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Dinneen E, Almeida-Magana R, Al-Hammouri T, Fernandes I, Mayor N, Mendes L, Winkler M, Silvanto A, Haider A, Freeman A, Shaw G. Intraoperative margin assessment during radical prostatectomy: is microscopy frozen in time or ready for digital defrost? Histopathology 2024. [PMID: 39104212 DOI: 10.1111/his.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Intraoperative frozen section (IFS) is used with the intention to improve functional and oncological outcomes for patients undergoing radical prostatectomy (RP). High resource requirements of IFS techniques such as NeuroSAFE may preclude widespread adoption, even if there are benefits to patients. Recent advances in fresh-tissue microscopic digital imaging technologies may offer an attractive alternative, and there is a growing body of evidence regarding these technologies. In this narrative review, we discuss some of the familiar limitations of IFS and compare these to the attractive counterpoints of modern digital imaging technologies such as the speed and ease of image generation, the locality of equipment within (or near) the operating room, the ability to maintain tissue integrity, and digital transfer of images. Confocal laser microscopy (CLM) is the modality most frequently reported in the literature for margin assessment during RP. We discuss several imitations and obstacles to widespread dissemination of digital imaging technologies. Among these, we consider how the 'en-face' margin perspective will challenge urologists and pathologists to understand afresh the meaning of positive margin significance. As a part of this, discussions on how to describe, categorize, react to, and evaluate these technologies are needed to improve patient outcomes. Limitations of this review include its narrative structure and that the evidence base in this field is relatively immature but developing at pace.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Ricardo Almeida-Magana
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Tarek Al-Hammouri
- Division of Surgery & Interventional Science, University College London, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Iona Fernandes
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Nikhil Mayor
- Department of Urology, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
- Imperial Prostate, Division of Surgery, Imperial College London, London, UK
| | - Larissa Mendes
- Department of Histopathology, University College Hospital London, London, UK
| | - Mathias Winkler
- Department of Urology, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
- Imperial Prostate, Division of Surgery, Imperial College London, London, UK
| | - Anna Silvanto
- Department of Histopathology, University College Hospital London, London, UK
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, London, UK
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
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Alessi S, Maggioni R, Luzzago S, Summers PE, Renne G, Zugni F, Belmonte M, Raimondi S, Vignati S, Mistretta FA, Di Meglio L, D'Ascoli E, Scarabelli A, Marvaso G, De Cobelli O, Musi G, Jereczek-Fossa BA, Curigliano G, Petralia G. Association between mpMRI detected tumor apparent diffusion coefficient and 5-year biochemical recurrence risk after radical prostatectomy. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01857-0. [PMID: 39014292 DOI: 10.1007/s11547-024-01857-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE To assess the ability of tumor apparent diffusion coefficient (ADC) values obtained from multiparametric magnetic resonance imaging (mpMRI) to predict the risk of 5-year biochemical recurrence (BCR) after radical prostatectomy (RP). MATERIALS AND METHODS This retrospective analysis included 1207 peripheral and 232 non-peripheral zone prostate cancer (PCa) patients who underwent mpMRI before RP (2012-2015), with the outcome of interest being 5-year BCR. ADC was evaluated as a continuous variable and as categories: low (< 850 µm2/s), intermediate (850-1100 µm2/s), and high (> 1100 µm2/s). Kaplan-Meier curves with log-rank testing of BCR-free survival, multivariable Cox proportional hazard regression models were formed to estimate the risk of BCR. RESULTS Among the 1439 males with median age 63 (± 7) years, the median follow-up was 59 months, and 306 (25%) patients experienced BCR. Peripheral zone PCa patients with BCR had lower tumor ADC values than those without BCR (874 versus 1025 µm2/s, p < 0.001). Five-year BCR-free survival rates were 52.3%, 74.4%, and 87% for patients in the low, intermediate, and high ADC value categories, respectively (p < 0.0001). Lower ADC was associated with BCR, both as continuously coded variable (HR: 5.35; p < 0.001) and as ADC categories (intermediate versus high ADC-HR: 1.56, p = 0.017; low vs. high ADC-HR; 2.36, p < 0.001). In the non-peripheral zone PCa patients, no association between ADC and BCR was observed. CONCLUSION Tumor ADC values and categories were found to be predictive of the 5-year BCR risk after RP in patients with peripheral zone PCa and may serve as a prognostic biomarker.
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Affiliation(s)
- Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
| | - Roberta Maggioni
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Paul E Summers
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Giuseppe Renne
- Division of Uropathology and Intraoperative Diagnostic Division, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Fabio Zugni
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Maddalena Belmonte
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Sara Raimondi
- Molecular and Pharmaco-Epidemiology Unit Department of Experimental Oncology IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Silvano Vignati
- Molecular and Pharmaco-Epidemiology Unit Department of Experimental Oncology IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Elisa D'Ascoli
- Postgraduation School in Radiodiagnostics, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Alice Scarabelli
- Postgraduation School in Radiodiagnostics, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of Early Drug Development for Innovative Therapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Giuseppe Petralia
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
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3
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Musi G, Mistretta FA, Ivanova M, de Cobelli O, Bellin A, Vago GG, Pravettoni G, Pala O, Lepanto D, Bottero D, Piccinelli ML, Tallini M, Marvaso G, Ferro M, Petralia G, Jereczek-Fossa BA, Fusco N, Renne G, Luzzago S. Evaluation of margins during radical prostatectomy: confocal microscopy vs frozen section analysis. BJU Int 2024. [PMID: 38890817 DOI: 10.1111/bju.16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVES To test the performance of ex vivo fluorescence confocal microscopy (FCM; Vivascope 2500M-G4), as compared to intra-operative frozen section (IFS) analysis, to evaluate surgical margins during robot-assisted radical prostatectomy (RARP), with final pathology as the reference standard. METHODS Overall, 54 margins in 45 patients treated with RARP were analysed with: (1) ex vivo FCM; (2) IFS analysis; and (3) final pathology. FCM margins were evaluated by two different pathologists (experienced [M.I.: 10 years] vs highly experienced [G.R.: >30 years]) as strongly negative, probably negative, doubtful, probably positive, or strongly positive. First, inter-observer agreement (Cohen's κ) between pathologists was tested. Second, we reported the sensitivity, specificity, positive predictive (PPV) and negative predictive value (NPV) of ex vivo FCM. Finally, agreement between ex vivo FCM and IFS analysis (Cohen's κ) was reported. For all analyses, four combinations of FCM results were evaluated. RESULTS At ex vivo FCM, the inter-observer agreement between pathologists ranged from moderate (κ = 0.74) to almost perfect (κ = 0.90), according to the four categories of results. Indeed, at ex vivo FCM, the highly experienced pathologist reached the best balance between sensitivity (70.5%) specificity (91.8%), PPV (80.0%) and NPV (87.1%). Conversely, on IFS analysis, the sensitivity, specificity, PPV and NPV were, respectively, 88.2% vs 100% vs 100% vs 94.8%. The agreement between the ex vivo FCM and IFS analyses ranged from moderate (κ = 0.62) to strong (κ = 0.86), according to the four categories of results. CONCLUSION Evaluation of prostate margins at ex vivo FCM appears to be feasible and reliable. The agreement between readers encourages its widespread use in daily practice. Nevertheless, as of today, the performance of FCM seems to be sub-par when compared to the established standard of care (IFS analysis).
