Abstract C28: MRI/Ultrasound image fused guided TRUS prostate biopsy: Multiparametric MRI low suspicion lesions do not correlate with high-grade prostate cancer

Introduction and Objectives: 3Telsa endorectal coil multiparametric magnetic resonance imaging (mpMRI) has been investigated as a new tool for physicians to improve prostate cancer detection. Depending on the number of MR sequences that are suggestive of cancer, MR lesions can be reported as having a low, moderate or high level of suspicion. Biopsy techniques to sample the MR lesions suspicious for cancer include in gantry platforms. While performing a prostate biopsy inside the MR gantry is challenging (long procedure times, expensive, not well tolerated by patients), platforms to perform office based MR / Ultrasound image fused TRUS biopsies have developed. While high suspicion lesions on MRI correlate strongly with the presence of cancer, the importance of low suspicion lesions has not been well characterized. We report the biopsy findings of patients with low suspicion lesions.

Methods: We reviewed all patients who underwent a 3 Tesla mpMRI of the prostate with endorectal coil from March 2007 to July 2011. Two radiologists independently reviewed and graded any suspicious lesions into low, moderate, or high risk groups. Lesions were stratified based on T2-weighted, spectroscopic, dynamic contrast enhanced (DCE) and diffusion weighted (DWI) MRI sequences. Low suspicion lesions are defined by a maximum of two positive parameters on mpMRI. Patients with only low suspicion lesions who subsequently underwent a random 12 core US biopsy + mpMRI/US fusion targeted biopsy were selected for and analyzed.

Results: Of 800 patients who received a mpMRI of the prostate, 92 patients (12%) had only low suspicion lesions on mpMRI. Mean age and PSA in this cohort were 59.7 years (36-81) and 7.84 ng/ml (0.3-64.7), respectively. All 92 patients underwent a mpMRI/US fusion biopsy plus a 12-core TRUS random biopsy. Sixty-two of these patients (67%) had no cancer detected. Of the remaining thirty patients (33%) who were diagnosed with cancer on biopsy, twenty-two patients had Gleason 6 disease and eight patients had Gleason 7 (3+4) disease. Ten patients went on to radical prostatectomy and no one was pathologically upgraded to high grade cancer. Thus, for low suspicion lesions, 90% had either Gleason 6 or no cancer on biopsy while 100% had no primary Gleason 4 on their biopsy.

Conclusions: Prostate MR imaging has improved considerably, as is true for many technology dependant medical devices. Currently 3T mpMRI of the prostate has become the most widely used imaging modality for lesion detection outside of ultrasound. As previously published, our image fusion biopsy platform allows for sampling of MRI suspicious areas. These results demonstrate that low suspicion lesions on mpMRI do not signify high grade cancer. This has implications not only for initial cancer detection and patient selection for treatment options, but may also obviate the need for annual biopsies in men on active surveillance. Larger cohort studies are required.

Citation Format: Peter A. Pinto, Jochen Kruecker, Maria Merino, W. Marston Linehan, Ismail Baris Turbey, Peter Choyke, Brad Wood. MRI/Ultrasound image fused guided TRUS prostate biopsy: Multiparametric MRI low suspicion lesions do not correlate with high-grade prostate cancer [abstract]. In: Proceedings of the AACR Special Conference on Advances in Prostate Cancer Research; 2012 Feb 6-9; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2012;72(4 Suppl):Abstract nr C28.

Menopausal-type symptoms among breast cancer patients on aromatase inhibitor therapy

OBJECTIVES

To examine self-reported menopausal-type symptoms among breast cancer patients on aromatase inhibitors (AIs) compared to women of the same age who had not been diagnosed with cancer, and to determine whether the percentage of breast cancer patients experiencing these symptoms changed over the first 6 months of AI treatment.

METHODS

Data from a 6-month cohort study of 100 breast cancer patients initiating AI therapy and of 200 women of a similar age without a history of cancer were analyzed. At baseline (prior to the initiation of AI therapy among the breast cancer patients), 3 months, and 6 months, a comprehensive questionnaire was administered to participants that ascertained data on the experiencing of specific menopausal-type symptoms.

RESULTS

The data showed statistically significant increases in the prevalence of certain symptoms from baseline to either follow-up point among the breast cancer patients; these symptoms included hot flushes, night sweats, pain during intercourse, hair loss, forgetfulness, depression, difficulty falling asleep, and interrupted sleep. Additionally, breast cancer patients were more likely than the women in the comparison group to report the new onset of many of these same symptoms during the follow-up time period.

CONCLUSIONS

Because bothersome symptoms and side-effects are a major reason for discontinuation and non-adherence to treatment, symptoms should be monitored and addressed by oncologists so that the breast cancer patient can maintain her quality of life and remain adherent to the treatment schedule.

