Diagnostic Performance of Prostate Imaging Reporting and Data System Version 2 for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-analysis

Context: In 2015, the updated Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) for the detection of prostate cancer (PCa) was established. Since then, several studies assessing the value of PI-RADSv2 have been published. Objective: To review the diagnostic performance of PI-RADSv2 for the detection of PCa. Evidence acquisition: MEDLINE and EMBASE databases were searched up to December 7, 2016. We included diagnostic accuracy studies that used PI-RADSv2 for PCa detection, using prostatectomy or biopsy as the reference standard. The methodological quality was assessed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity and specificity of all studies were calculated. Results were pooled and plotted in a hierarchical summary receiver operating characteristic plot with further exploration using meta-regression and multiple subgroup analyses. Head-to-head comparison between PI-RADSv1 and PI-RADSv2 was performed for available studies. Evidence synthesis: Twenty-one studies (3857 patients) were included. The pooled sensitivity was 0.89 (95% confidence interval [CI] 0.86-0.92) with specificity of 0.73 (95% CI 0.60-0.83) for PCa detection. Proportion of patients with PCa, magnetic field strength, and reference standard were significant factors affecting heterogeneity (p < 0.01). Multiple subgroup analyses showed consistent results. In six studies performing head-to-head comparison, PI-RADSv2 demonstrated higher pooled sensitivity of 0.95 (95% CI 0.85-0.98) compared with 0.88 (95% CI 0.80-0.93) for PI-RADSv1 (p = 0.04). However, the pooled specificity was not significantly different (0.73 [95% CI 0.47-0.89] vs 0.75 [95% CI 0.36-0.94], respectively; p = 0.90). Conclusions: PI-RADSv2 shows good performance for the detection of PCa. PI-RADSv2 has higher pooled sensitivity than PI-RADSv1 without significantly different specificity. Patient summary: We reviewed all previous studies using Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) for prostate cancer detection. We found that the updated PI-RADSv2 shows significant improvement compared with the original PIRADSv1. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.