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Affiliation(s)
- Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Mariia Ivanova
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Andrea Bellin
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Oriana Pala
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Daniela Lepanto
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Danilo Bottero
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | | | - Matteo Tallini
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Giulia Marvaso
- Department of Radiation Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Renne
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
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Darr C, Costa PF, Kahl T, Moraitis A, Engel J, Al-Nader M, Reis H, Köllermann J, Kesch C, Krafft U, Maurer T, Köhler D, Klutmann S, Falkenbach F, Kleesiek J, Fendler WP, Hadaschik BA, Herrmann K. Intraoperative Molecular Positron Emission Tomography Imaging for Intraoperative Assessment of Radical Prostatectomy Specimens. EUR UROL SUPPL 2023; 54:28-32. [PMID: 37361199 PMCID: PMC10285557 DOI: 10.1016/j.euros.2023.05.017] [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] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
In this prospective two-center feasibility study, we evaluate the diagnostic value of intraoperative ex vivo specimenPET/CT imaging of radical prostatectomy (RP) and lymphadenectomy specimens. Ten patients with high-risk prostate cancer underwent clinical prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) preoperatively on the day of surgery. Six patients received 68Ga-PSMA-11 and four 18F-PSMA-1007. Radioactivity of the resected specimen was measured again using a novel specimenPET/CT device (AURA10; XEOS Medical, Gent, Belgium) developed for intraoperative margin assessment. All index lesions of staging multiparametric magnetic resonance imaging could be visualized. Overall, specimenPET/CT correlated well with conventional PET/CT regarding detection of suspicious tracer foci (Pearson coefficient 0.935). In addition, specimenPET/CT demonstrated all lymph node metastases detected on conventional PET/CT (n = 3), as well as three previously undetected lymph node metastases. Importantly, all positive or close (<1 mm) surgical margins could be visualized in agreement with histopathology. In conclusion, specimenPET/CT enables detection of PSMA-avid lesions and warrants further investigation to tailor RP, based on a good correlation with final pathology. Future trials will prospectively compare ex vivo specimenPET/CT with a frozen section analysis for the detection of positive surgical margins and assessment of biochemical recurrence-free survival. Patient summary In this report, we examined prostatectomy and lymphadenectomy specimens for suspicious positron emission tomography (PET) signals after preoperative tracer injection. It was found that in all cases, a good signal could be visualized, with a promising correlation of surface assessment compared with histopathology. We conclude that specimenPET imaging is feasible and may help improve oncological outcomes in the future.
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Affiliation(s)
- Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Theresa Kahl
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Jenna Engel
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Mulham Al-Nader
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Henning Reis
- Department of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jens Köllermann
- Department of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Köhler
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Klutmann
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Falkenbach
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Kleesiek
- Institute of Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
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Wang Y, Wu Y, Zhu M, Tian M, Liu L, Yin L. The Diagnostic Performance of Tumor Stage on MRI for Predicting Prostate Cancer-Positive Surgical Margins: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:2497. [PMID: 37568860 PMCID: PMC10417235 DOI: 10.3390/diagnostics13152497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Surgical margin status in radical prostatectomy (RP) specimens is an established predictive indicator for determining biochemical prostate cancer recurrence and disease progression. Predicting positive surgical margins (PSMs) is of utmost importance. We sought to perform a meta-analysis evaluating the diagnostic utility of a high clinical tumor stage (≥3) on magnetic resonance imaging (MRI) for predicting PSMs. METHOD A systematic search of the PubMed, Embase databases, and Cochrane Library was performed, covering the interval from 1 January 2000 to 31 December 2022, to identify relevant studies. The Quality Assessment of Diagnostic Accuracy Studies 2 method was used to evaluate the studies' quality. A hierarchical summary receiver operating characteristic plot was created depicting sensitivity and specificity data. Analyses of subgroups and meta-regression were used to investigate heterogeneity. RESULTS This meta-analysis comprised 13 studies with 3924 individuals in total. The pooled sensitivity and specificity values were 0.40 (95% CI, 0.32-0.49) and 0.75 (95% CI, 0.69-0.80), respectively, with an area under the receiver operating characteristic curve of 0.63 (95% CI, 0.59-0.67). The Higgins I2 statistics indicated moderate heterogeneity in sensitivity (I2 = 75.59%) and substantial heterogeneity in specificity (I2 = 86.77%). Area, prevalence of high Gleason scores (≥7), laparoscopic or robot-assisted techniques, field strength, functional technology, endorectal coil usage, and number of radiologists were significant factors responsible for heterogeneity (p ≤ 0.01). CONCLUSIONS T stage on MRI has moderate diagnostic accuracy for predicting PSMs. When determining the treatment modality, clinicians should consider the factors contributing to heterogeneity for this purpose.
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Affiliation(s)
- Yu Wang
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; (Y.W.); (L.L.)
- Institute of Radiation Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Ying Wu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;
| | - Meilin Zhu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200032, China;
| | - Maoheng Tian
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China;
| | - Li Liu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; (Y.W.); (L.L.)
- Institute of Radiation Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Longlin Yin
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; (Y.W.); (L.L.)
- Institute of Radiation Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
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Gretser S, Hoeh B, Kinzler MN, Reitz A, Preisser F, Kluth LA, Mandel P, Chun FKH, Reis H, Wild PJ, Köllermann J. The NeuroSAFE frozen section technique during radical prostatectomy - Implementation and optimization of technical aspects in a routine pathology workflow. Pathol Res Pract 2023; 242:154297. [PMID: 36621159 DOI: 10.1016/j.prp.2022.154297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS In prostate cancer patients, application of the NeuroSAFE frozen section technique during radical prostatectomy has been shown to increase the rate of nerve sparing surgery and to improve functional outcome for the patients. The aim of this study is to report on technical and organizational optimization opportunities of the procedure. MATERIAL AND METHODS All patients submitted to bilateral intraoperative frozen section from January 2018 until December 2020 (n = 452) were retrospectively analyzed and parameters such as turnaround time, staff situation in the laboratory and histologic properties of the tumors were assessed. RESULTS The median turnaround time per case was 40.3 ( ± 10.5) min. In 2020 the average time needed from accessioning to diagnosis was 38.1 min. Multivariate linear regression suggested that the number of technical assistants/cryotomes (46.1 min vs. 39.13 min; p < 0.001), the place of microscopic examination (43.0 min vs. 38.7 min; p < 0.001) and the presence of a positive margin (38.0 vs. 44.0 min; p < 0.001) were significant influential factors. The turnaround time was independent of the uropathological expertize of the consultant (39.84 min vs. 40.7 min; p = 0.09), the tumor grade (42.3 vs 39.8 min; p = 0.493) and the presence of extraprostatic extension (44.0 vs 39.8 min; p = 0.099). CONCLUSION The implementation of simple optimization measures in the workflow as well as structured training of all pathology staff involved in the examination leads to a significant increase in the efficiency of the examination while maintaining the same level of resources. The results could thus be a contribution to the broader application of the procedure.
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Affiliation(s)
- S Gretser
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - B Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - M N Kinzler
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany; Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - A Reitz
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - F Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - L A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - P Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - F K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - H Reis
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - P J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany; Wildlab, University Hospital Frankfurt MVZ GmbH, Frankfurt am Main, Germany; Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany; Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
| | - J Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany
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7
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Preoperative Multiparametric Prostate Magnetic Resonance Imaging Structured Report Informs Risk for Positive Apical Surgical Margins During Radical Prostatectomy. J Comput Assist Tomogr 2023; 47:38-44. [PMID: 35995580 DOI: 10.1097/rct.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The prostatic apex is the most frequent location of positive surgical margin (PSM) after surgery. Data regarding the ability of multiparametric magnetic resonance imaging (mpMRI) to prospectively identify men at risk for apical PSMs (aPSMs) using a structured report are lacking. OBJECTIVES The aims of the study are to determine and to compare the rate of aPSM in men with versus without prospectively flagged at-risk prostate lesions during clinical mpMRI interpretation using whole-mount histopathology as the reference standard. METHODS This single-center, retrospective study of prospectively collected data included treatment-naive men with abnormal 3T mpMRI (PI-RADS v2 score ≥3) between January 2016 and December 2018 followed by surgery. During routine clinical interpretation, radiologists flagged prostate lesions abutting the apical most gland and/or encircling the distal most prostatic urethra using standardized language available as a "pick list" option in the structured report. Logistic regression was used to compare the rate of PSM in 2 groups (flagged vs nonflagged men). Propensity score covariate adjustment corrected for potential selection bias according to age, prostate-specific antigen (PSA), PSA density, grade group, and pT stage. The estimate was further adjusted by including surgeon as a covariate. RESULTS A total of 428 men were included. A statistically significant higher proportion of aPSMs was noted in flagged (56% [51/91]) compared with nonflagged apical lesions (31% [105/337]; adjusted odds ratio, 2.5; 95% confidence interval, 1.6-4.1; P < 0.01). The difference in aPSM between both groups also varied according to the surgeon performing the RP. Prostate-specific antigen, PSA density, lesion size, apical location, Prostate Imaging Reporting & Data System score, grade group, pT stage, and surgeon's experience were associated with higher PSM rate. Biochemical recurrence, defined as PSA greater than 0.2 ng/mL on 2 measurements after RP, was significantly associated with PSM status (propensity score adjusted odds ratio, 3.1; 95% confidence interval, 1.8-5.3; P < 0.0001); however, patients flagged by radiologists did not have a significant difference in biochemical recurrence rates as compared with nonflagged patients ( P = 0.11). CONCLUSIONS Standard language built into structured reports for mpMRI of the prostate helps identify preoperatively patients at risk for aPSM. CLINICAL IMPACT Multiparametric MRI is able to identify patients at increased risk for aPSM, and this information can be conveyed in a structured report to urologists, facilitating patient counseling and treatment decisions.
