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Bucher AM, Egger J, Dietz J, Strecker R, Hilbert T, Frodl E, Wenzel M, Penzkofer T, Hamm B, Chun FK, Vogl T, Kleesiek J, Beeres M. Value of MRI - T2 Mapping to Differentiate Clinically Significant Prostate Cancer. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01150-6. [PMID: 38926263 DOI: 10.1007/s10278-024-01150-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Standardized reporting of multiparametric prostate MRI (mpMRI) is widespread and follows international standards (Pi-RADS). However, quantitative measurements from mpMRI are not widely comparable. Although T2 mapping sequences can provide repeatable quantitative image measurements and extract reliable imaging biomarkers from mpMRI, they are often time-consuming. We therefore investigated the value of quantitative measurements on a highly accelerated T2 mapping sequence, in order to establish a threshold to differentiate benign from malignant lesions. For this purpose, we evaluated a novel, highly accelerated T2 mapping research sequence that enables high-resolution image acquisition with short acquisition times in everyday clinical practice. In this retrospective single-center study, we included 54 patients with clinically indicated MRI of the prostate and biopsy-confirmed carcinoma (n = 37) or exclusion of carcinoma (n = 17). All patients had received a standard of care biopsy of the prostate, results of which were used to confirm or exclude presence of malignant lesions. We used the linear mixed-effects model-fit by REML to determine the difference between mean values of cancerous tissue and healthy tissue. We found good differentiation between malignant lesions and normal appearing tissue in the peripheral zone based on the mean T2 value. Specifically, the mean T2 value for tissue without malignant lesions was (151.7 ms [95% CI: 146.9-156.5 ms] compared to 80.9 ms for malignant lesions [95% CI: 67.9-79.1 ms]; p < 0.001). Based on this assessment, a limit of 109.2 ms is suggested. Aditionally, a significant correlation was observed between T2 values of the peripheral zone and PI-RADS scores (p = 0.0194). However, no correlation was found between the Gleason Score and the T2 relaxation time. Using REML, we found a difference of -82.7 ms in mean values between cancerous tissue and healthy tissue. We established a cut-off-value of 109.2 ms to accurately differentiate between malignant and non-malignant prostate regions. The addition of T2 mapping sequences to routine imaging could benefit automated lesion detection and facilitate contrast-free multiparametric MRI of the prostate.
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Affiliation(s)
- Andreas Michael Bucher
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Jan Egger
- Institute for AI in Medicine, University Hospital Essen, Girardetstraße 2, 45131, Essen, Germany.
| | - Julia Dietz
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Ralph Strecker
- Siemens Healthineers AG, (EMEA Scientific Partnerships), Henkestraße 127, 91052, Erlangen, Germany
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, EPFL, QI E, 1015, Lausanne, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Eric Frodl
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Mike Wenzel
- Department of Urology, Goethe University Hospital, Goethe University Frankfurt, Frankfurt, Germany, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Kh Chun
- Department of Urology, Goethe University Hospital, Goethe University Frankfurt, Frankfurt, Germany, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Jens Kleesiek
- Institute for AI in Medicine, University Hospital Essen, Girardetstraße 2, 45131, Essen, Germany
- Department of Physics, TU Dortmund University, Otto-Hahn-Straße 4, 44227, Dortmund, Germany
- Cancer Research Center Cologne Essen (CCCE), West German Cancer Center Essen (WTZ), 45122, Essen, Germany
- German Cancer Research Center (DKFZ), Partner site University Hospital Essen, German Cancer Consortium (DKTK), 45122, Essen, Germany
- Medical Faculty, University of Duisburg-Essen, 45122, Essen, Germany
| | - Martin Beeres
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
- Departement of Neuroradiology, University-Hospital of Giessen and Marburg Campus Marburg, Baldingerstraße 1, 35043, Marburg, Germany
