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Bianchi L, Gaudiano C, Mottola M, Corcioni B, Tonin E, Droghetti M, Cattabriga A, Cocozza M, Palmeri A, Coppola F, Giunchi F, Schiavina R, Fiorentino M, Brunocilla E, Golfieri R, Bevilacqua A. Beyond multiparametric MRI and towards radiomics to detect prostate cancer: A machine learning model to predict clinically significant lesions. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bianchi L, Pissavini A, Droghetti M, Pugliese M, Massimiliano P, Riccardo S, Balestrazzi E, Mei R, Farolfi A, Vetrone L, Serani F, Calderoni L, Stretta M, Morganti A, Schiavina R, Castellucci P, Fanti S, Brunocilla E. PSMA-PET in high-risk prostate cancer patients suitable for radical treatments: Scenario of detection and clinical impact for staging setting. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Sambri A, Fiore M, Rottoli M, Bianchi G, Pignatti M, Bortoli M, Ercolino A, Ancetti S, Perrone AM, De Iaco P, Cipriani R, Brunocilla E, Donati DM, Gargiulo M, Poggioli G, De Paolis M. A Planned Multidisciplinary Surgical Approach to Treat Primary Pelvic Malignancies. Curr Oncol 2023; 30:1106-1115. [PMID: 36661733 PMCID: PMC9857743 DOI: 10.3390/curroncol30010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The pelvic anatomy poses great challenges to orthopedic surgeons. Sarcomas are often large in size and typically enclosed in the narrow confines of the pelvis with the close proximity of vital structures. The aim of this study is to report a systematic planned multidisciplinary surgical approach to treat pelvic sarcomas. Seventeen patients affected by bone and soft tissue sarcomas of the pelvis, treated using a planned multidisciplinary surgical approach, combining the expertise of orthopedic oncology and other surgeons (colleagues from urology, vascular surgery, abdominal surgery, gynecology and plastic surgery), were included. Seven patients were treated with hindquarter amputation; 10 patients underwent excision of the tumor. Reconstruction of bone defects was conducted in six patients with a custom-made 3D-printed pelvic prosthesis. Thirteen patients experienced at least one complication. Well-organized multidisciplinary collaborations between each subspecialty are the cornerstone for the management of patients affected by pelvic sarcomas, which should be conducted in specialized centers. A multidisciplinary surgical approach is of paramount importance in order to obtain the best successful surgical results and adequate margins for achieving acceptable outcomes.
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Mottaran A, Ercolino A, Bianchi L, Piazza P, Manes F, Amirhassankhani S, Salvador M, Chessa F, Corcioni B, Bertaccini A, Schiavina R, Brunocilla E. Twenty Years' Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center. Medicina (B Aires) 2023; 59:medicina59010133. [PMID: 36676757 PMCID: PMC9865264 DOI: 10.3390/medicina59010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/24/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
Background and Objectives: The aim of this article is to present a single-surgeon, open retroperitoneal lymph node dissection (RPLND) series for testicular cancer in a high-volume center. Materials and Methods: We reviewed data from patients who underwent RPLND performed by an experienced surgeon at our institution between 2000 and 2019. We evaluated surgical and perioperative outcomes, complications, Recurrence-Free Survival (RFS), Overall Survival (OS), and Cancer-Specific Survival (CSS). Results: RPLND was performed in primary and secondary settings in 21 (32%) and 44 (68%) patients, respectively. Median operative time was 180 min. Median hospital stay was 6 days. Complications occurred in 23 (35%) patients, with 9 (14%) events reported as Clavien grade ≥ 3. Patients in the primary RPLND group were significantly younger, more likely to have NSGCT, had higher clinical N0 and M0, and had higher nerve-sparing RPLND (all p ≤ 0.04) compared to those in the secondary RPLND group. In the median follow-up of 120 (56-180) months, 10 (15%) patients experienced recurrence. Finally, 20-year OS, CSS, and RFS were 89%, 92%, and 85%, respectively, with no significant difference in survival rates between primary vs. secondary RPLND subgroups (p = 0.64, p = 0.7, and p = 0.31, respectively). Conclusions: Open RPLND performed by an experienced high-volume surgeon achieves excellent oncological and functional outcomes supporting the centralization of these complex procedures.