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8
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Costa PF, Fendler WP, Herrmann K, Sandach P, Grafe H, Grootendorst MR, Püllen L, Kesch C, Krafft U, Radtke JP, Tschirdewahn S, Hadaschik BA, Darr C. Radiation Protection and Occupational Exposure on 68Ga-PSMA-11-Based Cerenkov Luminescence Imaging Procedures in Robot-Assisted Prostatectomy. J Nucl Med 2022; 63:1349-1356. [PMID: 34916249 PMCID: PMC9454458 DOI: 10.2967/jnumed.121.263175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/30/2021] [Indexed: 01/26/2023] Open
Abstract
Cerenkov luminescence imaging (CLI) was successfully implemented in the intraoperative context as a form of radioguided cancer surgery, showing promise in the detection of surgical margins during robot-assisted radical prostatectomy. The present study was designed to provide a quantitative description of the occupational radiation exposure of surgery and histopathology personnel from CLI-guided robot-assisted radical prostatectomy after the injection of 68Ga-PSMA-11 in a single-injection PET/CT CLI protocol. Methods: Ten patients with preoperative 68Ga-PSMA-11 administration and intraoperative CLI were included. Patient dose rate was measured before PET/CT (n = 10) and after PET/CT (n = 5) at a 1-m distance for 4 patient regions (head [A], right side [B], left side [C], and feet [D]). Electronic personal dosimetry (EPD) was used for intraoperative occupational exposure (n = 10). Measurements included the first surgical assistant and scrub nurse at the operating table and the CLI imager/surgeon at the robotic console and encompassed the whole duration of surgery and CLI image acquisition. An estimation of the exposure of histopathology personnel was performed by measuring prostate specimens (n = 8) with a germanium detector. Results: The measured dose rate value before PET/CT was 5.3 ± 0.9 (average ± SD) μSv/h. This value corresponds to a patient-specific dose rate constant for positions B and C of 0.047 μSv/h⋅MBq. The average dose rate value after PET/CT was 1.04 ± 1.00 μSv/h. The patient-specific dose rate constant values corresponding to regions A to D were 0.011, 0.026, 0.024, and 0.003 μSv/h⋅MBq, respectively. EPD readings revealed average personal equivalent doses of 9.0 ± 7.1, 3.3 ± 3.9, and 0.7 ± 0.7 μSv for the first surgical assistant, scrub nurse, and CLI imager/surgeon, respectively. The median germanium detector-measured activity of the prostate specimen was 2.96 kBq (interquartile range, 2.23-7.65 kBq). Conclusion: Single-injection 68Ga-PSMA-11 PET/CT CLI procedures are associated with a reasonable occupational exposure level, if kept under 110 procedures per year. Excised prostate specimen radionuclide content was below the exemption level for 68Ga. Dose rate-based calculations provide a robust estimation for EPD measurements.
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Affiliation(s)
- Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; .,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Wolfgang P. Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Patrick Sandach
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Hong Grafe
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Lukas Püllen
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany;,Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany;,Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
| | - Ulrich Krafft
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany;,Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
| | - Jan P. Radtke
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany;,Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
| | - Stephan Tschirdewahn
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany;,Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
| | - Boris A. Hadaschik
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany;,Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
| | - Christopher Darr
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; .,Department of Urology and Urological Oncology, University Hospital Essen, Essen, Germany
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9
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Pre-operative magnetic resonance imaging can predict prostate cancer with risk for positive surgical margins. Abdom Radiol (NY) 2022; 47:2486-2493. [PMID: 35578110 PMCID: PMC9226088 DOI: 10.1007/s00261-022-03543-z] [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: 12/25/2021] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 01/04/2023]
Abstract
Purpose Analysis of patients with pre-operative 3 T multiparametric prostate MRI (mpMRI) to determine reliable MRI-based risk predictors of patients at risk for positive surgical margins (PSM) in robotic assisted radical prostatectomy (RPE). Methods Consecutive patients with 3 T mpMRI and subsequent RPE from 01/2015 to 12/2018 were retrospectively included. Patients were compared regarding clinical and MRI related parameters such as length of capsular tumor contact (LCC) and distance to the membranous urethra (UD). Results Forty-nine of 179 patients (27%) had PSM in 70 different localizations, with the majority located at the capsule (57%, 40/70), mostly apical and/or posterior. The second most often PSM occurred at the apical urethra (22%, 15/70). PCA was visible on mpMRI at the localization of PSM in 93% at the capsule and in 80% at the urethra. PSA, PI-RADS classification, extraprostatic extension (EPE), and seminal vesicles infiltration (SVI) on MRI were significantly higher / more frequent in patients with PSM. LCC (AUC 0.710), EPE (AUC 0.693), and UD (1-AUC 0.673) predicted PSM (overall). An UD of ≤ 3.5 mm showed the highest accuracy of 95% (J = 0.946) for PSM at the urethra and a LCC of ≥ 22.5 mm with 77% (J = 0.378) for PSM at the capsule. Conclusion PSM occurred mostly in the apex and/or posteriorly at the capsule or at the apical urethra. LCC was the best MRI predictor for PSM at the capsule and UD for tumors with PSM at the apical urethra. Using these MRI parameters readers might pre-operatively determine PCA localizations at risk for PSM. Supplementary Information The online version contains supplementary material available at 10.1007/s00261-022-03543-z.
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10
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Dinneen E, Allen C, Strange T, Heffernan-Ho D, Banjeglav J, Lindsay J, Mulligan JP, Briggs T, Nathan S, Sridhar A, Grierson J, Haider A, Panayi C, Patel D, Freeman A, Aning J, Persad R, Ahmad I, Dutto L, Oakley N, Ambrosi A, Parry T, Kasivisvanathan V, Giganti F, Shaw G, Punwani S. Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy. Diagnostics (Basel) 2022; 12:1057. [PMID: 35626214 PMCID: PMC9139507 DOI: 10.3390/diagnostics12051057] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. Objective: The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77-0.86). The AUC was 0.76 (95% CI: 0.64-0.88), 0.78 (0.72-0.84), and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3, and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Clare Allen
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Tom Strange
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Daniel Heffernan-Ho
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Jelena Banjeglav
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Jamie Lindsay
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - John-Patrick Mulligan
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Tim Briggs
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Senthil Nathan
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Ashwin Sridhar
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Christos Panayi
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Dominic Patel
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UK; (A.H.); (C.P.); (D.P.); (A.F.)
| | - Jonathan Aning
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UK; (J.A.); (R.P.)
| | - Raj Persad
- North Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UK; (J.A.); (R.P.)
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UK; (I.A.); (L.D.)
| | - Lorenzo Dutto
- Department of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UK; (I.A.); (L.D.)
| | - Neil Oakley
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK;
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milano, Italy;
| | - Tom Parry
- Centre for Medical Imaging, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London W1W 7TS, UK;
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UK; (J.G.); (V.K.); (F.G.); (G.S.)
- Department of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK; (J.B.); (J.L.); (J.-P.M.); (T.B.); (S.N.); (A.S.)
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK; (C.A.); (T.S.); (D.H.-H.); (S.P.)
- Centre for Medical Imaging, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London W1W 7TS, UK;
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11
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Darr C, Fragoso Costa P, Kesch C, Krafft U, Püllen L, Harke NN, Hess J, Szarvas T, Haubold J, Reis H, Fendler WP, Herrmann K, Radtke JP, Hadaschik BA, Tschirdewahn S. Prostate specific membrane antigen-radio guided surgery using Cerenkov luminescence imaging-utilization of a short-pass filter to reduce technical pitfalls. Transl Androl Urol 2021; 10:3972-3985. [PMID: 34804840 PMCID: PMC8575587 DOI: 10.21037/tau-20-1141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background Intraoperative Cerenkov luminescence imaging (CLI) is a novel technique to assess surgical margins in patients undergoing nerve sparing radical prostatectomy (RP). Here, we analyze the efficacy of a 550-nm optical short-pass filter (OF) to improve its performance. Methods In this prospective single-center feasibility study ten patients with prostate cancer (PC) were included between December 2019 and April 2020, including three patients without tracer injection as a control group. After preoperative injection of 68-Ga-prostate-specific membrane antigen (PSMA)-11 followed by RP, CLI of the excised prostate and the incised index lesion was performed to visualize the primary tumor lesion. We compared the findings on intraoperative CLI to postoperative histopathology. Furthermore, CLI-intensities determined as tumor to background ratio (TBR) and contrast to noise ratio (CNR) were measured. Results Histopathology proved positive surgical margins (PSM) in 3 patients with corresponding findings in CLI. After magnetic resonance imaging (MRI)-informed incision above the index lesion 2 out of 3 prostates demonstrated elevated CLI signals with histopathological confirmation of PC cells. The use of the OF enabled a significant reduction of the area of the regions of interest from a median of 1.80 to 0.15 cm2 (reduction by 85%, P=0.005) leading to increased specificity. Signals due to PSMs were not suppressed by the 550-nm OF. The median TBR was reduced from 3.33 to 2.10. In all three patients of the control group elevated CLI intensities were detected at locations with diathermal energy deposition during surgery. After application of the 550-nm OF these were almost totally suppressed with a TBR of 1.10. Measurements of Cerenkov luminescence intensity with the 550-nm OF showed a significant Pearson's correlation of 0.82 between PSM and the elevated TBR (P=0.003) and a significant Pearson's correlation of 0.66 between PSM and elevated CNR (P=0.04). Measurements without the OF did not correlate significantly. Conclusions Intraoperative 68-Ga-PSMA CLI in PC is a tool that warrants further investigation to visualize PSM especially in intermediate and high-risk PC. Intraoperative CLI benefits from usage of a 550-nm OF to reduce false-positive signals.