Soft-tissue anatomy of the primates: phylogenetic analyses based on the muscles of the head, neck, pectoral region and upper limb, with notes on the evolution of these muscles

Apart from molecular data, nearly all the evidence used to study primate relationships comes from hard tissues. Here, we provide details of the first parsimony and Bayesian cladistic analyses of the order Primates based exclusively on muscle data. The most parsimonious tree obtained from the cladistic analysis of 166 characters taken from the head, neck, pectoral and upper limb musculature is fully congruent with the most recent evolutionary molecular tree of Primates. That is, this tree recovers not only the relationships among the major groups of primates, i.e. Strepsirrhini {Tarsiiformes [Platyrrhini (Cercopithecidae, Hominoidea)]}, but it also recovers the relationships within each of these inclusive groups. Of the 301 character state changes occurring in this tree, ca. 30% are non-homoplasic evolutionary transitions; within the 220 changes that are unambiguously optimized in the tree, ca. 15% are reversions. The trees obtained by using characters derived from the muscles of the head and neck are more similar to the most recent evolutionary molecular tree than are the trees obtained by using characters derived from the pectoral and upper limb muscles. It was recently argued that since the Pan/Homo split, chimpanzees accumulated more phenotypic adaptations than humans, but our results indicate that modern humans accumulated more muscle character state changes than chimpanzees, and that both these taxa accumulated more changes than gorillas. This overview of the evolution of the primate head, neck, pectoral and upper limb musculature suggests that the only muscle groups for which modern humans have more muscles than most other extant primates are the muscles of the face, larynx and forearm.

X-Ray Microscopy Of Multiphase Polymeric Materials

We have utilized the scanning transmission x-ray microscope at Brookhaven National Laboratory to acquire high energy resolution spectra of various polymers and to investigate the bulk characteristics of multiphasic polymeric materials with chemical sensitivity at a spatial resolution of about 50 nm. We present studies ranging from phase separated liquid crystalline polyesters and polyurethanes to various polymer blends. Improvements in the NEXAFS imaging and spectral acquisition protocol in the recent past provide much improved spectral fidelity and include in situ energy calibration with CO2.

The pragmatic use of apomorphine at the end of life

Parkinson's Disease (PD) is an irreversible degenerative neurological disorder with no known cure. Apomorphine is a potent short-acting D1/D2 dopamine agonist administered sub-cutaneously that is used in the treatment of PD. Optimising PD medication is an important aspect of end of life care. There are no previously reported cases of apomorphine providing symptom relief in terminal care of PD patients. This case highlights its potential benefits for symptom control at the end of life.

Association of interleukin-15-induced peripheral immune activation with hepatic stellate cell activation in persons coinfected with hepatitis C virus and HIV

Hepatic stellate cells (HSCs) mediate hepatitis C virus (HCV)-related liver fibrosis, and increased HSC activation in human immunodeficiency virus (HIV)/HCV coinfection may be associated with accelerated fibrosis. We examined the level of HSC activation in HIV/HCV-coinfected and HCV-monoinfected subjects and its relationship to the level of activation and gene expression of peripheral immune cells in coinfected subjects. HSC activation levels positively correlated with peripheral CD4+ and CD8+ T cell immune activation and were associated with enhanced interleukin-15 (IL-15) gene expression, suggesting a pathogenic role for IL-15-driven immunomediated hepatic fibrosis. Future strategies that reduce immune activation and HSC activation may delay progression of liver fibrosis.

Rapid development of advanced liver fibrosis after acquisition of hepatitis C infection during primary HIV infection

We report the first reported case of a 61-year-old MSM who was diagnosed with syphilis, primary HIV infection, and acute hepatitis C (HCV) within the same time period who rapidly developed significant liver fibrosis within 6 months of acquisition of both infections. It has been well described that individuals with primary HIV infection have an increase in activated CD8+ T cells, which causes a state of immune activation as was evident in this patient. Acquisition of HCV during this time could have further skewed this response resulting in massive hepatocyte destruction, inflammation, and subsequent liver fibrosis. Recent literature suggest that MSM with primary HIV infection have higher rates of acquisition of HCV than other HIV-positive cohorts and HCV acquisition can occur very soon after acquiring HIV. This case of rapid hepatic fibrosis progression coupled with the increasing incidence of HCV in individuals with primary HIV infection demonstrates a need for this phenomenon to be studied more extensively.

MRI-compatible Hands-on Cooperative Control of a Pneumatically Actuated Robot

MRI compatible robots are emerging as useful tools for image guided interventions. A shared control between a user and the MRI compatible robot makes it more intuitive instrument especially during setup phases of interventions. We present a MRI compatible, hands-on cooperative system using Innomotion robotic arm. An economic MRI compatible user input sensor was developed and its functionality was tested under typical application conditions. Performance improvement in phantom tasks shows promise of adding hands-on interface in MRI compatible robots.

Cranial base evolution within the hominin clade

The base of the cranium (i.e. the basioccipital, the sphenoid and the temporal bones) is of particular interest because it undergoes significant morphological change within the hominin clade, and because basicranial morphology features in several hominin species diagnoses. We use a parsimony analysis of published cranial and dental data to predict the cranial base morphology expected in the hypothetical last common ancestor of the Pan-Homo clade. We also predict the primitive condition of the cranial base for the hominin clade, and document the evolution of the cranial base within the major subclades within the hominin clade. This analysis suggests that cranial base morphology has continued to evolve in the hominin clade, both before and after the emergence of the genus Homo.

A d.c. magnetic metamaterial

Electromagnetic metamaterials are a class of materials that have been artificially structured on a subwavelength scale. They are currently the focus of a great deal of interest because they allow access to previously unrealizable properties such as a negative refractive index. Most metamaterial designs have so far been based on resonant elements, such as split rings, and research has concentrated on microwave frequencies and above. Here, we present the first experimental realization of a non-resonant metamaterial designed to operate at zero frequency. Our samples are based on a recently proposed template for an anisotropic magnetic metamaterial consisting of an array of superconducting plates. Magnetometry experiments show a strong, adjustable diamagnetic response when a field is applied perpendicular to the plates. We have calculated the corresponding effective permeability, which agrees well with theoretical predictions. Applications for this metamaterial may include non-intrusive screening of weak d.c. magnetic fields.