MRI-targeted biopsy versus standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis of rando
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MRI‑targeted biopsy versus standard transrectal ultrasound‑guided biopsy: a systematic review and meta‑analysis of randomized controlled trials Xu Hu1 · Zhi‑Qiang Yang1 · Yan‑Xiang Shao1 · Wei‑Chao Dou1 · San‑Chao Xiong1 · Wei‑Xiao Yang1 · Xiang Li2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose For men with a suspicion of prostate cancer (PCa), the transrectal ultrasound-guided biopsy (TRUS-Bx) was recommended. Multi-parametric magnetic resonance imaging (mp-MRI) could be more useful to more accurately selected patients who are with a clinical suspicion of PCa and eligible for biopsy, and avoid a biopsy if the result was negative. In the present study, we compared the MRI-targeted biopsy (MRI-TBx) with TRUS-Bx. Methods We searched the following online database: PubMed, Embase, and Cochrane Library, and the search was updated to March 2019. Results Finally, a total of 8 randomized controlled trials (RCTs) comprising 2593 patients were enrolled in the final analysis. MRI-TBx and TRUS-Bx did not significantly differ in overall PCa (RR = 1.30; 95% CI 0.98–1.72; P = 0.067), clinically significant PCa (RR = 1.35; 95% CI 0.98–1.86; P = 0.065), and clinically insignificant PCa (RR = 0.76; 95% CI 0.40–1.46; P = 0.416). While in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa (RR = 1.40; 95% CI 1.01–1.94; P = 0.045). Conclusion In the present study, we found that MRI-TBx potentially benefits the detection of overall and clinically significant PCa compared with TRUS-Bx in patients with a suspicion of PCa. Furthermore, in patients with initial biopsy, MRI-TBx had a significantly higher detection rate of overall PCa and a potentially higher detection rate of clinically significant PCa. While for patients with prior negative biopsy, we did not detect significant differences in overall and clinically significant PCa between two groups. More large and multicenter RCTs are further required. Keywords Magnetic resonance imaging · Transrectal ultrasound · Prostate biopsy · Randomized controlled study · Metaanalysis
Introduction
Xu Hu, Zhi-Qiang Yang and Yan-Xiang Shao have contributed equally to this article. * Xiang Li [email protected] 1
West China School of Medicine/West China Hospital, Sichuan University, Chengdu 610041, People’s Republic of China
Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, People’s Republic of China
2
Prostate cancer (PCa) is the most common cancer among American men [1]. The diagnosis of prostate cancer is different from other solid tumors and imaging is used for identifying patients who need a biopsy [2]. For men who present with an elevated serum prostate-specific antigen (PSA), or an abnormal digital rectal examination (DRE), the transrectal ultrasound-guided biopsy (TRUS-Bx) was recommended [3]. However, many men without cancer underwent unnecessary biopsies, clinically insignificant cancer was detected, while clinical
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