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Affiliation(s)
- Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Pedro Fragoso Costa
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Lukas Püllen
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Nina Natascha Harke
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Jochen Hess
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Institute of Diagnostics and Radiology, University Hospital Essen, Essen, Germany
| | - Henning Reis
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Institute of Pathology, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang Peter Fendler
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Boris Alexander Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Stephan Tschirdewahn
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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12
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Bianchi L, Chessa F, Angiolini A, Cercenelli L, Lodi S, Bortolani B, Molinaroli E, Casablanca C, Droghetti M, Gaudiano C, Mottaran A, Porreca A, Golfieri R, Romagnoli D, Giunchi F, Fiorentino M, Piazza P, Puliatti S, Diciotti S, Marcelli E, Mottrie A, Schiavina R. The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-assisted Radical Prostatectomy. Eur Urol 2021; 80:480-488. [PMID: 34332759 DOI: 10.1016/j.eururo.2021.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) can guide the surgical plan during robot-assisted radical prostatectomy (RARP), and intraoperative frozen section (IFS) can facilitate real-time surgical margin assessment. OBJECTIVE To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP). DESIGN, SETTING, AND PARTICIPANTS Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI. SURGICAL PROCEDURE In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance. MEASUREMENTS Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups. RESULTS AND LIMITATIONS Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01). CONCLUSIONS The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion. PATIENT SUMMARY Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna.
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna
| | - Andrea Angiolini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Simone Lodi
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Barbara Bortolani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Enrico Molinaroli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology IOV - IRCCS, 35128 Padua, Italy
| | - Rita Golfieri
- Università degli Studi di Bologna; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | | | - Francesca Giunchi
- Pathology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | | | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Stefano Puliatti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Università degli Studi di Bologna
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13
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Miyamoto H. Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis. Pathol Int 2021; 71:567-580. [PMID: 34154033 DOI: 10.1111/pin.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022]
Abstract
Despite recent improvements in diagnostic and surgical techniques in urological oncology, positive resection margin remains a significant concern for surgeons. Meanwhile, intraoperative pathology consultation with frozen section assessment (FSA), particularly for histological diagnosis of the lesions incidentally found or enlarged or sentinel lymph nodes, generally provides critical information which enables immediate decision making for optimal patient care. The intraoperative evaluation of surgical margins is also often requested, although there are some differences in its application between institutions and surgeons. Importantly, it remains to be determined whether intraoperative FSA indeed contributes to reducing the risk of final positive margins and thereby improving long-term patient outcomes. This review summarizes available data indicating the potential impact of FSA at the surgical margins during urological surgeries, including radical or partial cystectomy, partial nephrectomy, radical prostatectomy, penectomy, and orchiectomy. The accuracy and pitfalls of the intraoperative consultation/FSA diagnosis are also discussed.
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Affiliation(s)
- Hiroshi Miyamoto
- Departments of Pathology & Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, New York, USA
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14
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Cambria R, Ciardo D, Bazani A, Pansini F, Rondi E, Maestri D, Zerini D, Marvaso G, Romanelli P, Timon G, Fodor C, Petralia G, Alessi S, Pricolo P, Vischioni B, Fossati P, Molinelli S, Russo S, Ciocca M, De Cobelli O, Renne G, Orecchia R, Cattani F, Jereczek-Fossa BA. Ultrahypofractionated radiotherapy for localized prostate cancer with simultaneous boost to the dominant intraprostatic lesion: a plan comparison. TUMORI JOURNAL 2021; 108:263-269. [PMID: 33896239 DOI: 10.1177/03008916211011667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare different stereotactic body techniques-intensity-modulated radiotherapy with photons and protons, applied to radiotherapy of prostatic cancer-with simultaneous integrated boost (SIB) on the dominant intraprostatic lesion (DIL). METHODS Ten patients were selected for this planning study. Dosimetric results were compared between volumetric modulated arc therapy, intensity-modulated radiation therapy (IMRT), and intensity-modulated proton therapy both with two (IMPT 2F) and five fields (IMPT 5F) planning while applying the prescription schemes of 7.25 Gy/fraction to the prostate gland and 7.5 Gy/fraction to the DIL in 5 fractions. RESULTS Comparison of the coverages of the planning target volumes showed that small differences exist. The IMPT-2F-5F techniques allowed higher doses in the targets; conformal indexes resulted similar; homogeneity was better in the photon techniques (2%-5%). Regarding the organs at risk, all the techniques were able to maintain the dose well below the prescribed constraints: in the rectum, the IMPT-2F-5F and IMRT were more efficient in lowering the intermediate doses; in the bladder, the median dose was significantly better in the case of IMPT (2F-5F). In the urethra, the best sparing was achieved only by IMPT-5F. CONCLUSIONS Stereotactic radiotherapy with SIB for localized prostate cancer is feasible with all the investigated techniques. Concerning IMPT, the two-beam technique does not seem to have a greater advantage compared to the standard techniques; the 5-beam technique seems more promising also accounting for the range uncertainty.
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Affiliation(s)
- Raffaella Cambria
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Delia Ciardo
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Alessia Bazani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Floriana Pansini
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Elena Rondi
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Davide Maestri
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Dario Zerini
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giulia Marvaso
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Pola Romanelli
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giorgia Timon
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, Istituto Europeo di Oncologia IRCCS, via Ripamonti 435, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Sarah Alessi
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Paola Pricolo
- Department of Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | | | - Piero Fossati
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | | | - Stefania Russo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Ottavio De Cobelli
- Department of Urology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
| | - Giuseppe Renne
- Uropathology and Intraoperative Diagnostic Division, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, via Festa del Perdono, Milan, Italy
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15
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Alessi S, Maggioni R, Luzzago S, Colombo A, Pricolo P, Summers PE, Saia G, Manzoni M, Renne G, Marvaso G, De Cobelli O, Bellomi M, Jereczek-Fossa BA, Petralia G. Apparent Diffusion Coefficient and Other Preoperative Magnetic Resonance Imaging Features for the Prediction of Positive Surgical Margins in Prostate Cancer Patients Undergoing Radical Prostatectomy. Clin Genitourin Cancer 2021; 19:e335-e345. [PMID: 34023239 DOI: 10.1016/j.clgc.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the use of apparent diffusion coefficient (ADC) values and other MRI features for predicting positive surgical margins (PSMs) in patients undergoing radical prostatectomy. MATERIALS AND METHODS We retrospectively identified 400 consecutive patients who underwent surgery for prostate cancer between January 2015 and June 2016. ADC values of the index lesion and other preoperative magnetic resonance imaging features, including tumor site, laterality, level, Prostate Imaging Reporting and Data System category, European Society of Urogenital Radiology extracapsular extension score, and prostate volume, were assessed. Univariate and multivariable logistic regression were performed. Performance in predicting the occurrence of PSMs was measured using the area under the curve (AUC). AUC differences were evaluated with the DeLong method. The Youden index was calculated to identify the ADC threshold to best discriminate patients with PSMs. RESULTS Of the 400 patients, 105 (26.2%) had PSMs after radical prostatectomy. ADC values, Prostate Imaging Reporting and Data System category, extracapsular extension score, tumor site, and laterality were significantly associated with PSMs (P < .001) in univariate analysis. The AUC of the predictive model based on ADC alone was 68.2% (95% confidence interval, 62.2-74.2%) and did not significantly differ from the best multivariable predictive model which combined laterality, and site with ADC to attain an AUC of 70.0% (95% confidence interval, 64.2-75.8%; DeLong P = .318). The ADC threshold that maximized the Youden index was 960.3 µm2/s. CONCLUSION ADC values and preoperative magnetic resonance imaging features can help estimate the risk of PSMs after radical prostatectomy.