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Gaudiano C, Braccischi L, Taninokuchi Tomassoni M, Paccapelo A, Bianchi L, Corcioni B, Ciccarese F, Schiavina R, Droghetti M, Giunchi F, Fiorentino M, Brunocilla E, Golfieri R. Transverse prostate maximum sectional area can predict clinically significant prostate cancer in PI-RADS 3 lesions at multiparametric magnetic resonance imaging. Front Oncol 2023; 13:1082564. [PMID: 36890814 PMCID: PMC9986422 DOI: 10.3389/fonc.2023.1082564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
Background To evaluate multiparametric magnetic resonance imaging (mpMRI) parameters, such as TransPA (transverse prostate maximum sectional area), TransCGA (transverse central gland sectional area), TransPZA (transverse peripheral zone sectional area), and TransPAI (TransPZA/TransCGA ratio) in predicting prostate cancer (PCa) in prostate imaging reporting and data system (PI-RADS) 3 lesions. Methods Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), the area under the receiver operating characteristic curve (AUC), and the best cut-off, were calculated. Univariate and multivariate analyses were carried out to evaluate the capability to predict PCa. Results Out of 120 PI-RADS 3 lesions, 54 (45.0%) were PCa with 34 (28.3%) csPCas. Median TransPA, TransCGA, TransPZA and TransPAI were 15.4cm2, 9.1cm2, 5.5cm2 and 0.57, respectively. At multivariate analysis, location in the transition zone (OR=7.92, 95% CI: 2.70-23.29, P<0.001) and TransPA (OR=0.83, 95% CI: 0.76-0.92, P<0.001) were independent predictors of PCa. The TransPA (OR=0.90, 95% CI: 0.082-0.99, P=0.022) was an independent predictor of csPCa. The best cut-off of TransPA for csPCa was 18 (Sensitivity 88.2%, Specificity 37.2%, PPV 35.7%, NPV 88.9%). The discrimination (AUC) of the multivariate model was 0.627 (95% CI: 0.519-0.734, P<0.031). Conclusions In PI-RADS 3 lesions, the TransPA could be useful in selecting patients requiring biopsy.
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Droghetti M, Bianchi L, Beretta C, Balestrazzi E, Costa F, Feruzzi A, Piazza P, Roveroni C, Gaudiano C, Corcioni B, Giunchi F, Fiorentino M, Golfieri R, Schiavina R, Brunocilla E. Site-specific concordance of targeted and systematic biopsy cores at the index lesion on multiparametric magnetic resonance: can we spare the double-tap? World J Urol 2023; 41:27-33. [PMID: 36471133 DOI: 10.1007/s00345-022-04229-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To define the impact of systematic biopsy (SB) cores directed in the same area of index lesion in patients undergoing targeted biopsy (TB) and SB for prostate cancer (PCa) suspicion. METHODS We retrospectively analyzed data of biopsy-naïve patients with one single suspicious lesion at mpMRI who underwent TB plus SB at our institution between January 2015 and September 2021. A convenient sample of 336 patients was available for our analyses. The primary outcome was to evaluate the impact of overlapping SB cores directed to the index lesion at mpMRI. The secondary outcome was to evaluate the SB cores concordance in terms of highest Gleason Score Detection with TB cores. RESULTS 56% of patients were found to have site-specific concordance. SB cores determined disease upgrade in 22.1% patients. Thirty-one (16.4%) site-concordant patients experienced upgrade through overlapping SB cores, while 149 (79.3%) had no benefit by SB cores, and 8 (4.3%) patients had the worst ISUP at TB cores. 50% of the patients with negative-TB were upgraded to insignificant PCa, and 17.5% was upgraded from negative to unfavorable-intermediate- or high-risk PCa. Overall, 14 (19.4%) patients were also upgraded from ISUP 1 on TB to csPCa, with 28.5% of these harboring high-risk PCa. In csPCas at TB, 9 (12.5%) patients were upgraded from intermediate- to high-risk disease by SB. CONCLUSIONS TB alone consents to identify worst ISUP PCa in vast majority of patients scheduled for biopsy. A non-negligible number of patients are upgraded via-SB cores, including also index lesion overlapping cores. Omitting these cores might lead to a suboptimal patient management.
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Bianchi L, Ceci F, Costa F, Balestrazzi E, Droghetti M, Piazza P, Pissavini A, Mei R, Farolfi A, Castellucci P, Puliatti S, Larcher A, Gandaglia G, Robesti D, Mottrie A, Briganti A, Morganti AG, Fanti S, Montorsi F, Schiavina R, Brunocilla E. The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence. Cancers (Basel) 2022; 15:cancers15010247. [PMID: 36612242 PMCID: PMC9818949 DOI: 10.3390/cancers15010247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. Methods: 324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (≤3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were: Metastases-free survival (MFS) and Castration Resistant Pca free survival (CRPC-FS). Results: median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p ≥ 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p ≤ 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p ≤ 0.03). Conclusion: PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.
