10. Agreement analysis: added values of MRI‐pathway and systematic biopsy.
| Population | Target condition | N participants (studies) | Proportion prostate cancer detected in % (95% CI) | ||||||
| Biopsy status | MRI, proportion in % (95% CI)a | MRI‐pathway and SBx combined (total cancer detected) | MRI‐pathway | SBx | Both MRI‐pathway and SBx | Only MRI‐pathway (added valueb) | Only SBx (added valueb) | ||
| Mixedc | Positive + negative 100 (100 to 100) | G = 1d | 5442 (21) | 19.5 (16.9 to 22.7) | 10.3 (8.1 to 13.1) | 16.8 (14.2 to 19.9) | 7.6 (5.5 to 10.2) | 2.7 (1.8 to 4.0) | 9.2 (7.4 to 11.4) |
| G ≥ 1 | 6524 (24) | 50.2 (46.4 to 54.3) | 37.9 (33.4 to 42.6) | 43.3 (39.1 to 47.8) | 30.9 (26.3 to 36.0) | 6.9 (5.2 to 9.2) | 12.4 (10.2 to 14.9) | ||
| G ≥ 2 | 6944 (25) | 26.7 (23.3 to 30.7) | 22.9 (19.5 to 26.9) | 19.4 (15.9 to 23.6) | 15.6 (12.2 to 19.6) | 7.3 (5.9 to 9.0) | 3.8 (2.5 to 5.7) | ||
| G ≥ 3 | 5981 (21) | 15.0 (12.7 to 18.0) | 12.7 (10.5 to 15.6) | 9.7 (7.5 to 12.7) | 7.4 (5.3 to 10.2) | 5.3 (4.3 to 6.5) | 2.3 (1.4 to 3.7) | ||
| Positive 67.6 (60.2 to 74.3) | G = 1d | 3460 (19) | 19.7 (15.9 to 24.7) | 15.8 (12.2 to 20.7) | 15.8 (12 to 20.8) | 12.0 (8.4 to 16.8) | 3.9 (2.6 to 5.7) | 3.8 (2.3 to 6.2) | |
| G ≥ 1 | 3998 (20) | 68.0 (62.3 to 73.5) | 61.1 (54.1 to 67.7) | 58.9 (51.5 to 65.9) | 52.0 (43.6 to 59.9) | 9.1 (5.9 to 13.5) | 6.9 (4.6 to 10.1) | ||
| G ≥ 2 | 3998 (20) | 42.6 (37.6 to 48.1) | 37.9 (32.7 to 43.7) | 31.6 (26.2 to 37.9) | 27.0 (21.4 to 33.4) | 10.9 (8.5 to 13.9) | 4.6 (2.9 to 7.2) | ||
| G ≥ 3 | 3902 (18) | 24.2 (20.9 to 28.1) | 21 (17.8 to 24.8) | 16.3 (13.1 to 20.3) | 13.2 (10.1 to 16.9) | 7.9 (6.3 to 9.7) | 3.1 (1.9 to 5.2) | ||
| Negative 32.4 (25.7 to 39.8) | G = 1d | 1666 (19) | 16.8 (12.9 to 21.6) | NA | 16.8 (12.9 to 21.6) | NA | NA | 16.8 (12.9 to 21.6) | |
| G ≥ 1 | 1781 (20) | 23.1 (19.7 to 26.9) | NA | 23.1 (19.7 to 26.9) | NA | NA | 23.1 (19.7 to 26.9) | ||
| G ≥ 2 | 1781 (20) | 7.2 (5.3 to 9.8) | NA | 7.2 (5.3 to 9.8) | NA | NA | 7.2 (5.3 to 9.8) | ||
| G ≥ 3 | 1725 (18) | 2.7 (1.6 to 4.6) | NA | 2.7 (1.6 to 4.6) | NA | NA | 2.7 (1.6 to 4.6) | ||
