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

Evidence supports comparable PPV between biparametric MRI (bpMRI) and multiparametric MRI (mpMRI). However, concern of missed cancers limits wider bpMRI adoption. To compare bpMRI and mpMRI in terms of the NPV for clinically significant prostate cancer. 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. 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]. This study found no evidence of a significant difference between bpMRI and mpMRI in NPV for clinically significant prostate cancer. 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.