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Piazza P, Bianchi L, Luzzago S, Bandini M, Mottaran A, Amirhassankhani S, Puliatti S, De Concilio B, Celia A, Serra C, Cappelli A, Modestino F, De Cinque A, Golfieri R, Musi G, Lugano A, De Cobelli F, Mauri G, Orsi F, Capitanio U, Schiavina R, De Cobelli O, Montorsi F, Brunocilla E. The impact of histology and type of energy used on oncological outcomes after local tumor ablation of small renal masses. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Droghetti M, Bortolani B, Cercenelli L, Piazza P, Boschi S, Mottaran A, Chessa F, Ercolino A, Angiolini A, Lodi S, Pissavini A, Fontanella L, Spinozzi L, Melloni R, Bevilacqua F, Cangemi D, Gaudiano C, Corcioni B, Golfieri R, Marcelli E, Bianchi L, Schiavina R, Brunocilla E. The impact of 3D modeling in surgical planning and outcomes of partial nephrectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02545-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bianchi L, Vetrone L, Mei R, Farolfi A, Giunchi F, De Giovanni A, Serani F, Costa F, Droghetti M, Pissavini A, Schiavina R, Brunocilla E, Castellucci P, Fanti S. Immunohistochemical PSMA expression and histology predictors in primary staging high-risk prostate cancer patients studied with PSMA PET/CT. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Piazza P, Bianchi L, Luzzago S, Bandini M, Amirhassankhani S, Droghetti M, Celia A, Serra C, Cappelli A, De Cinque A, Modestino F, Golfieri R, Musi G, Gallina A, De Cobelli F, Mauri G, Orsi F, Capitanio U, Schiavina R, De Cobelli O, Montorsi F, Brunocilla E. PERC-score as a nephrometry scoring system in percutaneous tumour ablation: Comparison with RENAL, mRENAL, PADUA and SPARE in a multi-centre series. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Porreca A, Di Gianfrancesco L, Artibani W, Busetto G, Carrieri G, Antonelli A, Bianchi L, Brunocilla E, Bocciardi A, Carini M, Celia A, Cochetti G, Gallina A, Mearini E, Minervini A, Schiavina R, Serni S, D’Agostino D, Corsi P, Crestani A. Robot-assisted, laparoscopic, and open radical cystectomy: Surgical data of 1400 patients from The Italian Radical Cystectomy Registry (RIC) on intraoperative outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bianchi L, Cercenelli L, Bortolani B, Piazza P, Droghetti M, Boschi S, Gaudiano C, Carpani G, Chessa F, Lodi S, Tartarini L, Bertaccini A, Golfieri R, Marcelli E, Schiavina R, Brunocilla E. 3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes. Front Oncol 2022; 12:1046505. [PMID: 36338693 PMCID: PMC9634646 DOI: 10.3389/fonc.2022.1046505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/07/2022] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE to evaluate the impact of 3D model for a comprehensive assessment of surgical planning and quality of partial nephrectomy (PN). MATERIALS AND METHODS 195 patients with cT1-T2 renal mass scheduled for PN were enrolled in two groups: Study Group (n= 100), including patients referred to PN with revision of both 2D computed tomography (CT) imaging and 3D model; Control group (n= 95), including patients referred to PN with revision of 2D CT imaging. Overall, 20 individuals were switched to radical nephrectomy (RN). The primary outcome was the impact of 3D models-based surgical planning on Trifecta achievement (defined as the contemporary absence of positive surgical margin, major complications and ≤30% postoperative eGFR reduction). The secondary outcome was the impact of 3D models on surgical planning of PN. Multivariate logistic regressions were used to identify predictors of selective clamping and Trifecta's achievement in patients treated with PN (n=175). RESULTS Overall, 73 (80.2%) patients in Study group and 53 (63.1%) patients in Control group achieved the Trifecta (p=0.01). The preoperative plan of arterial clamping was recorded as clampless, main artery and selective in 22 (24.2%), 22 (24.2%) and 47 (51.6%) cases in Study group vs. 31 (36.9%), 46 (54.8%) and 7 (8.3%) cases in Control group, respectively (p<0.001). At multivariate logistic regressions, the use of 3D model was found to be independent predictor of both selective or super-selective clamping and Trifecta's achievement. CONCLUSION 3D-guided approach to PN increase the adoption of selective clamping and better predict the achievement of Trifecta.
