Diagnostic performance of ESUR scoring system for extraprostatic prostate cancer extension: A meta-analysis

We aimed to evaluate the diagnostic performance of the European Society of Urogenital Radiology (ESUR) scoring system for detection of extraprostatic extension (EPE) in prostate cancer (PCa) by performing a meta-analysis.

A literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar was performed to identify relevant studies from January 2012 to December 2020. We included diagnostic accuracy studies using ESUR scoring system for detection of EPE, and with prostatectomy histopathological results as the reference standard. Quality assessment was performed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The summary estimates of sensitivity and specificity were pooled using bivariate random-effects modeling. We conducted multiple subgroup analyses and meta-regression to explore varied clinical settings.

10 studies with a total of 1698 participants were included in this meta-analysis. Pooled sensitivity and specificity were 0.71 (95% CI 0.61-0.80) and 0.76 (95% CI 0.67-0.84), respectively, with the area under ROC of 0.80 (95% CI 0.77-0.84). The Higgins I² statistics demonstrated substantial heterogeneity in both sensitivity (I² = 86.5%) and specificity (I² = 91.6%), meta-regression revealed that the cutoff values (ESUR score ≥ 3 vs. ESUR score ≥ 4, P = 0.02) and malignancy rate (<40% vs. ≥40%, P = 0.04) were significant factors responsible for heterogeneity. Using endorectal coil and higher field strength (3.0 T) showed no additional benefit for EPE detection.

The evidence available for ESUR scoring system tends to show moderate diagnostic performance for detection of EPE, and the cutoff values (P = 0.02) and malignancy rate (P = 0.04) were significant factors contributed to the heterogeneity.