Exclusive MRI-targeted biopsy: not so fast

The design of the trial by Rouvière and colleagues differs from that of the aforementioned studies in one important way: all men had systematic biopsy, regardless of MRI results, and if a lesion was visible on MRI, targeted biopsy was also done. [...]a proportion of false-negative diagnoses could be calculated for men with no MRI-visible lesion. By employing each patient as his own control, this study design provided a conclusion that was not apparent in either of the earlier investigations: although targeting might be somewhat more sensitive than systematic sampling, the combination of the two methods provides the greatest detection. At the beginning of a new programme, the sensitivity of targeted biopsy alone might be less than is reported in previous clinical trials. [...]as elegantly shown in MRI-FIRST, combined biopsy should be considered as the present standard.