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Taninokuchi Tomassoni M, Cattabriga A, Gaudiano C, Ciccarese F, Corcioni B, Bianchi L, Schiavina R, Brunocilla E, Golfieri R. Dynamic FDG PET/CT on bladder paraganglioma: A case report. Front Med (Lausanne) 2022; 9:1002663. [PMID: 36300177 PMCID: PMC9588919 DOI: 10.3389/fmed.2022.1002663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022] Open
Abstract
Paraganglioma (PGL) is characterized by equivocal clinical manifestations and arriving to a suspicion might be challenging. Nevertheless, diagnostic imaging and nuclear medicine are a fundamental part of the diagnosis and management of this particular neuroendocrine tumor (NET). We herein report a rare case of bladder paraganglioma with unusual onset and typical PET/CT characteristics that led to its recognition.
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Costa F, Bianchi L, Pissavini A, Droghetti M, Piazza P, Balestrazzi E, Chessa F, Ceci F, Mei R, Farolfi A, Puliatti S, Larcher A, Gandaglia G, Mottrie A, Bianchi A, Fanti S, Montorsi F, Schiavina R, Brunocilla E. The impact of PSMA PET/CT on oncologic outcomes of patients with recurrent prostate cancer: the experience of 3 high-volume european centers. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Piazza P, Bianchi L, Chessa F, Droghetti M, Amirhassankhani S, Vagnoni V, Bertaccini A, Garofalo M, Costa F, Beretta C, Recenti D, Ercolino A, Balestrazzi E, Angiolini A, Manes F, Pissavini A, Fontanella L, Di Fresco S, Madeddu C, Mottaran A, Schiavina R, Brunocilla E. Perioperative and functional outcomes of robot-assisted radical cystectomy with totally intracorporeal orthotopic Y ileal neobladder: Results from a high-volume institution. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Ercolino A, Manes F, Vasuri F, Bianchi L, Garofalo M, Piazza P, Corcioni B, Schiavina R, Golfieri R, Fiorentino M, Colecchia M, Brunocilla E. A case report of myoid gonadal stromal tumor treated with testis sparing surgery. Transl Androl Urol 2022; 11:1458-1465. [PMID: 36386257 PMCID: PMC9641068 DOI: 10.21037/tau-22-179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background Myoid gonadal stromal tumors (MGST) of the testis represent a very rare finding. They are an emerging clinicopathological entity with specific features and identity. Nowadays, pathological recognition and diagnosis of MGSTs still represents a difficult challenge in most cases and there are no data of specific radiological features of these tumors expect for what seen by ultrasound; besides a conservative surgical approach was never performed to treat these lesions. Case Description We present the case of a 20-year-old young man patient with symptoms suspicious for left varicocele, who was incidentally diagnosed with right testicular nodule via scrotal doppler ultrasound powered with contrast enhancement infusion and subsequent multiparametric magnetic resonance imaging. Then, lesion was treated through a testis sparing surgical approach. Histopathology, which included an external revision by an experienced Center, revealed a MGST with benign features, so that no further treatment was considered. 3 and 12 months after surgery a contrast enhancement ultrasound was performed with no evidence of recurrence. Conclusions Previous reported cases of MGST were all difficult to characterize as a specific pathological entity; treatment usually applied was radical orchiectomy and a subsequent total Body CT was performed for staging purpose. No metastatic spreading nor recurrence were ever reported. Considering the favorable behavior of this pathologic entity, testis-sparing surgery with no radiation exposure during follow-up is a safe and effective strategy.
