Precisión diagnóstica de la resonancia magnética multiparamétrica en cáncer de próstata: revisión sistemática y metaanálisis bivariado de 4954 pacientes

Introduction: multiparametric magnetic resonance imaging (mpMRI) has proven to be crucial for detecting clinically significant prostate cancer (csPCa), a disease that remains one of the leading causes of morbidity and mortality in men. Studies such as PROMIS and PRECISION show that, when combined with targeted biopsy, mpMRI outperforms systematic transrectal biopsy with 10 to 12 cores in diagnostic accuracy. Objective: to evaluate the diagnostic efficacy of mpMRI in an updated context. Design and methods: this study is a subanalysis of a protocol registered in PROSPERO (CRD42024552125). A systematic review was conducted using PubMed, CENTRAL Cochrane, and ClinicalTrials.gov, including articles published between 2012 and 2024. Studies comparing mpMRI with biparametric MRI (bpMRI) were selected. Risk of bias was assessed using the QUADAS-2 tool. Sensitivity, specificity, and area under the curve (AUC) were analyzed through a bivariate model; other diagnostic efficiency indicators were obtained using a univariate model. Results: nineteen studies with a total of 4954 patients were included. The pooled sensitivity was 90.7 %, specificity 64.4 %, and AUC 0.898, confirming its high diagnostic accuracy. Limitations: the main limitation was being a subanalysis subject to the guidelines of the original protocol. Originality and value: this is an updated meta-analysis with robust methodology and a large sample size that reinforces current evidence. Conclusions: the results demonstrate that mpMRI, even in an updated context and with a large sample size, maintains its high sensitivity, confirming it as an essential tool for the early diagnosis of csPCa.