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Affiliation(s)
- Sarah Alessi
- Postgraduate School in Radiodiagnostics, University of Milan.
| | | | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology IRCCS
| | - Alberto Colombo
- Division of Radiology, IEO European Institute of Oncology IRCCS
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS
| | - Paul E Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS
| | - Giulia Saia
- Division of Radiology, IEO European Institute of Oncology IRCCS
| | - Marco Manzoni
- Uropathology and Intraoperative Diagnostic Division, IEO European Institute of Oncology IRCCS
| | - Giuseppe Renne
- Uropathology and Intraoperative Diagnostic Division, IEO European Institute of Oncology IRCCS
| | - Giulia Marvaso
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan
| | - Ottavio De Cobelli
- Postgraduate School in Radiodiagnostics, University of Milan; Department of Oncology and Hemato-Oncology, University of Milan
| | - Massimo Bellomi
- Department of Urology, IEO European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan
| | - Barbara A Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan; Precision Imaging and Research Unit - Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS Milan Italy
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16
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Park MY, Park KJ, Kim MH, Kim JK. Preoperative MRI-based estimation of risk for positive resection margin after radical prostatectomy in patients with prostate cancer: development and validation of a simple scoring system. Eur Radiol 2021; 31:4898-4907. [PMID: 33386982 DOI: 10.1007/s00330-020-07569-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/29/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop a simplified MRI-based model to predict the risk for positive surgical margins (PSMs) after radical prostatectomy (RP) in patients with prostate cancer (PCa). METHODS Consecutive patients who underwent RP for PCa were retrospectively identified from a tertiary referral hospital. Patients who underwent RP between January 2014 and June 2014 were assigned as derivation cohort (n = 330) and those between January 2018 and February 2018 were assigned as validation cohort (n = 100). MRI-based predictors associated with PSM were assessed: tumor size, tumor-capsule contact length, the Prostate Imaging Reporting and Data System (PI-RADS) category, tumor location (tumor contact to the apex or posterolateral side near the neurovascular bundle), apical depth, and prostate volume. A prediction model was developed by using multivariable logistic regression, and then it was transformed into a scoring system. The prediction and calibration performance of this scoring system was evaluated using the C statistics and Hosmer-Lemeshow goodness-of-fit test. RESULTS A total of 121 (36.7%) and 32 (32.0%) of patients in the derivation and validation cohorts had PSMs after RP. The scoring system consisted of the following variables: tumor-capsule contact length, PI-RADS category, tumor located at the apex and/or posterolateral side. This scoring system provided good prediction performance for PSM in the derivation (C statistics, 0.80 [95% CI: 0.76, 0.85]) and validation (C statistics, 0.77 [95% CI: 0.68, 0.87]) cohorts, and also showed good calibration in both cohorts (p = 0.83 and 0.86, respectively). CONCLUSIONS An MRI-based scoring system can help estimate the risk of PSM after RP. KEY POINTS • An MRI-based scoring system served as a tool to estimate the risk of positive surgical margin (C statistics, 0.80 and 0.77 in the derivation and validation cohorts, respectively) after radical prostatectomy. • Tumor with contact to the apex or posterolateral aspect, the tumor contact length to capsule, and higher PI-RADS category were independent predictors for the presence of positive resection margins after radical prostatectomy in men with prostate cancer. • High-risk patients as determined by the scoring system demonstrated adverse post-surgical outcomes compared with low- or intermediate-risk patients, in regard to longer length (mean length, 13.0 mm versus 3.9 mm in low risk or 6.2 mm in intermediate risk; p ≤ 0.001) and higher Gleason grade at the margin (grades 4 and 5 in 69.4% and 20.4% versus 16.7% and 16.7% in low risk or 46.7% and 5.4% in intermediate risk; p < 0.001).
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Affiliation(s)
- Mi Yeon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Mi-Hyun Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jeong Kon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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17
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Darr C, Harke NN, Radtke JP, Yirga L, Kesch C, Grootendorst MR, Fendler WP, Costa PF, Rischpler C, Praus C, Haubold J, Reis H, Hager T, Herrmann K, Binse I, Hadaschik B. Intraoperative 68Ga-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Feasibility Study. J Nucl Med 2020; 61:1500-1506. [PMID: 32060212 PMCID: PMC7539648 DOI: 10.2967/jnumed.119.240424] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 11/16/2022] Open
Abstract
Our objective was to assess the feasibility and accuracy of Cerenkov luminescence imaging (CLI) for assessment of surgical margins intraoperatively during radical prostatectomy. Methods: A single-center feasibility study included 10 patients with high-risk primary prostate cancer (PC). 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scans were performed followed by radical prostatectomy and intraoperative CLI of the excised prostate. In addition to imaging the intact prostate, in the first 2 patients the prostate gland was incised and imaged with CLI to visualize the primary tumor. We compared the tumor margin status on CLI to postoperative histopathology. Measured CLI intensities were determined as tumor-to-background ratio. Results: Tumor cells were successfully detected on the incised prostate CLI images as confirmed by histopathology. Three of 10 men had histopathologically positive surgical margins (PSMs), and 2 of 3 PSMs were accurately detected on CLI. Overall, 25 (72%) of 35 regions of interest proved to visualize a tumor signal according to standard histopathology. The median tumor radiance in these areas was 11,301 photons/s/cm2/sr (range, 3,328-25,428 photons/s/cm2/sr), and median tumor-to-background ratio was 4.2 (range, 2.1-11.6). False-positive signals were seen mainly at the prostate base, with PC cells overlaid by benign tissue. PSMA immunohistochemistry revealed strong PSMA staining of benign gland tissue, which impacts measured activities. Conclusion: This feasibility showed that 68Ga-PSMA CLI is a new intraoperative imaging technique capable of imaging the entire specimen's surface to detect PC tissue at the resection margin. Further optimization of the CLI protocol, or the use of lower-energy imaging tracers such as 18F-PSMA, is required to reduce false-positives. A larger study will be performed to assess diagnostic performance.
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Affiliation(s)
- Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Nina N Harke
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Leubet Yirga
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Christine Praus
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostics and Radiology, University Hospital Essen, Essen, Germany
| | - Henning Reis
- Institute of Pathology, University Duisburg-Essen, Essen, Germany; and
| | - Thomas Hager
- Institute of Pathology, University Duisburg-Essen, Essen, Germany; and
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Ina Binse
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
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18
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Darr C, Finis F, Wiesenfarth M, Giganti F, Tschirdewahn S, Krafft U, Kesch C, Bonekamp D, Forsting M, Wetter A, Reis H, Hadaschik BA, Haubold J, Radtke JP. Three-dimensional Magnetic Resonance Imaging-based Printed Models of Prostate Anatomy and Targeted Biopsy-proven Index Tumor to Facilitate Patient-tailored Radical Prostatectomy-A Feasibility Study. Eur Urol Oncol 2020; 5:357-361. [PMID: 32873530 DOI: 10.1016/j.euo.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
In this prospective single-center feasibility study, we demonstrate that the use of three-dimensional (3D)-printed prostate models support nerve-sparing radical prostatectomy (RP) and intraoperative frozen sectioning (IFS) in ten men suffering from intermediate- and high-risk prostate cancer (PC), of whom seven harbored pT3 disease. Patient-specific 3D resin models were printed based on preoperative multiparametric magnetic resonance imaging (mpMRI) to provide an exact 3D impression of significant tumor lesions. RP and IFS were planned in a patient-tailored fashion. The 36-region Prostate Imaging Reporting and Data System (PI-RADS) v2.0 scheme was used to compare the MRI/3D print with whole-mount histopathology. In all cases, localization of the index lesion was correctly displayed by MRI and the 3D model. Localization of significant PC lesions correlated significantly (Pearson`s correlation coefficient of 0.88; p < 0.001). In addition, a significant correlation of the width, length, and volume of the tumor and prostate gland, derived from the printed model and histopathology, was found, using Pearson's correlation analyses and Bland-Altman plots. In conclusion, 3D-printed prostate models correlate well with final pathology and can be used to tailor RP. PATIENT SUMMARY: The use of three-dimensional (3D)-printed prostate models based on preoperative magnetic resonance imaging (MRI) may improve prostatectomy outcome. This study confirmed the accuracy of 3D-printed prostates compared with pathology from radical prostatectomy specimens. Thus, MRI-derived 3D-printed prostate models can assist in prostate cancer surgery.
