NPV of Biparametric and Multiparametric Prostate MRI: A Comparative Systematic Review and Meta-Analysis

Background: Evidence supports comparable PPV between biparametric MRI (bpMRI) and multiparametric MRI (mpMRI). However, concern of missed cancers limits wider bpMRI adoption. Objective: To compare bpMRI and mpMRI in terms of the NPV for clinically significant prostate cancer. Evidence Acquisition: Multiple publication databases, trial registries, and conference proceedings were searched over varying timeframes for studies reporting comparative results for bpMRI and mpMRI. Information was extracted for negative examinations (PI-RADS or Likert category 1 or 2), which were classified as true or false negatives for clinically significant prostate cancer (International Society of Urological Pathology grade group ≥2), with pathologic reference standard (biopsy and/or radical prostatectomy). Risk of bias was assessed using QUADAS-Comparative. Pooled NPVs were calculated using random-effects meta-analysis. Evidence Synthesis: The meta-analysis included 18 studies. Fifteen studies evaluated simulated bpMRI examinations (examinations performed as mpMRI but interpreted with removal of dynamic contrast-enhancement images); three compared parallel arms of patients who underwent bpMRI or mpMRI. No study evaluated patients randomly allocated to undergo bpMRI or mpMRI. Three studies' reference standard included longitudinal follow-up biopsy. Pooled NPV was not significantly different between bpMRI (n=2857 patients) and mpMRI (n=2751 patients) overall [92% (95% CI: 89%, 94%) vs 92% (95% CI: 89%, 94%); p=.90], in nine studies after excluding those at high risk of bias in at least one domain for QUADAS-Comparative [92% (95% CI: 86%, 95%) vs 92% (95%: 95%, 96%), p=.83], in three studies of only 1.5-T examinations [89% (95% CI: 78%, 95%) vs 87% (95% CI: 77%), 93%], p=.76], in 12 studies of only 3-T examinations [93% (90%, 95%) vs 93% (91%, 95%); p=.90], in 12 studies of only biopsy-naïve patients [92% (95% CI: 88%, 94%) vs 91% (95% CI: 89%, 93%), p=.89], or in three studies of only previously biopsied patients [94% (95% CI: 89%, 97%) vs 94% (95% CI: 85%, 98%), p=.95]. Conclusion: This study found no evidence of a significant difference between bpMRI and mpMRI in NPV for clinically significant prostate cancer. Clinical Impact: The results provide further support for bpMRI as an alternative to mpMRI in clinical practice. Future studies should include randomized designs with longitudinal follow-up.