assess the diagnostic accuracy of magnetic resonance imaging (MRI) for local PCa staging and explore the influence of different imaging protocols. EVIDENCE ACQUISITION We searched the PubMed, Embase, and Cochrane databases from 2000 up to August 2014. We included studies that used MRI for detection of extracapsular extension (ECE; T3a), seminal vesicle invasion (SVI; T3b), or overall stage T3 PCa, with prostatectomy as the reference standard. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool by two independent reviewers. Data necessary to complete 2×2 tables were obtained, and patient, study, and imaging characteristics were extracted. Accuracy was reported for the most experienced or first reader. Results were pooled and plotted in summary receiver operating characteristics plots. EVIDENCE SYNTHESIS A total of 75 studies (9796 patients) could be analysed. Pooled data for ECE (45 studies, 5681 patients), SVI (34 studies, 5677 patients), and overall stage T3 detection (38 studies, 4001 patients) showed sensitivity and specificity of 0.57 (95% confidence interval [CI] 0.49-0.64) and 0.91 (95% CI 0.88-0.93), 0.58 (95% CI 0.47-0.68) and 0.96 (95% CI 0.95-0.97), and 0.61 (95% CI 0.54-0.67) and 0.88 (95% CI 0.85-0.91), respectively. Functional imaging in addition to T2-weighted imaging and use of higher field strengths (3 T) improved sensitivity for ECE and SVI. ECE sensitivity was not improved by endorectal coil use. CONCLUSIONS MRI has high specificity but poor and heterogeneous sensitivity for local PCa staging. An endorectal coil showed no additional benefit for ECE detection, but slightly improved sensitivity for SVI detection. Higher field strengths and the use of functional imaging techniques can slightly improve sensitivity. PATIENT SUMMARY We pooled the results from all previous studies that evaluated magnetic resonance imaging (MRI) for detection of tumour growth outside the prostate. MRI is not sensitive enough to find all tumours with extraprostatic growth.

[1]  N. Shah,et al.  The role of 1.5 Tesla magnetic resonance imaging in staging prostate cancer , 2013, ANZ journal of surgery.

[2]  A. D'Amico,et al.  Preoperative 3-Tesla multiparametric endorectal magnetic resonance imaging findings and the odds of upgrading and upstaging at radical prostatectomy in men with clinically localized prostate cancer. , 2013, International journal of radiation oncology, biology, physics.

[3]  P. Tan,et al.  Phased-array magnetic resonance imaging of the prostate with correlation to radical prostatectomy specimens: local experience. , 2004, Asian journal of surgery.

[4]  Mark Emberton,et al.  Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. , 2013, European urology.

[5]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[6]  Thomas Hambrock,et al.  Prostate cancer: body-array versus endorectal coil MR imaging at 3 T--comparison of image quality, localization, and staging performance. , 2007, Radiology.

[7]  John A. Taylor,et al.  Correlation of endorectal coil magnetic resonance imaging of the prostate with pathologic stage , 2004, World Journal of Urology.

[8]  Jiaoti Huang,et al.  RARP in high-risk prostate cancer: use of multi-parametric MRI and nerve sparing techniques , 2014, Asian journal of andrology.

[9]  M. Moche,et al.  Value of Endorectal Magnetic Resonance Imaging at 3T for the Local Staging of Prostate Cancer , 2014, Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren.

[10]  K. Pummer,et al.  Accuracy of 3-Tesla magnetic resonance imaging for the staging of prostate cancer in comparison to the partin tables , 2009, Acta radiologica.

[11]  G. Ligabue,et al.  Comparative Evaluation Between External Phased Array Coil at 3 T and Endorectal Coil at 1.5 T: Preliminary Results , 2006, Journal of computer assisted tomography.

[12]  Aytekin Oto,et al.  Seminal vesicle invasion in prostate cancer: evaluation by using multiparametric endorectal MR imaging. , 2013, Radiology.

[13]  Susan Mallett,et al.  QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies , 2011, Annals of Internal Medicine.

[14]  M. Kattan,et al.  Clinical and pathological significance of the level and extent of capsular invasion in clinical stage T1-2 prostate cancer. , 1998, Human pathology.

[15]  Boris Bodelle,et al.  MRI of the prostate: interobserver agreement compared with histopathologic outcome after radical prostatectomy. , 2012, European journal of radiology.

[16]  O. Geier,et al.  Routine pelvic MRI using phased-array coil for detection of extraprostatic tumour extension: accuracy and clinical significance , 2012, European Radiology.

[17]  D. Beyersdorff,et al.  MRI of prostate cancer at 1.5 and 3.0 T: comparison of image quality in tumor detection and staging. , 2005, AJR. American journal of roentgenology.