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Affiliation(s)
- Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Friederike Finis
- Department of Urology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Stephan Tschirdewahn
- Department of Urology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Forsting
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Henning Reis
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Boris A Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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19
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Radtke JP, Nyarangi-Dix J, Wiesenfarth M, Hadaschik B. Re: The Key Combined Value of Multiparametric Magnetic Resonance Imaging, and Magnetic Resonance Imaging-targeted and Concomitant Systematic Biopsies for the Prediction of Adverse Pathological Features in Prostate Cancer Patients Undergoing Radical Prostatectomy. Eur Urol 2020; 79:164-165. [PMID: 32847701 DOI: 10.1016/j.eururo.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jan Philipp Radtke
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Department of Radiology, German Cancer Research Center.
| | | | - Manuel Wiesenfarth
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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20
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Padhani AR, Petralia G. Radiologists Should Integrate Clinical Risk Factors with MRI Findings for Meaningful Prostate Cancer Staging. Radiology 2020; 296:96-97. [PMID: 32374207 DOI: 10.1148/radiol.2020201082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anwar R Padhani
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, England (A.R.P.); European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy (G.P.); and Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy (G.P.)
| | - Giuseppe Petralia
- From the Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, England (A.R.P.); European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy (G.P.); and Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy (G.P.)
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21
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Sighinolfi MC, Eissa A, Spandri V, Puliatti S, Micali S, Reggiani Bonetti L, Bertoni L, Bianchi G, Rocco B. Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles. BJU Int 2020; 125:656-663. [PMID: 32012426 DOI: 10.1111/bju.15024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of the paper is to provide an overview of intraoperative sampling methods for frozen section (FS) analysis and of surgical techniques for a secondary neurovascular bundle (NVB) resection, as the method of surgical margin (SM) sampling and the management of a positive SM (PSM) at the nerve-sparing (NS) area are under evaluated issues. FS analysis during radical prostatectomy (RP) can help to tailor the plane of dissection based on cancer extension and thus extend the indications for NS surgery. EVIDENCE ACQUISITION We performed a PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Cochrane Library, and Elton B. Stephens Co. (EBSCO)host search to include articles published in the last decade, evaluating FS analysis in the NS area and surgical attempts to convert a PSM to a negative status. EVIDENCE SYNTHESIS Overall, 19 papers met our inclusion criteria. The ways to collect samples for FS analysis included: systematic (analysing the whole posterolateral aspect of the prostate specimen, i.e., neurovascular structure-adjacent frozen-section examination [NeuroSAFE]); magnetic resonance imaging (MRI)-guided (biopsies from MRI-suspicious areas, retrieved by the surgeon in a cognitive way); and random biopsies from the soft periprostatic tissues. Techniques to address a PSM in the NS area included: full resection of the spared NVB, from its caudal to cranial aspect, often including the rectolateral part of the Denonvilliers' fascia; partial resection of the NVB, in cases where sampling attempts to localise a PSM; incremental approach, meaning a partial or full resection that extends until no prostate tissue is found in the soft periprostatic environment. CONCLUSIONS There is no homogeneity in prostate sampling for FS analysis, although most recent evidence is moving toward a systematic sampling of the entire NS area. The management of a PSM is variable and can be affected by the sampling strategy (difficult localisation of the persisting tumour at the NVB). The difficult identification of the exact soft tissue location contiguous to a PSM could be considered as the critical point of FS analysis and of spared-NVB management.
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Affiliation(s)
| | - Ahmed Eissa
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Valentina Spandri
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Laura Bertoni
- Pathology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
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22
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T-staging of prostate cancer: Identification of useful signs to standardize detection of posterolateral extraprostatic extension on prostate MRI. Clin Imaging 2020; 59:1-7. [DOI: 10.1016/j.clinimag.2019.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/02/2019] [Accepted: 08/19/2019] [Indexed: 01/10/2023]
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23
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Dinneen EP, Van Der Slot M, Adasonla K, Tan J, Grierson J, Haider A, Freeman A, Oakley N, Shaw G. Intraoperative Frozen Section for Margin Evaluation During Radical Prostatectomy: A Systematic Review. Eur Urol Focus 2019; 6:664-673. [PMID: 31787570 DOI: 10.1016/j.euf.2019.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/27/2019] [Accepted: 11/05/2019] [Indexed: 01/12/2023]
Abstract
CONTEXT Surgical margin status and preservation of the neurovascular bundles (NVB) are important prognostic indicators for oncological and functional outcomes of patients undergoing radical prostatectomy (RP). Intraoperative frozen section (IFS) has been used to evaluate margin status during surgery with the intention of reducing positive surgical margins (PSMs) and guiding safe preservation of the NVBs during RP, but its value is controversial. OBJECTIVE To evaluate current literature comparing outcomes of men undergoing RP with IFS versus RP without IFS. EVIDENCE ACQUISITION Medline, Embase, and Cochrane Library searches for all relevant publications (PROSPERO ID CRD42019125940), including comparative studies reporting on men undergoing RP with and without IFS, were performed. Outcomes of interest were surgical margin status, long-term oncological outcomes, NVB status, and erectile function (EF) recovery. Data were narratively synthesised in light of methodological and clinical heterogeneity of included studies. EVIDENCE SYNTHESIS After screening 834 publications, 10 nonrandomised retrospective comparative studies (including 16 897 patients) were retrieved. The technique of IFS differed considerably between studies. Eight studies reported a reduction in PSM rates (-1.4% to -14.5%) with IFS, though two studies report higher PSM rates (+0.4% and +10%) with IFS. Three studies reported on long-term oncological outcomes, and no difference was seen with IFS. Three studies reported on the performance of IFS systematically at the posterolateral margin of the prostate (neurovascular structure-adjacent frozen-section examination [NeuroSAFE] technique). In all these three studies, either NVB preservation or EF recovery was improved. All studies were deemed to be at either a serious or a moderate risk of bias. CONCLUSIONS No randomised controlled trials were identified, and significant heterogeneity existed with regard to many features of the studies included. Within the limitations of this review, the evidence suggests that IFS during RP can facilitate a modest reduction in PSM rates. There is evidence that IFS performed systematically at the posterolateral margin of the prostate can facilitate more NVB preservation. However, in the main, the lack of prospective, randomised, standardised research with long-term oncological and functional outcomes precludes strong conclusions and highlights the need for such studies. PATIENT SUMMARY The data of this review suggest that frozen section sampling of the prostate (ie, whilst the patient is still asleep) during prostate cancer surgery can reduce the likelihood of cancer being detected at the edge of the removed prostate. It also finds that a type of frozen section analysis (neurovascular structure-adjacent frozen-section examination [NeuroSAFE] technique) can help allow the nerves around the prostate to be left intact safely during surgery. However, the studies in this review are very different from one another and generally at a high risk of errors. Therefore, comparisons and conclusions must be made carefully.
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Affiliation(s)
- Eoin P Dinneen
- Division of Surgery and Interventional Science, University College London, Fitzrovia, London, UK; Department of Urology, University College London Hospital, London, UK.
| | - Michelle Van Der Slot
- Department of Pathology and Urology, Anser Prostate Operation Clinic, Maasstad Hospital, Rotterdam, The Netherlands
| | - Kelvin Adasonla
- Department of Urology, University College London Hospital, London, UK
| | - Jin Tan
- Department of Urology, University College London Hospital, London, UK
| | - Jack Grierson
- Surgical & Interventional Trials Unit, University College London, Fitzrovia, London, UK
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, London, UK
| | - Neil Oakley
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Greg Shaw
- Division of Surgery and Interventional Science, University College London, Fitzrovia, London, UK; Department of Urology, University College London Hospital, London, UK
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Regional Standardization of Prostate Multiparametric MRI Performance and Reporting: Is There a Role for a Director of Prostate Imaging? AJR Am J Roentgenol 2019; 213:844-850. [DOI: 10.2214/ajr.19.21111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Eissa A, Zoeir A, Sighinolfi MC, Puliatti S, Bevilacqua L, Del Prete C, Bertoni L, Azzoni P, Reggiani Bonetti L, Micali S, Bianchi G, Rocco B. "Real-time" Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art. Clin Genitourin Cancer 2019; 18:95-104. [PMID: 31784282 DOI: 10.1016/j.clgc.2019.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 01/18/2023]
Abstract
Histopathologic examination of the pathologic specimens using hematoxylin & eosin stains represents the backbone of the modern pathology. It is time-consuming; thus, "real-time" assessment of prostatic and periprostatic tissue has gained special interest in the diagnosis and management of prostate cancer. The current study focuses on the review of the different available techniques for "real-time" evaluation of surgical margins during radical prostatectomy (RP). We performed a comprehensive search of the Medline database to identify all the articles discussing "real-time" or intraoperative assessment of surgical margins during RP. Several filters were applied to the search to include only English articles performed on human subjects and published between January 2000 and March 2019. The search revealed several options for pathologic assessment of surgical margins including intraoperative frozen sections, confocal laser endomicroscopy, optical spectroscopy, photodynamic diagnosis, optical coherence tomography, multiphoton microscopy, structured illumination microscopy, 3D augmented reality, and ex vivo fluorescence confocal microscope. Frozen section represents the gold standard technique for real-time pathologic examinations of surgical margins during RP; however, several other options showed promising results in the initial clinical trials, and considering the rapid development in the field of molecular and cellular imaging, some of these options may serve as an alternative to frozen section.
