Head-to-head comparison of diagnostic test accuracy between biparametric and multiparametric MRI: an updated systematic review and bivariate meta-analysis.

[BACKGROUND] Prostate Cancer (PCa) is a leading cause of cancer-related mortality globally. Clinically significant PCa (CsPCa) is associated with more aggressive disease, making accurate diagnosis crucial. Multiparametric Magnetic Resonance Imaging (Mp-MRI) is a well-established tool for PCa detection, but the dynamic contrast-enhanced (DCE) sequence raises concerns due to cost, risks, and patient experience. Biparametric MRI (Bp-MRI) has emerged as an alternative, but its diagnostic performance compared to Mp-MRI has not been thoroughly examined through a systematic review and meta-analysis in recent years.

[METHODS] A systematic review and meta-analysis were conducted to compare the diagnostic accuracy of Bp-MRI and Mp-MRI for detecting CsPCa by assessing the databases MEDLINE/PubMed, CENTRAL Cochrane, and ClinicalTrials.gov. Studies published between 2012 and 2024 that compared Bp-MRI and Mp-MRI using histopathological analysis as the reference standard were included. Data were extracted to obtain diagnostic test accuracy measurements (sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) and study characteristics. Statistical analysis involved two bivariate random-effects models, a summary Receiver Operating Characteristic (sROC) curve, and meta-regression models assessing the comparison of both diagnostic test accuracies and the interaction of different study-level covariates.

[RESULTS] Nineteen studies involving 5,173 patients were included. Mp-MRI demonstrated a pooled sensitivity of 0.90 (95% CI: 0.87-0.93) and a specificity of 0.64 (95% CI: 0.50-0.76), while Bp-MRI showed a pooled sensitivity of 0.89 (95% CI: 0.85-0.92) and a specificity of 0.73 (95% CI: 0.62-0.82). Both modalities showed similar diagnostic performance with overlapping sROC curves. Meta-regression revealed no statistically significant difference between the two tools, and the study-level covariates did not influence the results.

[CONCLUSION] Bp-MRI is a viable alternative to Mp-MRI for detecting CsPCa, with comparable diagnostic accuracy, especially when contrast agents are a concern. Further prospective randomized studies are needed to confirm these findings.

[REGISTRY] PROSPERO (CRD42024552125).