[18]  O. Hélénon,et al.  Extraprostatic spread of clinically localized prostate cancer: factors predictive of pT3 tumor and of positive endorectal MR imaging examination results. , 2002, Radiology.

[19]  Tai‐Lung Cha,et al.  Combining prostrate‐specific antigen and Gleason score increases the diagnostic power of endorectal coil magnetic resonance imaging in prostate cancer pathological stage , 2013, Journal of the Chinese Medical Association : JCMA.

[20]  P. Walsh,et al.  The significance of positive surgical margin in areas of capsular incision in otherwise organ confined disease at radical prostatectomy. , 2007, The Journal of urology.

[21]  M. Borre,et al.  Phased array magnetic resonance imaging for staging clinically localised prostrate cancer. , 2005, Acta oncologica.

[22]  P. Dettmar,et al.  Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer , 2001, BJU international.

[23]  Robert E Lenkinski,et al.  Prostate cancer: accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging--initial results. , 2007, Radiology.

[24]  J. Ferlay,et al.  Global Cancer Statistics, 2002 , 2005, CA: a cancer journal for clinicians.

[25]  Jun Nakashima,et al.  Endorectal MRI for prediction of tumor site, tumor size, and local extension of prostate cancer. , 2004, Urology.

[26]  T. Cangiano,et al.  Endorectal coil magnetic resonance imaging and clinicopathologic findings in T1c adenocarcinoma of the prostate. , 2000, Urologic oncology.

[27]  C. Claussen,et al.  Accuracy of preoperative endorectal MRI in predicting extracapsular extension and influence on neurovascular bundle sparing in radical prostatectomy , 2013, World Journal of Urology.

[28]  J. Cheon,et al.  The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score. , 2011, Asian journal of andrology.

[29]  Evis Sala,et al.  Transition zone prostate cancers: features, detection, localization, and staging at endorectal MR imaging. , 2006, Radiology.

[30]  D. Jung,et al.  Preoperative MR imaging in the evaluation of seminal vesicle invasion in prostate cancer: Pattern analysis of seminal vesicle lesions , 2008, Journal of magnetic resonance imaging : JMRI.

[31]  M. Recio,et al.  Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology , 2014, Clinical and Translational Oncology.

[32]  C. Claussen,et al.  Seminal Vesicle Invasion: Accuracy and Analysis of Infiltration Patterns with High-Spatial Resolution T2-Weighted Sequences on Endorectal Magnetic Resonance Imaging , 2013, Urologia Internationalis.

[33]  Rajan T. Gupta,et al.  Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy. , 2014, Urologic oncology.

[34]  Jelle O. Barentsz,et al.  Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis , 2002, European Radiology.

[35]  J. Witjes,et al.  Use of the Prostate Imaging Reporting and Data System (PI-RADS) for Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: A Diagnostic Meta-analysis. , 2015, European urology.

[36]  Jonathan L Wright,et al.  Experience improves staging accuracy of endorectal magnetic resonance imaging in prostate cancer: what is the learning curve? , 2007, The Canadian journal of urology.

[37]  T. H. van der Kwast,et al.  EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. , 2014, European urology.

[38]  J. Fütterer,et al.  Value of 3-T Magnetic Resonance Imaging in Local Staging of Prostate Cancer , 2008, Topics in magnetic resonance imaging : TMRI.

[39]  K. Nepple,et al.  Concordance of preoperative prostate endorectal MRI with subsequent prostatectomy specimen in high-risk prostate cancer patients. , 2013, Urologic oncology.

[40]  D. Nieboer,et al.  Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. , 2015, European urology.

[41]  Jeong Kon Kim,et al.  Incremental value of magnetic resonance imaging for clinically high risk prostate cancer in 922 radical prostatectomies. , 2013, The Journal of urology.

[42]  H. Yin,et al.  Seminal vesicle invasion in prostate cancer: prediction with combined T2-weighted and diffusion-weighted MR imaging , 2009, European Radiology.

[43]  T. Scheenen,et al.  Prostate cancer: local staging at 3-T endorectal MR imaging--early experience. , 2006, Radiology.

[44]  Bum Soo Kim,et al.  Comparison of Pelvic Phased-Array versus Endorectal Coil Magnetic Resonance Imaging at 3 Tesla for Local Staging of Prostate Cancer , 2012, Yonsei medical journal.

[45]  P. Tan,et al.  Local experience of endorectal magnetic resonance imaging of prostate with correlation to radical prostatectomy specimens. , 2008, Annals of the Academy of Medicine, Singapore.

[46]  Y. Kanai,et al.  Ability of preoperative 3.0‐Tesla magnetic resonance imaging to predict the absence of side‐specific extracapsular extension of prostate cancer , 2013, International journal of urology : official journal of the Japanese Urological Association.

