PURPOSE: Micro-ultrasound is a novel, high-resolution, ultrasound technology, aiming to improve prostate imaging and, consequently, the diagnostic accuracy of ultrasound-guided prostate biopsy (PB). Micro-ultrasound-guided PB may present comparable detection rates to, the standard of care, multiparametric magnetic resonance imaging (mpMRI)-targeted PB for the diagnosis of clinically significant prostate cancer (PCa). We aimed to compare the detection rate of micro-ultrasound versus mpMRI-targeted PB for PCa diagnosis.
MATERIALS AND METHODS: We performed a systematic review and meta-analysis of diagnostic accuracy studies comparing micro-ultrasound-guided PB to mpMRI-targeted PB as a reference standard test (PROSPERO ID: CRD42020198326). Records were identified by searching in PubMed, Scopus and Cochrane Library databases, as well as in potential sources of grey literature until November 30, 2020.
RESULTS: We included 18 studies in the qualitative and 13 in the quantitative synthesis. In the quantitative synthesis, 1125 participants received micro-ultrasound-guided, followed by mpMRI-targeted and systematic PB. Micro-ultrasound and mpMRI-targeted PBs displayed similar detection rates across all PCa grades. The pooled detection ratio for ISUP Grade Group (GG) ≥2 PCa was 1.05 (95%CI: 0.93-1.19, I=0%), 1.25 (95%CI: 0.95-1.64, I=0%) for GG ≥3 and 0.94 (95%CI: 0.73-1.22, I=0%) for clinically insignificant (GG=1) PCa. The overall detection ratio for PCa was 0.99 (95%CI: 0.89-1.11, I=0%).
CONCLUSIONS: Micro-ultrasound-guided PB provides comparable detection rates for PCa diagnosis with the mpMRI-guided PB. Therefore, it could be considered as an attractive alternative to mpMRI-targeted PB. Nevertheless, high quality randomized trials are warranted to corroborate our findings.