Use of the Prostate Imaging Reporting and Data System (PI-RADS) for Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: A Diagnostic Meta-analysis

Abstract

Context: In 2012, an expert panel of the European Society of Urogenital Radiology (ESUR) published the Prostate Imaging Reporting and Data System (PI-RADS) for prostate cancer (PC) detection with multiparametric magnetic resonance imaging (mp-MRI). Since then, many centers have reported their experiences.

Purpose: To review the diagnostic accuracy of PI-RADS for PC detection with mp-MRI.

Evidence acquisition: We searched Medline and Embase up to March 20, 2014. We included diagnostic accuracy studies since 2012 that used PI-RADS with mp-MRI for PC detection in men, using prostatectomy or biopsy as the reference standard. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool by two independent reviewers. Data necessary to complete 2×2 contingency tables were obtained from the included studies, and test characteristics including sensitivity and specificity were calculated. Results were pooled and plotted in a summary receiver operating characteristics plot.

Evidence synthesis: Fourteen studies (1785 patients) could be analyzed. The pooled data showed sensitivity of 0.78 (95% confidence interval [CI] 0.70-0.84) and specificity of 0.79 (95% CI 0.68-0.86) for PC detection, with negative predictive values ranging from 0.58 to 0.95. Sensitivity analysis revealed pooled sensitivity of 0.82 (95% CI 0.72-0.89) and specificity of 0.82 (95% CI 0.67-0.92) in studies with correct use of PI-RADS (ie, clear description in the methodology and no adjustment of criteria). For studies with a less strict or adjusted use of PI-RADS criteria, or unclear description of the methodology, had pooled sensitivity of 0.73 (95% CI 0.62-0.82) and specificity of 0.75 (95% CI 0.61-0.84).

Conclusions: In patients for whom PC is suspected, PI-RADS appears to have good diagnostic accuracy in PC detection, but no recommendation regarding the best threshold can be provided because of heterogeneity.

Patient summary: Pooling of results from all previous studies that used a relatively new 5-point scoring system for prostate magnetic resonance imaging showed that this scoring system appears to be able to detect prostate cancer accurately.

Keywords: European Society of Urogenital Radiology; Magnetic resonance imaging; Meta-analysis; Prostate Imaging Reporting and Data System (PI-RADS); Prostate cancer; Scoring method.