[47]  C. Morash,et al.  Diagnostic accuracy of surface coil magnetic resonance imaging at 1.5 T for local staging of elevated risk prostate cancer. , 2010, Canadian Urological Association journal = Journal de l'Association des urologues du Canada.

[48]  D. Kuban,et al.  Endorectal magnetic resonance imaging for predicting pathologic T3 disease in Gleason score 7 prostate cancer: implications for prostate brachytherapy. , 2013, Brachytherapy.

[49]  Michael W Kattan,et al.  Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension. , 2004, Radiology.

[50]  A. Svindland,et al.  Preoperative magnetic resonance imaging for detecting uni- and bilateral extraprostatic disease in patients with prostate cancer , 2014, World Journal of Urology.

[51]  L. Bachmann,et al.  The role of 11C-choline and 18F-fluorocholine positron emission tomography (PET) and PET/CT in prostate cancer: a systematic review and meta-analysis. , 2013, European urology.

[52]  J. Babb,et al.  Prostate cancer: Utility of diffusion‐weighted imaging as a marker of side‐specific risk of extracapsular extension , 2013, Journal of magnetic resonance imaging : JMRI.

[53]  B. Bloch,et al.  Prediction of prostate cancer extracapsular extension with high spatial resolution dynamic contrast-enhanced 3-T MRI , 2012, European Radiology.

[54]  M. Kattan,et al.  Comparison of endorectal magnetic resonance imaging, guided prostate biopsy and digital rectal examination in the preoperative anatomical localization of prostate cancer. , 2005, The Journal of urology.

[55]  R. Ball,et al.  Comparison of body-array MRI and Partin tables for predicting extracapsular prostate cancer , 2013 .

[56]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[57]  F. Beuvon,et al.  Endorectal 3D T2-weighted 1mm-slice thickness MRI for prostate cancer staging at 1.5Tesla: should we reconsider the indirects signs of extracapsular extension according to the D'Amico tumor risk criteria? , 2012, European journal of radiology.

[58]  Wun-Jae Kim,et al.  Usefulness of a Combined Approach of T1-Weighted, T2-Weighted, Dynamic Contrast-Enhanced, and Diffusion-Weighted Imaging in Prostate Cancer , 2012, Korean journal of urology.

[59]  M. Reiser,et al.  Per-sextant localization and staging of prostate cancer: correlation of imaging findings with whole-mount step section histopathology. , 2007, AJR. American journal of roentgenology.

[60]  A. Jemal,et al.  Global cancer statistics, 2012 , 2015, CA: a cancer journal for clinicians.

[61]  A. Costello,et al.  ENDORECTAL MAGNETIC RESONANCE IMAGING STAGING OF PROSTATE CANCER , 2007, ANZ journal of surgery.

[62]  B. K. Park,et al.  Value of diffusion-weighted imaging at 3 T for prediction of extracapsular extension in patients with prostate cancer: a preliminary study. , 2014, AJR. American journal of roentgenology.

[63]  H. Hricak,et al.  Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. , 2006, Radiology.

[64]  A. Wetter,et al.  Combined MRI and MR spectroscopy of the prostate before radical prostatectomy. , 2006, AJR. American journal of roentgenology.

[65]  P. Grenier,et al.  Accuracy of high resolution (1.5 tesla) pelvic phased array magnetic resonance imaging (MRI) in staging prostate cancer in candidates for radical prostatectomy: results from a prospective study. , 2013, Urologic oncology.

[66]  P. P. Iu,et al.  ESUR prostate MR guidelines. , 2013, European radiology.

[67]  O. Akin,et al.  Local staging of prostate cancer with endorectal surface coil MR imaging in a mid-field magnetic system. , 2003, Clinical imaging.

[68]  B. K. Park,et al.  Diffusion‐weighted MR imaging for the evaluation of seminal vesicle invasion in prostate cancer: Initial results , 2008, Journal of magnetic resonance imaging : JMRI.

[69]  Jelle O. Barentsz,et al.  Prostate cancer: comparison of local staging accuracy of pelvic phased-array coil alone versus integrated endorectal–pelvic phased-array coils , 2007, European Radiology.

[70]  M Bolla,et al.  EAU guidelines on prostate cancer. , 2001, European urology.

[71]  B. K. Park,et al.  Comparison of Phased-Array 3.0-T and Endorectal 1.5-T Magnetic Resonance Imaging in the Evaluation of Local Staging Accuracy for Prostate Cancer , 2007, Journal of computer assisted tomography.

[72]  A. Sasse,et al.  Magnetic resonance image in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer: a systematic review of literature and meta-analysis. , 2013, International braz j urol : official journal of the Brazilian Society of Urology.