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Xiao Y, Zeng Y, Han L, Lin G, Ke H, Xu S, Lyu G, Li S. A novel simplified transperineal prostate biopsy guided by perineal ultrasound. Br J Radiol 2024; 97:1351-1356. [PMID: 38781498 PMCID: PMC11186561 DOI: 10.1093/bjr/tqae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 03/06/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Prostate biopsies are mainly performed through transrectal or perineal approaches, while ultrasound probes are located in the rectum for guidance. However, reports on the use of perineal ultrasound-guided transperineal prostate biopsy (PG-TPPB) are few. METHODS A retrospective case-control study was designed. A total of 111 patients who underwent PG-TPPB from February 2019 to December 2020 were investigated retrospectively. Simultaneously, 188 patients who underwent transrectal prostate biopsy (TRPB) were included as control. The prostate cancer detection rates (PCDR), complication rates, and application values were compared between the 2 groups. RESULTS The overall PCDR in the PG-TPPB and TRPB groups were 33.3% (37/111) and 39.9% (75/188), respectively (P = .258). There was no significant difference in the PCDR between the 2 groups under each prostate-specific antigen level (all P > .05). The single-needle PCDR in the PG-TPPB and TRPB groups were 21.5% (277/1 287) and 24.0% (513/2 134), respectively (P = .091). The incidence of complications in the PG-TPPB group was significantly lower than that in the TRPB group (8.1% vs 21.3%, P = .003). CONCLUSIONS The PCDRs of PG-TPPB and TRPB were the same. However, the postoperative complication rate of PG-TPPB was significantly lower than that of TRPB. Moreover, PG-TPPB required simpler equipment and did not require enema administration, which is suitable for patients with rectal contraindications. ADVANCES IN KNOWLEDGE The reports on PG-TPPB are few. Our study indicated that PG-TPPB reduced the postoperative complication rate. Moreover, PG-TPPB required simpler equipment. Importantly, PG-TPPB is suitable for patients with rectal contraindications.
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Affiliation(s)
- Yang Xiao
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Yating Zeng
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Lina Han
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Guobin Lin
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Helin Ke
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Shaodan Xu
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Guorong Lyu
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
- Department of Medicine, Quanzhou Medical College, Quanzhou, 362000, China
| | - Shilin Li
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
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Wenzel M, von Hardenberg J, Welte MN, Doryumu S, Hoeh B, Wittler C, Höfner T, Kriegmair MC, Michel MS, Chun FK, Herrmann J, Mandel P, Westhoff N. Monoprophylaxis With Cephalosporins for Transrectal Prostate Biopsy After the Fluoroquinolone-Era: A Multi-Institutional Comparison of Severe Infectious Complications. Front Oncol 2021; 11:684144. [PMID: 34178678 PMCID: PMC8222717 DOI: 10.3389/fonc.2021.684144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background To compare severe infectious complication rates after transrectal prostate biopsies between cephalosporins and fluoroquinolones for antibiotic monoprophylaxis. Material and Methods In the multi-institutional cohort, between November 2014 and July 2020 patients received either cefotaxime (single dose intravenously), cefpodoxime (multiple doses orally) or fluoroquinolones (multiple-doses orally or single dose intravenously) for transrectal prostate biopsy prophylaxis. Data were prospectively acquired and retrospectively analyzed. Severe infectious complications were evaluated within 30 days after biopsy. Logistic regression models predicted biopsy-related infectious complications according to antibiotic prophylaxis, application type and patient- and procedure-related risk factors. Results Of 793 patients, 132 (16.6%) received a single dose of intravenous cefotaxime and were compared to 119 (15%) who received multiple doses of oral cefpodoxime and 542 (68.3%) who received fluoroquinolones as monoprophylaxis. The overall incidence of severe infectious complications was 1.0% (n=8). No significant differences were observed between the three compared groups (0.8% vs. 0.8% vs. 1.1%, p=0.9). The overall rate of urosepsis was 0.3% and did not significantly differ between the three compared groups as well. Conclusion Monoprophylaxis with third generation cephalosporins was efficient in preventing severe infectious complications after prostate biopsy. Single intravenous dose of cefotaxime and multiday regimen of oral cefpodoxime showed a low incidence of infectious complications <1%. No differences were observed in comparison to fluoroquinolones.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.,GeSRU Academics Prostate Cancer Working Group, Planegg, Germany
| | - Jost von Hardenberg
- GeSRU Academics Prostate Cancer Working Group, Planegg, Germany.,Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maria N Welte
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.,GeSRU Academics Prostate Cancer Working Group, Planegg, Germany
