MRI-based radiomics for prediction of extraprostatic extension of prostate cancer: a systematic review and meta-analysis.

PURPOSE: We to systematically evaluate the diagnostic performance of MRI radiomics in detecting extracapsular extension (EPE) of prostate cancer (PCa). METHODS: A literature search of online databases of PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar online scientific publication databases was performed to identify studies published up to July 2023. The summary estimates were pooled with the hierarchical summary receiver-operating characteristic (HSROC) model. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, the quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2) and the radiomics quality score (RQS). Meta-regression and subgroup analyses were performed to explore the impact of varying clinical settings. RESULTS: A total of ten studies met the inclusion criteria. The pooled sensitivity and specificity were 0.77 (95% CI 0.68-0.84, I2 = 83.5%) and 0.75 (95% CI 0.67-0.82, I2 = 83.5%), respectively, with an area under the HSROC curve of 0.88 (95% CI 0.85-0.91). Study quality was not high while assessing with the RQS. Substantial heterogeneity was observed between studies; however, meta-regression analysis did not reveal any significant contributing factors. CONCLUSIONS: MRI radiomics demonstrated moderate sensitivity and specificity, offering similar diagnostic performance with previous risk stratifications and models that primarily based on radiologists' subjective experience. However, all studies included were retrospective, thus the performance of radiomics needs to validate in prospective, multicenter studies.

PI-RADS v2.1 and PSAD for the prediction of clinically significant prostate cancer among patients with PSA levels of 4-10 ng/ml.

This study intended to evaluate the diagnostic accuracy of the prostate imaging reporting and data system (PI-RADS) and prostate-specific antigen density (PSAD) for clinically significant prostate cancer (csPCa) with PSA levels of 4-10 ng/ml. Between July 2018 and June 2022, a total of 453 patients with PSA levels of 4-10 ng/ml were retrospectively included, which were randomly assigned to the training group (323 patients) and validation group (130 patients). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with their 95% CI were calculated. The overall diagnostic performance was determined with area under the receiver operating characteristic curve (AUC), and an integrated nomogram combining PI-RADS score and PSAD was constructed and tested in a validation cohort. In the training group, the AUC for PI-RADS 2.1 and PSAD alone were 0.875 (95% CI 0.834-0.916) and 0.712 (95% CI 0.648-0.775). At the cutoff PI-RADS score ≥ 4, the sensitivity and specificity were 86.2% (95% CI 77.4-1.9%) and 84.7% (95% CI 79.6-88.8%), respectively. For PSAD, the sensitivity and specificity were 73.3% (95% CI 63.0-82.4%) and 62.1% (95% CI 55.8-68.5%) at the cutoff 0.162 ng/ml/ml. While combining PI-RADS with PSAD, the diagnostic performance was improved significantly, with AUC of 0.893 (95% CI 0.853-0.933). In the validation group, the nomogram yielded a AUC of 0.871 (95% CI 0.807-0.934), which is significantly higher than PI-RADS alone (0.829, 95% CI 0.759-0.899, P = 0.02). For patients with PSA levels of 4-10 ng/ml, PSAD demonstrated moderate diagnostic accuracy whereas PI-RADS showed high performance. By combination of PSAD and PI-RADS together, the diagnostic performance could be improved significantly.

Inter-reader agreement of the prostate imaging reporting and data system version v2.1 for detection of prostate cancer: A systematic review and meta-analysis.

Objectives: We aimed to systematically assess the inter-reader agreement of the Prostate Imaging Reporting and Data System Version (PI-RADS) v2.1 for the detection of prostate cancer (PCa). Methods: We included studies reporting inter-reader agreement of different radiologists that applied PI-RADS v2.1 for the detection of PCa. Quality assessment of the included studies was performed with the Guidelines for Reporting Reliability and Agreement Studies. The summary estimates of the inter-reader agreement were pooled with the random-effect model and categorized (from slight to almost perfect) according to the kappa (κ) value. Multiple subgroup analyses and meta-regression were performed to explore various clinical settings. Results: A total of 12 studies comprising 2475 patients were included. The pooled inter-reader agreement for whole gland was κ=0.65 (95% CI 0.56-0.73), and for transitional zone (TZ) lesions was κ=0.62 (95% CI 0.51-0.72). There was substantial heterogeneity presented throughout the studies (I 2= 95.6%), and meta-regression analyses revealed that only readers' experience (<5 years vs. ≥5 years) was the significant factor associated with heterogeneity (P<0.01). In studies providing head-to-head comparison, there was no significant difference in inter-reader agreement between PI-RADS v2.1 and v2.0 for both the whole gland (0.64 vs. 0.57, p=0.37), and TZ (0.61 vs. 0.59, p=0.81). Conclusions: PI-RADS v2.1 demonstrated substantial inter-reader agreement among radiologists for whole gland and TZ lesions. However, the difference in agreement between PI-RADS v2.0 and v2.1 was not significant for the whole gland or the TZ.

Diagnostic performance of ESUR scoring system for extraprostatic prostate cancer extension: A meta-analysis.

PURPOSE: We aimed to evaluate the diagnostic performance of the European Society of Urogenital Radiology (ESUR) scoring system for detection of extraprostatic extension (EPE) in prostate cancer (PCa) by performing a meta-analysis. MATERIALS AND METHODS: A literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar was performed to identify relevant studies from January 2012 to December 2020. We included diagnostic accuracy studies using ESUR scoring system for detection of EPE, and with prostatectomy histopathological results as the reference standard. Quality assessment was performed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The summary estimates of sensitivity and specificity were pooled using bivariate random-effects modeling. We conducted multiple subgroup analyses and meta-regression to explore varied clinical settings. RESULTS: 10 studies with a total of 1698 participants were included in this meta-analysis. Pooled sensitivity and specificity were 0.71 (95% CI 0.61-0.80) and 0.76 (95% CI 0.67-0.84), respectively, with the area under ROC of 0.80 (95% CI 0.77-0.84). The Higgins I2 statistics demonstrated substantial heterogeneity in both sensitivity (I2 = 86.5%) and specificity (I2 = 91.6%), meta-regression revealed that the cutoff values (ESUR score ≥ 3 vs. ESUR score ≥ 4, P = 0.02) and malignancy rate (<40% vs. ≥40%, P = 0.04) were significant factors responsible for heterogeneity. Using endorectal coil and higher field strength (3.0 T) showed no additional benefit for EPE detection. CONCLUSION: The evidence available for ESUR scoring system tends to show moderate diagnostic performance for detection of EPE, and the cutoff values (P = 0.02) and malignancy rate (P = 0.04) were significant factors contributed to the heterogeneity.