Abstract
The diagnostic accuracy of magnetic resonance imaging (MRI)-targeted biopsy by using
the transperineal (TP) versus transrectal (TR) route in the detection of clinically
significant prostate cancer (csPCa) remains to be revealed. A systematic search of
PubMed, Embase, Ovid, and the Cochrane Library up to April 2019 was conducted. We
pooled odds ratios with 95% confidence intervals (CIs) for csPCa detected by TP and
TR MRI-targeted biopsy. The relative sensitivity (or risk ratio) between TP and TR
route was synthesized. We also pooled the diagnostic sensitivity of either approach
using the combined biopsy results as the reference standard. A total of 328 patients
with positive multiparametric MRI underwent TP MRI-targeted biopsy, and 315 patients
underwent TR MRI-targeted biopsy. The TP route detected more csPCa, with a detection
rate of 62.2% (204/328) compared to 41.3% (130/315) for the TR route (odds ratio =
2.37; 95% CI, 1.71-3.26). After adjusting for differences in cancer prevalence, TP
MRI-targeted biopsy detected 91.3% (105/115) of csPCa compared to 72.2% (83/115) by
the TR route (risk ratio = 1.26; 95% CI, 1.02-1.54). The pooled diagnostic sensitivity
of the TP route (86%; 95% CI, 77-96) was better than the TR route (73%, 62-88%). The
TR approach missed more csPCa located at the anterior zone of the prostate (20 vs.
3). The TP route performed better than the TR route in MRI-targeted biopsy, especially
in detecting csPCa located at the anterior prostate. More large prospective randomized
or head-to-head comparison studies comparing the two approaches are warranted.
Keywords
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Article info
Publication history
Published online: May 20, 2019
Accepted:
May 12,
2019
Received in revised form:
April 19,
2019
Received:
February 12,
2019
Footnotes
X.T., Z.L. and T.C. contributed equally to this article, and all should be considered first author.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