| Biopsy‐naïve | Positive + negative 100 (100 to 100) | G = 1d | 4079 (17) | 20.9 (18.0 to 24.7) | 11.2 (8.4 to 14.9) | 18.5 (15.6 to 22.2) | 8.8 (6.2 to 12.3) | 2.4 (1.4 to 4.0) | 9.8 (8.0 to 11.8) |
| G ≥ 1 | 4799 (19) | 53.2 (48.7 to 57.9) | 41.0 (35.8 to 46.4) | 47.8 (42.8 to 52.9) | 35.6 (30.2 to 41.2) | 5.4 (3.6 to 8.0) | 12.2 (8.7 to 16.7) | ||
| G ≥ 2 | 5219 (20) | 27.7 (23.7 to 32.6) | 23.4 (19.4 to 28.2) | 21.4 (17.2 to 26.5) | 17.1 (13.0 to 22) | 6.3 (4.8 to 8.2) | 4.3 (2.6 to 6.9) | ||
| G ≥ 3 | 4306 (16) | 15.5 (12.6 to 19.5) | 12.7 (9.9 to 16.5) | 10.8 (8.0 to 14.8) | 8.0 (5.4 to 11.6) | 4.7 (3.5 to 6.3) | 2.8 (1.7 to 4.8) | ||
| Positive 67.0 (58.7 to 74.4) | G = 1d | 2682 (16) | 21.1 (16.7 to 27.1) | 17.0 (12.6 to 22.9) | 17.7 (13.3 to 23.8) | 13.6 (9.3 to 19.5) | 3.4 (2.1 to 5.3) | 4.1 (2.5 to 6.7) | |
| G ≥ 1 | 2955 (17) | 70.9 (65.0 to 76.6) | 63.7 (56.3 to 70.6) | 63.8 (56.2 to 70.7) | 56.6 (47.7 to 64.6) | 7.1 (4.2 to 11.9) | 7.2 (4.7 to 10.8) | ||
| G ≥ 2 | 2955 (17) | 44.2 (38.6 to 50.4) | 39.2 (33.3 to 45.7) | 34.4 (28.3 to 41.3) | 29.5 (23.2 to 36.5) | 9.8 (7.1 to 13.2) | 4.9 (2.8 to 8.3) | ||
| G ≥ 3 | 2899 (15) | 24.8 (21.0 to 29.6) | 21.2 (17.4 to 25.7) | 17.5 (13.8 to 22.3) | 13.9 (10.3 to 18.3) | 7.3 (5.4 to 9.7) | 3.7 (2.2 to 6.1) | ||
| Negative 33.0 (25.6 to 41.3) | G = 1 | 1287 (16) | 18.4 (14.2 to 23.7) | NA | 18.4 (14.2 to 23.7) | NA | NA | 18.4 (14.2 to 23.7) | |
| G ≥ 1 | 1343 (17) | 25.5 (20.7 to 30.9) | NA | 25.5 (20.7 to 30.9) | NA | NA | 25.5 (20.7 to 30.9) | ||
| G ≥ 2 | 1343 (17) | 8.1 (5.6 to 11.6) | NA | 8.1 (5.6 to 11.6) | NA | NA | 8.1 (5.6 to 11.6) | ||
| G ≥ 3 | 1297 (15) | 3.0 (1.6 to 5.5) | NA | 3.0 (1.6 to 5.5) | NA | NA | 3.0 (1.6 to 5.5) | ||
|
Prior‐negative biopsy |
Positive + negative 100 (100 to 100) | G = 1d | 1202 (8) | 17.6 (13.0 to 25.0) | 9.8 (6.9 to 14.3) | 13.5 (8.9 to 21.0) | 5.8 (3.2 to 10.0) | 4.1 (2.6 to 6.2) | 7.7 (3.9 to 14.8) |
| G ≥ 1 | 1564 (10) | 40.7 (35.1 to 47.2) | 30.0 (24.1 to 37.0) | 30.3 (24.3 to 37.5) | 19.6 (13.7 to 27.1) | 10.3 (7.5 to 13.9) | 10.7 (7.4 to 15) | ||
| G ≥ 2 | 1564 (10) | 22.8 (20.0 to 26.2) | 20.5 (17.7 to 23.5) | 13.2 (10.8 to 16.4) | 10.9 (8.7 to 13.5) | 9.6 (7.7 to 11.8) | 2.3 (1.2 to 4.5) | ||
