HIFU局部前列腺癌部分腺体消融后复发的MRI准确性：系统评价与Meta分析

前列腺癌仍是男性中最常被诊断的癌症。高强度聚焦超声（HIFU）作为一种热消融技术，旨在实现部分腺体消融（PGA），最大程度减少旁器官损伤同时控制肿瘤。HIFU PGA后的监测依赖于连续的PSA检测、多参数MRI和活检。MRI在检测临床意义上的癌症（csPCa）复发的诊断准确性存在挑战。本系统评价与Meta分析旨在评估MRI在检测HIFU PGA后局部前列腺癌早期复发中的准确性。遵循PRISMA指南，通过MEDLINE和Scopus进行至2024年5月8日的全面文献检索。纳入的研究包括随机对照试验和队列研究，研究对象为接受HIFU PGA为主要治疗的局部前列腺癌男性。主要评价指标包括基于活检结果，MRI检测临床意义癌（ISUP ≥ 2）的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。对具有足够csPCa和无csPCa患者（≥5例）进行统计分析。共有15项研究符合纳入标准，涵盖1093名患者，其中12项研究适合进行Meta分析。HIFU PGA后检测临床显著性前列腺癌（csPCa）复发的MRI敏感性变化范围广（0-89%），合并的敏感性为0.52（95% CI：0.36-0.68）。特异性范围为44%至100%，合并特异性为0.81（95% CI：0.68-0.91）。合并NPV为0.82（95% CI：0.72-0.90），合并PPV为0.50（95% CI：0.35-0.65）。三项研究报道了在治疗区内的诊断性能，敏感性范围为0.42至0.80，特异性范围为0.45至0.97。HIFU局部腺体消融后，MRI在检测临床意义上的复发的诊断性能较低，治疗叶的合并敏感性为0.52（95% CI：0.36-0.68），特异性为0.81（95% CI：0.68-0.91）。本评价的局限性包括报告复发部位的研究数量较少，尤其是在治疗叶内外。

Prostate cancer remains the most frequently diagnosed cancer among men. High-Intensity Focused Ultrasound (HIFU) has emerged as a thermal ablative technique for partial-gland-ablation (PGA), aiming to minimize collateral damage while maximizing tumor control. Monitoring after HIFU PGA relies on serial PSA testing, multiparametric-MRI, and biopsies. The diagnostic accuracy of MRI for clinically-significant cancer(csPCa) recurrence is challenging.This systematic review and meta-analysis aim to evaluate the accuracy of MRI in detecting early recurrence of localized prostate cancer following HIFU PGA.Adhering to PRISMA guidelines, a comprehensive literature search was conducted until May 8th 2024 using MEDLINE and Scopus. The inclusion criteria encompassed randomized controlled trials and cohort studies involving men diagnosed with localized prostate cancer who had as primary treatment HIFU PGA. The primary outcome measures included the sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) of MRI for csPCa(ISUP ≥ 2) based on biopsy results. We pooled data from studies with sufficient csPCa and csPCa-free patients (≥5) post HIFU for statistical analysis.Fifteen studies meet the inclusion criteria, encompassing 1093 patients and 12 studies were eligible for meta-analysis. MRI sensitivity in detecting clinically-significant prostate cancer (csPCa) recurrence post HIFU PGA varied widely (0-89%), with a pooled sensitivity of 0.52 (95% CI:0.36-0.68). Specificity ranged from 44% to 100%, with a pooled specificity of 0.81 (95% CI:0.68-0.91). The pooled NPV was 0.82 (95% CI:0.72-0.90), and the pooled PPV was 0.50 (95% CI:0.35-0.65). Three studies reported in-field diagnostic performance with sensitivities ranging from 0.42 to 0.80 and specificities from 0.45 to 0.97.MRI accuracy for clinically-significant recurrence after partial gland ablation with HIFU for localized prostate cancer shows low diagnostic performance in the treated lobe with pooled sensitivity of 0.52 (95% CI:0.36-0.68) and specificity of 0.81 (95% CI:0.68-0.91). Limits of this review include the low number of studies reporting about site of recurrence in or out of the treated lobe.