| | - Samuel Doryumu
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Thomas Höfner
- GeSRU Academics Prostate Cancer Working Group, Planegg, Germany.,Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Felix Kh Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Jonas Herrmann
- GeSRU Academics Prostate Cancer Working Group, Planegg, Germany.,Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Niklas Westhoff
- GeSRU Academics Prostate Cancer Working Group, Planegg, Germany.,Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Immunohistochemistry for Prostate Biopsy-Impact on Histological Prostate Cancer Diagnoses and Clinical Decision Making. ACTA ACUST UNITED AC 2021; 28:2123-2133. [PMID: 34207594 PMCID: PMC8293248 DOI: 10.3390/curroncol28030197] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND To test the value of immunohistochemistry (IHC) staining in prostate biopsies for changes in biopsy results and its impact on treatment decision-making. METHODS Between January 2017-June 2020, all patients undergoing prostate biopsies were identified and evaluated regarding additional IHC staining for diagnostic purpose. Final pathologic results after radical prostatectomy (RP) were analyzed regarding the effect of IHC at biopsy. RESULTS Of 606 biopsies, 350 (58.7%) received additional IHC staining. Of those, prostate cancer (PCa) was found in 208 patients (59.4%); while in 142 patients (40.6%), PCa could be ruled out through IHC. IHC patients harbored significantly more often Gleason 6 in biopsy (p < 0.01) and less suspicious baseline characteristics than patients without IHC. Of 185 patients with positive IHC and PCa detection, IHC led to a change in biopsy results in 81 (43.8%) patients. Of these patients with changes in biopsy results due to IHC, 42 (51.9%) underwent RP with 59.5% harboring ≥pT3 and/or Gleason 7-10. CONCLUSIONS Patients with IHC stains had less suspicious characteristics than patients without IHC. Moreover, in patients with positive IHC and PCa detection, a change in biopsy results was observed in >40%. Patients with changes in biopsy results partly underwent RP, in which 60% harbored significant PCa.
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Wenzel M, Preisser F, Wittler C, Hoeh B, Wild PJ, Tschäbunin A, Bodelle B, Würnschimmel C, Tilki D, Graefen M, Becker A, Karakiewicz PI, Chun FKH, Kluth LA, Köllermann J, Mandel P. Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy. Diagnostics (Basel) 2021; 11:882. [PMID: 34063557 PMCID: PMC8155831 DOI: 10.3390/diagnostics11050882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The impact of MRI-lesion targeted (TB) and systematic biopsy (SB) Gleason score (GS) as a predictor for final pathological GS still remains unclear. METHODS All patients with TB + SB, and subsequent radical prostatectomy (RP) between 01/2014-12/2020 were analyzed. Rank correlation coefficient predicted concordance with pathological GS for patients' TB and SB GS, as well as for the combined effect of SB + TB. RESULTS Of 159 eligible patients, 77% were biopsy naïve. For SB taken in addition to TB, a Spearman's correlation of +0.33 was observed regarding final GS. Rates of concordance, upgrading, and downgrading were 37.1, 37.1 and 25.8%, respectively. For TB, a +0.52 correlation was computed regarding final GS. Rates of concordance, upgrading and downgrading for TB biopsy GS were 45.9, 33.3, and 20.8%, respectively. For the combination of SB + TB, a correlation of +0.59 was observed. Rates of concordance, upgrading and downgrading were 49.7, 15.1 and 35.2%, respectively. The combined effect of SB + TB resulted in a lower upgrading rate, relative to TB and SB (both p < 0.001), but a higher downgrading rate, relative to TB (p < 0.01). CONCLUSIONS GS obtained from TB provided higher concordance and lower upgrading and downgrading rates, relative to SB GS with regard to final pathology. The combined effect of SB + TB led to the highest concordance rate and the lowest upgrading rate.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Peter J. Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
- Frankfurt Institute for Advanced Studies (FIAS), 60590 Frankfurt, Germany
- Wildlab, University Hospital Frankfurt MVZ GmbH, 60590 Frankfurt, Germany
| | - Alexandra Tschäbunin
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
- Department of Urology, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany; (D.T.); (M.G.)
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 3E4, Canada; (C.W.); (P.I.K.)
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (P.J.W.); (A.T.); (J.K.)
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, University Frankfurt, 60590 Frankfurt, Germany; (F.P.); (C.W.); (B.H.); (A.B.); (F.K.H.C.); (L.A.K.); (P.M.)
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