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Affiliation(s)
- Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Zoeir
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Bevilacqua
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Del Prete
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bertoni
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
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Schiavina R, Bianchi L, Borghesi M, Dababneh H, Chessa F, Pultrone CV, Angiolini A, Gaudiano C, Porreca A, Fiorentino M, De Groote R, D'Hondt F, De Naeyer G, Mottrie A, Brunocilla E. MRI Displays the Prostatic Cancer Anatomy and Improves the Bundles Management Before Robot-Assisted Radical Prostatectomy. J Endourol 2019; 32:315-321. [PMID: 29256639 DOI: 10.1089/end.2017.0701] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate the impact of multiparametric magnetic0 resonance imaging (mpMRI) to guide the nerve-sparing (NS) surgical plan in prostate cancer (PCa) patients referred to robot-assisted radical prostatectomy (RARP). METHODS One hundred thirty-seven consecutive PCa patients were submitted to RARP between September 2016 and February 2017 at two high-volume European centers. Before RARP, each patient was referred to 1.5T or 3T mpMRI. NS was recorded as Grade 1, Grade 2, Grade 3, and Grade 4 according to Tewari and colleagues classification. A preliminary surgical plan to determinate the extent of NS approach was recorded based on clinical data. The final surgical plan was reassessed after mpMRI revision. The appropriateness of surgical plan change was considered based on the presence of extracapsular extension or positive surgical margins (PSMs) at level of neurovascular bundles area at final pathology. Furthermore, we analyzed a control group during the same period of 166 PCa patients referred to RARP in both institutions without preoperative mpMRI to assess the impact of the use of mpMRI on the surgical margins. RESULTS Considering 137 patients with preoperative mpMRI, the mpMRI revision induced the main surgeon to change the NS surgical plan in 46.7% of cases on patient-based and 56.2% on side-based analysis. The surgical plan change results equally assigned between the direction of more radical and less radical approach both on patient-based (54.7% vs 54.3%) and on side-based levels (50% vs 50%), resulting an overall appropriateness of 75%. Moreover, patients staged with mpMRI revealed significant lower overall PSMs compared with control group with no mpMRI (12.4% vs 24.1%; p ≤ 0.01). CONCLUSIONS mpMRI induces robotic surgeons to change the surgical plan in almost half of individuals, thus tailoring the NS approach, without compromising the oncologic outcomes. Compared to patients treated without mpMRI, the use of preoperative mpMRI can significantly reduce the overall PSMs.
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Affiliation(s)
- Riccardo Schiavina
- 1 Department of Urology, University of Bologna , Bologna, Italy .,2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
| | - Lorenzo Bianchi
- 1 Department of Urology, University of Bologna , Bologna, Italy .,3 Department of Urology, OLV , Aalst, Belgium .,4 ORSI Academy , Melle, Belgium
| | - Marco Borghesi
- 1 Department of Urology, University of Bologna , Bologna, Italy .,2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
| | - Hussam Dababneh
- 1 Department of Urology, University of Bologna , Bologna, Italy
| | | | - Cristian Vincenzo Pultrone
- 1 Department of Urology, University of Bologna , Bologna, Italy .,2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
| | | | | | - Angelo Porreca
- 6 Department of Urology, Abano Terme Hospital , Abano Terme, Italy
| | - Michelangelo Fiorentino
- 7 Laboratory of Oncologic and Transplantation Molecular Pathology, S. Orsola-Malpighi Hospital, University of Bologna , Bologna, Italy
| | | | | | | | - Alexandre Mottrie
- 3 Department of Urology, OLV , Aalst, Belgium .,4 ORSI Academy , Melle, Belgium .,5 Department of Radiology, University of Bologna , Bologna, Italy
| | - Eugenio Brunocilla
- 1 Department of Urology, University of Bologna , Bologna, Italy .,2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna , Bologna, Italy
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27
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Luzzago S, Petralia G, Musi G, Catellani M, Alessi S, Di Trapani E, Mistretta FA, Serino A, Conti A, Pricolo P, Nazzani S, Mirone V, Matei DV, Montanari E, de Cobelli O. Multiparametric Magnetic Resonance Imaging Second Opinion May Reduce the Number of Unnecessary Prostate Biopsies: Time to Improve Radiologists’ Training Program? Clin Genitourin Cancer 2019; 17:88-96. [DOI: 10.1016/j.clgc.2018.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/04/2018] [Accepted: 10/13/2018] [Indexed: 01/11/2023]
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Prostate Imaging Reporting and Data System in prostate cancer staging and planning for radical prostatectomy. Wideochir Inne Tech Maloinwazyjne 2019; 14:262-270. [PMID: 31118993 PMCID: PMC6528114 DOI: 10.5114/wiitm.2019.83869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/16/2019] [Indexed: 02/04/2023] Open
Abstract
Introduction The Prostate Imaging Reporting and Data System (PI-RADS) was mainly developed for the purposes of prostate cancer (PCa) detection. However, its widespread use suggests that it may play a role in a preoperative workup prior to endoscopic radical prostatectomy (ERP). Aim To evaluate the prognostic value of PI-RADS in predicting extraprostatic extension (EPE) and its influence on surgical planning of ERP. Material and methods The analysis involved data of 154 consecutive prostate cancer patients, in whom multiparametric 3.0T magnetic resonance imaging (mpMRI) was performed before ERP. Standard descriptive assessment of mpMRI images was compared with the PI-RADS system with respect to prostate cancer staging and subsequent potential surgical template adjustment. Results PI-RADS significantly outperformed the standard way of mpMRI reporting in staging (AUC = 0.615 vs. 0.552, p = 0.036) with PI-RADS 5 established as the best threshold. After reevaluation of imaging, the initial surgical plan was modified based on mpMRI in terms of feasibility and extent of neurovascular bundle preservation during ERP on 96 (31.2%) sides, while on the remaining 212 (68.8%) sides the templates were left unchanged. Decisions based on mpMRI were not associated with increased risk of a positive surgical margin (PSM). Conclusions The PI-RADS outperforms the standard staging method using mpMRI and may assist the decision-making process regarding the extent of resection during ERP without increasing the risk of PSM.
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Caglic I, Povalej Brzan P, Warren AY, Bratt O, Shah N, Barrett T. Defining the incremental value of 3D T2-weighted imaging in the assessment of prostate cancer extracapsular extension. Eur Radiol 2019; 29:5488-5497. [PMID: 30887192 PMCID: PMC6719333 DOI: 10.1007/s00330-019-06070-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/05/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022]
Abstract
Objectives To assess the added value of 3D T2-weighted imaging (T2WI) over conventional 2D T2WI in diagnosing extracapsular extension (ECE). Methods Seventy-five patients undergoing 3-T MRI before radical prostatectomy were included. PI-RADS ≥ 4 lesions were assessed for ECE on 2D T2W images using a 5-point Likert scale (1 = no ECE, 5 = definite ECE) and the length of tumour prostatic capsular contact. A second read using 3D T2W images and reformats evaluated ECE and the maximal 3D capsular contact length and surface. Results One hundred six lesions were identified at MRI. ECE was confirmed by histology in 54% (57/106) of lesions and 64% (48/75) of patients. Sensitivity and specificity for 3D T2 reads were 75.4% versus 64.9% (p = 0.058), respectively, and 83.7% versus 85.7% (p = 0.705) for 2D T2 reads, respectively. 3D T2W reads showed significantly higher mean subjective Likert scores of 3.7 ± 1.4 versus 3.3 ± 1.4 (p = 0.001) in ECE-positive lesions and lower mean Likert score of 1.5 ± 1 versus 1.6 ± 0.9 (p = 0.27) in ECE-negative lesions compared with 2D T2W reads. 3D contact significantly increased sensitivity from 59.6 to 73.7% (p = 0.03), whilst maintaining the same specificity of 87.8% (p = 1). High-grade group tumours (≥ Gleason 4 + 3) showed significantly higher ECE prevalence than low-grade tumours (88% versus 44%, p < 0.001) and a positive predictive value (PPV) for ECE of 90.9% with ≥ 5 mm of contact versus PPV of 90.4% at ≥ 12.5 mm for lower grade tumours. Conclusions 3D T2WI significantly increases sensitivity and confidence in calling ECE. The capsular contact length threshold differed between low- and high-grade cancers. Key Points • 3D capsular contact length and 3D surface contact significantly increased sensitivity in diagnosing ECE. • 3D T2W reads significantly increased reader confidence in calling ECE. • Thresholds for capsular contact length differed between low-grade and high-grade cancers. Electronic supplementary material The online version of this article (10.1007/s00330-019-06070-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. .,Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK. .,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia.
