Evidence map›Paper›PMID 24934207›Full record

ArticleBMJ open2014

Multiparametric MRI followed by targeted prostate biopsy for men with suspected prostate cancer: a clinical decision analysis.

Sarah R Willis, Hashim U Ahmed, Caroline M Moore, Ian Donaldson, Mark Emberton, Alec H Miners, Jan van der Meulen

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Article
  3. Article
  4. Article
  5. Prostate MRI - an update for the referring urologist.Central European journal of urology · 2016
    Review
  6. Review
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Sarah R WillisDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Hashim U AhmedDivision of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Caroline M MooreDivision of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Ian DonaldsonDivision of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Mark EmbertonDivision of Surgery and Interventional Science, University College London, London, UK Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Alec H MinersDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Jan van der MeulenDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.

Funding

Department of Health 09/22/67Medical Research Council G0701302Medical Research Council G1002509Wellcome Trust
6 · The paper itself

Abstract

objectiveTo compare the diagnostic outcomes of the current approach of transrectal ultrasound (TRUS)-guided biopsy in men with suspected prostate cancer to an alternative approach using multiparametric MRI (mpMRI), followed by MRI-targeted biopsy if positive.

designClinical decision analysis was used to synthesise data from recently emerging evidence in a format that is relevant for clinical decision making. POPULATION: A hypothetical cohort of 1000 men with suspected prostate cancer.

interventionsmpMRI and, if positive, MRI-targeted biopsy compared with TRUS-guided biopsy in all men. OUTCOME MEASURES: We report the number of men expected to undergo a biopsy as well as the numbers of correctly identified patients with or without prostate cancer. A probabilistic sensitivity analysis was carried out using Monte Carlo simulation to explore the impact of statistical uncertainty in the diagnostic parameters.

resultsIn 1000 men, mpMRI followed by MRI-targeted biopsy 'clinically dominates' TRUS-guided biopsy as it results in fewer expected biopsies (600 vs 1000), more men being correctly identified as having clinically significant cancer (320 vs 250), and fewer men being falsely identified (20 vs 50). The mpMRI-based strategy dominated TRUS-guided biopsy in 86% of the simulations in the probabilistic sensitivity analysis.

conclusionsOur analysis suggests that mpMRI followed by MRI-targeted biopsy is likely to result in fewer and better biopsies than TRUS-guided biopsy. Future research in prostate cancer should focus on providing precise estimates of key diagnostic parameters.

Indexed as

Decision Support TechniquesMagnetic Resonance ImagingDecision TreesHumansImage-Guided BiopsyMaleProstateProstatic Neoplasmsbiopsydecision treesdiagnosisprostatic neoplasms

Identifiers

PMID24934207
PMCPMC4067835

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Registered trials

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