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Piazza P, Bianchi L, Luzzago S, Bandini M, Amirhassankhani S, Droghetti M, Celia A, Serra C, Cappelli A, De Cinque A, Modestino F, Golfieri R, Musi G, Gallina A, De Cobelli F, Mauri G, Orsi F, Capitanio U, Schiavina R, De Cobelli O, Montorsi F, Brunocilla E. Perc-score as a nephrometry scoring system in percutaneous tumour ablation: comparison with renal, mrenal, padua and spare in a multi-centre series. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ciccarese F, Corcioni B, Bianchi L, De Cinque A, Paccapelo A, Galletta GL, Schiavina R, Brunocilla E, Golfieri R, Gaudiano C. Clinical Application of the New Prostate Imaging for Recurrence Reporting (PI-RR) Score Proposed to Evaluate the Local Recurrence of Prostate Cancer after Radical Prostatectomy. Cancers (Basel) 2022; 14:cancers14194725. [PMID: 36230647 PMCID: PMC9562904 DOI: 10.3390/cancers14194725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: We investigated the diagnostic accuracy of the new Prostate Imaging for Recurrence Reporting (PI-RR) score and its inter-observer variability. Secondly, we compared the detection rate of PI-RR and PET and analyzed the correlation between Prostate Specific Antigen (PSA) levels and the PI-RR score. Methods: We included in the analysis 134 patients submitted to multiparametric magnetic resonance imaging for suspected local recurrence. The images were independently reviewed by two radiologists, assigning a value from 1 to 5 to the PI-RR score. Inter-observer agreement and diagnostic accuracy of the PI-RR score (compared to histopathological data, available for 19 patients) were calculated. The detection rate was compared to those of choline PET/CT (46 patients) and PSMA PET/CT (22 patients). The distribution of the PSA values in relation to the PI-RR scores was also analyzed. Results: The accuracy of the PI-RR score was 68.4%. The reporting agreement was excellent (K = 0.884, p < 0.001). The PI-RR showed a higher detection rate than choline PET/CT (69.6% versus 19.6%) and PSMA PET-CT (59.1% versus 22.7%). The analysis of the PSA distribution documented an increase in the PI-RR score as the PSA value increased. Conclusion: The excellent reproducibility of the PI-RR score supports its wide use in the clinical practice to standardize recurrence reporting. The detection rate of PI-RR was superior to that of PET, but was linked to the PSA level.
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d’Altilia N, Mancini V, Falagario UG, Martino L, Di Nauta M, Calò B, Del Giudice F, Basran S, Chung BI, Porreca A, Bianchi L, Schiavina R, Brunocilla E, Busetto GM, Bettocchi C, Annese P, Cormio L, Carrieri G. A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques. Cancers (Basel) 2022; 14:cancers14184350. [PMID: 36139511 PMCID: PMC9496957 DOI: 10.3390/cancers14184350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence “without pads” or “social continence” based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery.
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Bianchi L, Schiavina R, Bortolani B, Cercenelli L, Gaudiano C, Mottaran A, Droghetti M, Chessa F, Boschi S, Molinaroli E, Balestrazzi E, Costa F, Rustici A, Carpani G, Piazza P, Cappelli A, Bertaccini A, Golfieri R, Marcelli E, Brunocilla E. Novel Volumetric and Morphological Parameters Derived from Three-dimensional Virtual Modeling to Improve Comprehension of Tumor's Anatomy in Patients with Renal Cancer. Eur Urol Focus 2022; 8:1300-1308. [PMID: 34429273 DOI: 10.1016/j.euf.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Three-dimensional (3D) models improve the comprehension of renal anatomy. OBJECTIVE To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor's blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); ST (tumor's sphericity); ConvT (tumor's convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface). INTERVENTION RAPN with a 3D model. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss. RESULTS AND LIMITATIONS Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits. CONCLUSIONS Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN. PATIENT SUMMARY Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.
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Bicchetti M, Simone G, Giannarini G, Girometti R, Briganti A, Brunocilla E, Cardone G, De Cobelli F, Gaudiano C, Del Giudice F, Flammia S, Leonardo C, Pecoraro M, Schiavina R, Catalano C, Panebianco V. A novel pathway to detect muscle-invasive bladder cancer based on integrated clinical features and VI-RADS score on MRI: results of a prospective multicenter study. Radiol Med 2022; 127:881-890. [PMID: 35763251 PMCID: PMC9349064 DOI: 10.1007/s11547-022-01513-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
To determine the clinical, pathological, and radiological features, including the Vesical Imaging-Reporting and Data System (VI-RADS) score, independently correlating with muscle-invasive bladder cancer (BCa), in a multicentric national setting.
Method and Materials
Patients with BCa suspicion were offered magnetic resonance imaging (MRI) before trans-urethral resection of bladder tumor (TURBT). According to VI-RADS, a cutoff of ≥ 3 or ≥ 4 was assumed to define muscle-invasive bladder cancer (MIBC). Trans-urethral resection of the tumor (TURBT) and/or cystectomy reports were compared with preoperative VI-RADS scores to assess accuracy of MRI for discriminating between non-muscle-invasive versus MIBC. Performance was assessed by ROC curve analysis. Two univariable and multivariable logistic regression models were implemented including clinical, pathological, radiological data, and VI-RADS categories to determine the variables with an independent effect on MIBC.