| G ≥ 3 | 1514 (9) | 12.6 (10.5 to 15.6) | 11.5 (9.4 to 14.2) | 6.3 (4.4 to 9.1) | 5.1 (3.4 to 7.7) | 6.3 (5.2 to 7.7) | 1.1 (0.5 to 2.6) | ||
| Positive 69.6 (54.7 to 81.3) | G = 1d | 655 (7) | 19.5 (13.9 to 28.8) | 16.5 (11.0 to 25.2) | 12.4 (7.2 to 21.6) | 9.4 (4.6 to 17.9) | 7.1 (4.1 to 11.8) | 3.0 (1.0 to 8.0) | |
| G ≥ 1 | 920 (8) | 54.8 (44.6 to 66.4) | 48.5 (37.0 to 61.5) | 39.4 (27.1 to 53.9) | 33.1 (20.1 to 48.7) | 15.4 (8.2 to 26.4) | 6.3 (3.8 to 9.8) | ||
| G ≥ 2 | 920 (8) | 31.3 (27.4 to 36.1) | 28.6 (24.7 to 33.1) | 18.3 (15.1 to 22.5) | 15.7 (12.7 to 19.1) | 13.0 (9.7 to 17.0) | 2.7 (1.2 to 5.7) | ||
| G ≥ 3 | 880 (7) | 17.9 (14.3 to 22.9) | 16.7 (13.1 to 21.5) | 9.4 (6.4 to 14.2) | 8.2 (5.2 to 12.6) | 8.5 (6.1 to 11.5) | 1.2 (0.4 to 3.2) | ||
| Negative 30.4 (18.7 to 45.3) | G = 1 | 341 (7) | 14.2 (5.9 to 30.2) | NA | 14.2 (5.9 to 30.2) | NA | NA | 14.2 (5.9 to 30.2) | |
| G ≥ 1 | 400 (8) | 19.5 (12.9 to 28.3) | NA | 19.5 (12.9 to 28.3) | NA | NA | 19.5 (12.9 to 28.3) | ||
| G ≥ 2 | 400 (8) | 5.3 (3.1 to 8.9) | NA | 5.3 (3.1 to 8.9) | NA | NA | 5.3 (3.1 to 8.9) | ||
| G ≥ 3 | 390 (7) | 3.3 (1.7 to 6.3) | NA | 3.3 (1.7 to 6.3) | NA | NA | 3.3 (1.7 to 6.3) | ||
| CI: confidence interval; G: International Society of Urological Pathology grade; MRI: magnetic resonance imaging; MRI‐pathway: magnetic resonance imaging with or without magnetic resonance imaging‐targeted biopsy; MRI‐TBx: magnetic resonance imaging‐targeted biopsy: N: number; NA: not applicable; SBx: systematic biopsy | |||||||||
aProportion of participants with a positive or negative MRI result, based on the studies reporting grade 2 or higher. bAdded value MRI‐pathway is the proportion of prostate cancer not detected by systematic biopsy but only by the MRI‐pathway; added value of systematic biopsy is the proportion of prostate cancer not detected by the MRI‐pathway but only by systematic biopsy. cMixed: biopsy‐naïve and prior‐negative biopsy men. dThe tests are considered as 'add‐on tests', taking into account grade reclassification by each test (Appendix 3). Therefore, G = 1 results differ from results in Table 15, where the tests are considered as 'replacement tests', not taking into account grade reclassification.