Shear-Wave Elastography for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-Analysis

The objective of this study is to review the diagnostic performance of shear-wave elastography (SWE) in the detection of prostate cancer (PCa).The MEDLINE, EMBASE, and Cochrane library databases were searched up to December 23, 2016. We included diagnostic accuracy studies that used SWE for PCa detection with prostatectomy or biopsy used as the reference standard. The methodologic quality of the studies was evaluated by two independent reviewers using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The sensitivity and specificity of all studies were calculated. Results were pooled and plotted in a hierarchical summary ROC plot with further exploration done using meta-regression analysis and subgroup analysis.Eight studies (a total of 1028 patients) were evaluated. The pooled sensitivity was 0.83 (95% CI, 0.66-0.92) with a specificity of 0.85 (95% CI, 0.78-0.90) for the detection of PCa. Study design (prospective vs retrospective) was the only significant factor affecting heterogeneity (p0.01). At subgroup analysis, the pooled sensitivity and specificity were 0.84 (95% CI, 0.64-0.94) and 0.84 (95% CI, 0.76-0.90), respectively, in studies using shear-wave speed imaging and 0.84 (95% CI, 0.64-0.94) and 0.86 (95% CI, 0.78-0.91), respectively, in studies based on per-lesion analysis.SWE shows good performance for the detection of PCa. However, specific recommendations regarding cutoff value cannot be made because of study heterogeneity.