[73]  J. Kim,et al.  Is endorectal coil necessary for the staging of clinically localized prostate cancer? Comparison of non-endorectal versus endorectal MR imaging , 2010, World Journal of Urology.

[74]  F. Migliorini,et al.  Accuracy of preoperative endo-rectal coil magnetic resonance imaging in detecting clinical under-staging of localized prostate cancer , 2013, World Journal of Urology.

[75]  Yemisi Takwoingi,et al.  MetaDAS: A SAS macro for meta-analysis of diagnostic accuracy studies , 2010 .

[76]  Satoru Takahashi,et al.  Efficacy of Using Three-Tesla Magnetic Resonance Imaging Diagnosis of Capsule Invasion for Decision-Making About Neurovascular Bundle Preservation in Robotic-Assisted Radical Prostatectomy , 2013, Korean journal of urology.

[77]  J. Meuwly,et al.  Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension? , 2013, Canadian Urological Association journal = Journal de l'Association des urologues du Canada.

[78]  J Alfred Witjes,et al.  Staging prostate cancer with dynamic contrast-enhanced endorectal MR imaging prior to radical prostatectomy: experienced versus less experienced readers. , 2005, Radiology.

[79]  H. Hricak,et al.  Clinical stage T1c prostate cancer: evaluation with endorectal MR imaging and MR spectroscopic imaging. , 2009, Radiology.

[80]  K. Zou,et al.  Role of endorectal coil magnetic resonance imaging in treatment of patients with prostate cancer and in determining radical prostatectomy surgical margin status: report of a single surgeon's practice. , 2007, Urology.

[81]  J. Fütterer,et al.  ESUR prostate MR guidelines 2012 , 2012, European Radiology.

[82]  P. Grenier,et al.  Role of pelvic phased array magnetic resonance imaging in staging of prostate cancer specifically in patients diagnosed with clinically locally advanced tumours by digital rectal examination , 2013, World Journal of Urology.

[83]  A. Jemal,et al.  Global Cancer Statistics , 2011 .

[84]  H. Hricak,et al.  Incremental value of multiplanar cross-referencing for prostate cancer staging with endorectal MRI. , 2007, AJR. American journal of roentgenology.

[85]  P. Albertsen.  Is screening for prostate cancer with prostate specific antigen an appropriate public health measure? , 2005, Acta oncologica.

[86]  L. Kiemeney,et al.  The predictive value of endorectal 3 Tesla multiparametric magnetic resonance imaging for extraprostatic extension in patients with low, intermediate and high risk prostate cancer. , 2013, The Journal of urology.

[87]  S. Power,et al.  The accuracy of magnetic resonance imaging in prostate cancer staging: a single-institution experience , 2015, Irish Journal of Medical Science (1971 -).

[88]  Tae Heon Kim,et al.  The Role of Endorectal Magnetic Resonance Imaging in Predicting Extraprostatic Extension and Seminal Vesicle Invasion in Clinically Localized Prostate Cancer , 2010, Korean journal of urology.

[89]  E. Bergstralh,et al.  Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate‐specific antigen testing: 15‐year outcome , 2005, BJU international.

[90]  K. Taari,et al.  Endorectal magnetic resonance imaging of prostatic cancer: comparison between fat-suppressed T2-weighted fast spin echo and three-dimensional dual-echo, steady-state sequences , 2001, European Radiology.

[91]  Hedvig Hricak,et al.  Value of a standardized lexicon for reporting levels of diagnostic certainty in prostate MRI. , 2014, AJR. American journal of roentgenology.

[92]  T Okada,et al.  Dynamic endorectal magnetic resonance imaging for local staging and detection of neurovascular bundle involvement of prostate cancer: correlation with histopathologic results. , 2001, Urology.

[93]  A. Cesinaro,et al.  3-T MRI with phased-array coil in local staging of prostatic cancer. , 2008, Academic radiology.

[94]  L. Molinier,et al.  Assessment of the risk of positive surgical margins with pelvic phased-array magnetic resonance imaging in patients with clinically localized prostate cancer: a prospective study. , 2001, Urology.

[95]  M. Harisinghani,et al.  Impact of preoperative endorectal MRI stage classification on neurovascular bundle sparing aggressiveness and the radical prostatectomy positive margin rate. , 2009, Urologic oncology.

[96]  Lars Egevad,et al.  A contemporary update on pathology reporting for prostate cancer: biopsy and radical prostatectomy specimens. , 2012, European urology.

[97]  O. Hélénon,et al.  Endorectal color doppler sonography and endorectal MR imaging features of nonpalpable prostate cancer: correlation with radical prostatectomy findings. , 2000, AJR. American journal of roentgenology.

[98]  Jonathan J Deeks,et al.  The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. , 2005, Journal of clinical epidemiology.