SynthesisEuropean radiology2025
Detection rates for prostate cancer using PI-RADS 2.1 upgrading rules in transition zone lesions align with risk assessment categories: a systematic review and meta-analysis.
Synthesis in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Development and internal validation of a noninvasive predictive model based on iron and fat measurements for pathologic risk stratification in prostate cancer.Translational andrology and urology · 2026Article
- Location- and ADC-based stratification of transition zone PI-RADS 3 lesions to optimize biopsy indication.Abdominal radiology (New York) · 2026Article
- Navigating PI-RADS v2.1 in clinical practice: pitfalls, variability, and the supportive role of AI.Abdominal radiology (New York) · 2026Review
- The evolving PI-RADS paradigm.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Review
- Non-Invasive Detection of Prostate Cancer with Novel Time-Dependent Diffusion MRI and AI-Enhanced Quantitative Radiological Interpretation: PROS-TD-AI.Journal of imaging · 2026Article
- Incremental diagnostic value of MRI PI-RADS classification combined with PSA density for prostate cancer.Frontiers in oncology · 2026Article
- Preoperative Magnetic Resonance Imaging Findings of the Transition Zone Predict Incidental Prostate Cancer in HoLEP.Cancer diagnosis & prognosisArticle
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Authors and funding
7 authors.
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Abstract
objectiveTo evaluate and compare cancer detection rates (CDRs) of transition zone (TZ) lesions upgraded from PI-RADSv2.1 score 2 to 3 ("2 + 1") or from 3 to 4 ("3 + 1") using DWI and assess their clinical impact. MATERIALS AND
methodsA systematic literature search was performed in Embase, Medline, and Web of Science for studies assessing TZ lesions with DWI in PI-RADSv2.1, with histology-confirmed grade group ≥ 2 cancer (GG ≥ 2) as the primary outcome. Risk of bias was evaluated using QUADAS-2. Pooled sensitivity, specificity, CDRs, and odds ratios (ORs) were estimated at the lesion level using a bivariate binomial random-effects model.
resultsEight studies with 1535 TZ lesions were included. GG ≥ 2 CDRs for PI-RADS scores of 1, 2, 2 + 1, 3, 3 + 1, 4, and 5 were 2% (95%CI: 0%-12%), 6% (4%-10%), 13% (6%-23%), 19% (15%-25%), 37% (24%-52%), 49% (32%-67%), and 73% (66%-79%), respectively. Scores of 2 + 1 had higher GG ≥ 2 CDRs than 2 (OR 3.37 (1.53-7.44), p = 0.003) but were similar to 3 (OR 0.80 (0.44-1.45), p = 0.46). Scores of 3 + 1 had higher GG ≥ 2 CDRs than 3 (OR 2.67 (1.27-5.59), p = 0.009) but were similar to 4 (OR 0.68 (0.33-1.44), p = 0.32). False-positive rates remained substantial (≥ 2 + 1: 69% (55%-80%); ≥ 3: 54% (46%-62%)).
conclusionThe risk of having significant prostate cancer in "2 + 1" and "3 + 1" TZ lesions, with an upgrading based on DWI images, is appropriately categorized within the PI-RADS v2.1 scoring system, as shown by this meta-analysis. KEY POINTS: Question PI-RADS v2.1 incorporates rules allowing scores of some transition zone (TZ) lesions to be increased. Literature on the clinical impact of these rules is scarce. Findings For TZ lesions upgraded with DWI: "2 + 1" lesions show a cancer detection rate (CDR) of 13%, and "3 + 1" lesions show a CDR of 37%. Clinical relevance Upgraded TZ lesions may impact individualized biopsy-decisions, especially as "3 + 1" lesions harbor significant disease in 2-out-of-5 patients. Still, the high rate of grade group = 1 and benign findings in these sub-categories emphasizes the need for strategies to minimize overdiagnosis.
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