Results
A final cohort of 139 patients was enrolled (median age 70 [IQR: 64, 76.5]). MRI showed sensitivity, specificity, PPV, NPV, and accuracy for MIBC diagnosis ranging from 83–93%, 80–92%, 67–81%, 93–96%, and 84–89% for the more experienced readers. The area under the curve (AUC) was 0.95 (0.91–0.99). In the multivariable logistic regression model, the VI-RADS score, using both a cutoff of 3 and 4 (P < .0001), hematuria (P = .007), tumor size (P = .013), and concomitant hydronephrosis (P = .027) were the variables correlating with a bladder cancer staged as ≥ T2. The inter-reader agreement was substantial (k = 0.814).
Conclusions
VI-RADS assessment scoring proved to be an independent predictor of muscle-invasiveness, which might implicate a shift toward a more aggressive selection approach of patients’ at high risk of MIBC, according to a novel proposed predictive pathway.
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Corcioni B, Brandi N, Marasco G, Gaudiano C, De Cinque A, Ciccarese F, Ercolino A, Schiavina R, Brunocilla E, Renzulli M, Golfieri R. Multiparametric Ultrasound for the diagnosis of Leydig cell tumours in non‐palpable testicular lesions. Andrology 2022; 10:1387-1397. [DOI: 10.1111/andr.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022]
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Busetto GM, D’Agostino D, Colicchia M, Palmer K, Artibani W, Antonelli A, Bianchi L, Bocciardi A, Brunocilla E, Carini M, Carrieri G, Cormio L, Falagario UG, De Berardinis E, Sciarra A, Leonardo C, Del Giudice F, Maggi M, de Cobelli O, Ferro M, Musi G, Ercolino A, Di Maida F, Gallina A, Introini C, Mearini E, Cochetti G, Minervini A, Montorsi F, Schiavina R, Serni S, Simeone C, Parma P, Serao A, Mangano MS, Pomara G, Ditonno P, Simonato A, Romagnoli D, Crestani A, Porreca A. Robot-Assisted, Laparoscopic, and Open Radical Cystectomy: Pre-Operative Data of 1400 Patients From The Italian Radical Cystectomy Registry. Front Oncol 2022; 12:895460. [PMID: 35600337 PMCID: PMC9117739 DOI: 10.3389/fonc.2022.895460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/06/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction The Italian Radical Cystectomy Registry (RIC) is an observational prospective study aiming to understand clinical variables and patient characteristics associated with short- and long-term outcomes among bladder cancer (BC) patients undergoing radical cystectomy (RC). Moreover, it compares the effectiveness of three RC techniques - open, robotic, and laparoscopic. Methods From 2017 to 2020, 1400 patients were enrolled at one of the 28 centers across Italy. Patient characteristics, as well as preoperative, postoperative, and follow-up (3, 6, 12, and 24 months) clinical variables and outcomes were collected. Results Preoperatively, it was found that patients undergoing robotic procedures were younger (p<.001) and more likely to have undergone preoperative neoadjuvant chemotherapy (p<.001) and BCG instillation (p<.001). Hypertension was the most common comorbidity among all patients (55%), and overall, patients undergoing open and laparoscopic RC had a higher Charlson Comorbidities Index (CCI) compared to robotic RC (p<.001). Finally, laparoscopic patients had a lower G-stage classification (p=.003) and open patients had a higher ASA score (p<.001). Conclusion The present study summarizes the characteristic of patients included in the RIC. Future results will provide invaluable information about outcomes among BC patients undergoing RC. This will inform physicians about the best techniques and course of care based on patient clinical factors and characteristics.
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Tappero S, Parodi S, Mantica G, Borghesi M, Fiori C, Manfredi M, Bandini M, Mari A, Valastro F, Cerruto MA, Gozzo A, Chessa F, Schiavina R, Briganti A, Minervini A, Antonelli A, Porpiglia F, Brunocilla E, Montorsi F, Suardi N, Terrone C. MP23-15 IMPACT OF PREVIOUS TREATMENTS FOR PROSTATE CANCER ON PERIOPERATIVE AND ONCOLOGICAL OUTCOMES IN PATIENTS TREATED WITH RADICAL CYSTECTOMY FOR BLADDER CANCER. J Urol 2022. [DOI: 10.1097/ju.0000000000002562.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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