bpMRI, mpMRI show comparable NPV for prostate cancer

Biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) show comparable negative predictive value (NPV) when it comes to identifying clinically significant prostate cancer, researchers have reported.

The results offer additional incentives for using bpMRI to diagnose the disease, wrote a team led by Emmanuel Salinas-Miranda, MD, of the Ottawa Hospital in Canada. The group's findings were published March 5 in the American Journal of Roentgenology.

"[Our study provides] further support for the use of bpMRI as an alternative to mpMRI in clinical practice, complementing prior literature showing comparable PPV [positive predictive value] between the two tests," it noted.

Biparametric MRI (bpMRI) has "emerged as an alternative to the standard-of-care approach of mpMRI," the team explained, as its benefits include "shorter examination times, increased patient tolerance, reduced costs, and increased accessibility mainly through avoidance of gadolinium-based contrast agents (GBCAs)." But wider use of the protocol has been limited by the potential for missed cancers.

"[A] primary concern regarding adoption of bpMRI is a potentially higher 'miss rate' for [clinically significant prostate cancer], especially for examinations with poor image quality or those that are interpreted by less-experienced radiologists," the authors wrote. "Thus, insight into the NPV of bpMRI would help inform the examination's integration into clinical practice."

Salinas-Miranda and colleagues compared the two types of exams via a review of 18 studies. They tracked negative examinations (PI-RADS or Likert category 1 or 2) classified as true or false negatives for clinically significant prostate cancer, with pathologic reference standard of biopsy and/or radical prostatectomy.

The key finding the group reported was that, overall, pooled NPV among the studies included in the research was not significantly different between bpMRI (n = 2,857 patients) and mpMRI (n = 2,751 patients) at 92% and 92% respectively (p = 0.9).

"The results complement prior evidence showing comparable PPV between bpMRI and mpMRI," the authors explained.

The research's outcome is promising, but more is needed, according to Salinas-Miranda and colleagues.

"Future studies should include randomized allocation of patients to undergo bpMRI or mpMRI with longitudinal follow-up for the reference-standard determinations," they concluded.

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