Comparative diagnostic accuracy of multiparametric-MRI and Micro-ultrasound for clinically significant prostate cancer-a bivariate meta-analysis of prospective studies.
Carlos A Garcia-Becerra, Maria I Arias-Gallardo, Jesus E Juarez-Garcia et al.
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In 30 seconds
This systematic review and bivariate meta-analysis compared micro-ultrasound (Micro-US) with multiparametric MRI (mpMRI) for detecting clinically significant prostate cancer in prospective studies using biopsy or prostatectomy as the reference standard. Eight studies involving 2626 patients were included: one randomised controlled trial and seven prospective cohorts. Pooled sensitivity was similar for Micro-US and mpMRI (0.87 vs 0.88), while specificity was lower for Micro-US (0.25 vs 0.30); meta-regression found no significant sensitivity difference but a specificity difference favouring mpMRI (P = 0.003).
Key findings
- Pooled sensitivity was 0.87 (95%CI: 0.80-0.92) for Micro-US and 0.88 (95% CI: 0.81-0.93) for mpMRI.
- Pooled specificity was 0.25 (95% CI: 0.17-0.36) for Micro-US and 0.30 (95% CI: 0.18-0.46) for mpMRI.
- Meta-regression found no significant sensitivity difference (P = 0.72), but specificity favoured mpMRI (P = 0.003).
- Across prevalence scenarios, PPVs were 0.41-0.46 and NPVs were 0.72-0.80.
Why it matters
The findings suggest Micro-US may detect clinically significant prostate cancer with sensitivity similar to mpMRI, while its lower specificity could mean more false-positive results. This comparison is relevant when considering diagnostic pathways that balance detection with unnecessary follow-up. The evidence also highlights that apparent similarity in sensitivity does not establish equivalence across all diagnostic outcomes.
What to keep in mind
The evidence comprised only eight prospective studies, including one randomised trial; the authors call for further high-quality prospective studies.