Comparing the Diagnostic Performance of Micro- Ultrasound-Guided Biopsy Versus Multiparametric Magnetic Resonance Imaging-Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-Analysis

Abstract

Background Micro-ultrasound is a novel, high-resolution imaging modality that aims to improve the accuracy of prostate cancer diagnosis compared with TRUS-guided biopsy. While traditional ultrasound systems operate at 8 to 12 MHz, micro-ultrasound operates at 29 MHz, allowing enhanced recognition of microstructures with 300% higher resolution. Micro-ultrasound can potentially identify and target in real-time suspicious lesions, improving sensitivity and the negative predictive value for clinically significant prostate cancer. It may be a low-cost alternative to multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer. Methods A systematic review and meta-analysis was performed comparing the diagnostic performance of microultrasound- guided prostate biopsies with mpMRI-targeted prostate biopsies in the detection of clinically significant prostate cancer. PubMed, EMBASE, SCOPUS, and Cochrane CENTRAL databases were searched to identify relevant studies published up to July 2022. Results A total of 15 studies were included for the systematic review, with 12 of those studies being included for the meta-analysis. The pooled sensitivity and specificity for micro-ultrasound-guided biopsies detecting clinically significant prostate cancer were 89% (95% CI 83 to 93) and 31% (95% CI 23 to 40) respectively (I2 = 0%). In comparison, the pooled sensitivity and specificity for mpMRI-targeted biopsies detecting clinically significant prostate cancer were 86% (95% CI 73 to 93) and 32% (95% CI 18 to 50) respectively (I2 = 16%). There was no statistically significant difference in the sensitivity or specificity between micro-ultrasound and mpMRI. Subgroup analysis found no difference in MRI subgroups based on blinding (P = 0.383). Conclusion Micro-ultrasound-guided biopsies are comparable to mpMRI targeted biopsies with no difference in the detection of clinically significant prostate cancer between the 2 modalities. Large, multicentre, prospective studies are required to further substantiate the use of micro-ultrasound as an alternative to or in conjunction with mpMRI in the detection of prostate cancer.