| | - Petra Povalej Brzan
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia.,University of Maribor, Faculty of Electrical Engineering and Computer Science, Maribor, Slovenia
| | - Anne Y Warren
- Department of Histopathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Ola Bratt
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nimish Shah
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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30
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Low PI-RADS assessment category excludes extraprostatic extension (≥pT3a) of prostate cancer: a histology-validated study including 301 operated patients. Eur Radiol 2019; 29:5478-5487. [PMID: 30887199 PMCID: PMC6719329 DOI: 10.1007/s00330-019-06092-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/31/2019] [Accepted: 02/08/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate whether low PI-RADS v2 assessment categories are effective at excluding extraprostatic extension (EPE) of prostate cancer (≥pT3a PCa). METHODS The local institutional ethics committee approved this retrospective analysis of 301 consecutive PCa patients. Patients were classified as low- or intermediate/high-risk based on clinical parameters and underwent pre-surgical multiparametric magnetic resonance imaging. A PI-RADS v2 assessment category and ESUR EPE score were assigned for each lesion by two readers working in consensus. Histopathologic analysis of the whole-mount radical prostatectomy specimen was the reference standard. Univariate and multivariate analyses were performed to evaluate the association of PI-RADS v2 assessment category with final histology ≥pT3a PCa. RESULTS For a PI-RADS v2 assessment category threshold of 3, the overall performance for ruling out (sensitivity, negative predictive value, negative likelihood ratio) ≥pT3a PCa was 99%/98%/0.04 and was similar in both the low-risk (96%/97%/0.12; N = 137) and the intermediate/high-risk groups (100%/100%/0.0; N = 164). In univariate analysis, all clinical and tumor characteristics except age were significantly associated with ≥pT3a PCa. In multivariate analysis, PI-RADS v2 assessment categories ≤ 3 had a protective effect relative to categories 4 and 5. The inclusion of ESUR EPE score improved the AUC of ≥pT3a PCa prediction (from 0.73 to 0.86, p = 0.04 in the overall cohort). The impact of PI-RADS v2 assessment category is reflected in a nomogram derived on the basis of our cohort. CONCLUSIONS In our cohort, low PI-RADS v2 assessment categories of 3 or less confidently ruled out the presence of ≥pT3a PCa irrespective of clinical risk group. KEY POINTS • Our analysis of 301 mp-MRI and RARP specimens showed that the addition of PI-RADS v2 assessment categories to clinical parameters improves the exclusion of ≥pT3a (extraprostatic) prostate cancer. • PI-RADS v2 assessment categories of 1 to 3 are useful for excluding ≥pT3a prostate cancer with a NPV of 98%; such patients can be considered as candidates for less invasive approaches. • The ability to exclude ≥pT3a prostate cancer may improve confidence in choosing nerve-sparing surgery or in avoiding pelvic nodal dissections, and similarly for patients undergoing radiotherapy, in adopting short-course adjuvant hormonal therapy or foregoing prophylactic nodal irradiation.
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Diagnostic Performance of Prospectively Assigned Likert Scale Scores to Determine Extraprostatic Extension and Seminal Vesicle Invasion With Multiparametric MRI of the Prostate. AJR Am J Roentgenol 2019; 212:576-581. [DOI: 10.2214/ajr.18.20320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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32
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Keller EX, Bachofner J, Britschgi AJ, Saba K, Mortezavi A, Kaufmann B, Fankhauser CD, Wild P, Sulser T, Hermanns T, Eberli D, Poyet C. Prognostic value of unifocal and multifocal positive surgical margins in a large series of robot-assisted radical prostatectomy for prostate cancer. World J Urol 2018; 37:1837-1844. [PMID: 30519744 DOI: 10.1007/s00345-018-2578-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate the prognostic value of positive surgical margins (PSM) focality for the prediction of biochemical recurrence (BCR) in patients undergoing robotic-assisted radical prostatectomy (RARP) for prostate cancer. METHODS All men with clinically localized prostate cancer undergoing RARP in our tertiary referral centre between May 2005 and August 2016 were retrospectively identified. Patients with neoadjuvant therapy were excluded. Comparisons were made between cases with negative surgical margins (NSM), unifocal PSM (uPSM), and multifocal PSM (mPSM). RESULTS From a total of 973 patients available for analysis, 315 (32%) had a PSM. In these patients, 190 had uPSM and 125 had mPSM. Focality of PSM was significantly associated with tumour stage and grade, preoperative PSA, and postoperative PSA persistence (all p < 0.001), but not with nerve sparing (NS) (p = 0.15). PSA persistence was found in 120 (12%) patients, resulting in 853 patients available for survival analyses with a median follow-up of 52 months. Both uPSM and mPSM were found to be independent predictors of BCR, conferring a hazard ratio of 1.9 (95% CI 1.3-3.0; p = 0.002) and 3.4 (95% CI 2.1-5.6; p < 0.001), respectively, when compared to NSM. In subgroup analyses, PSM was particularly predictive for BCR when patients underwent unilateral or bilateral NS (p ≤ 0.003). CONCLUSIONS Based on a large case series of RARP, we found PSM focality to be an independent predictor of BCR, with a 1.9- and 3.4-fold risk increase for BCR in case of uPSM and mPSM, respectively. PSM seems to be of particular prognostic relevance when NS has been performed.
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Affiliation(s)
- Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Jacqueline Bachofner
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Anna Jelena Britschgi
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Karim Saba
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Basil Kaufmann
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Christian D Fankhauser
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Peter Wild
- Institute of Surgical Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tullio Sulser
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Nyarangi-Dix J, Wiesenfarth M, Bonekamp D, Hitthaler B, Schütz V, Dieffenbacher S, Mueller-Wolf M, Roth W, Stenzinger A, Duensing S, Roethke M, Teber D, Schlemmer HP, Hohenfellner M, Radtke JP. Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for the Prediction of Extraprostatic Disease-A Risk Model for Patient-tailored Risk Stratification When Planning Radical Prostatectomy. Eur Urol Focus 2018; 6:1205-1212. [PMID: 30477971 DOI: 10.1016/j.euf.2018.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/19/2018] [Accepted: 11/10/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) facilitates the detection of significant prostate cancer. Therefore, addition of mpMRI to clinical parameters might improve the prediction of extraprostatic extension (EPE) in radical prostatectomy (RP) specimens. OBJECTIVE To investigate the accuracy of a novel risk model (RM) combining clinical and mpMRI parameters to predict EPE in RP specimens. DESIGN, SETTING, AND PARTICIPANTS We added prebiopsy mpMRI to clinical parameters and developed an RM to predict individual side-specific EPE (EPE-RM). Clinical parameters of 264 consecutive men with mpMRI prior to MRI/transrectal ultrasound fusion biopsy and subsequent RP between 2012 and 2015 were retrospectively analysed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariate regression analyses were used to determine significant EPE predictors for RM development. The prediction performance of the novel EPE-RM was compared with clinical T stage (cT), MR-European Society of Urogenital Radiology (ESUR) classification for EPE, two established nomograms (by Steuber et al and Ohori et al) and a clinical nomogram based on the coefficients of the established nomograms, and was constructed based on the data of the present cohort, using receiver operating characteristics (ROCs). For comparison, models' likelihood ratio (LR) tests and Vuong tests were used. Discrimination and calibration of the EPE-RM were validated based on resampling methods using bootstrapping. RESULTS AND LIMITATIONS International society of Urogenital Pathology grade on biopsy, ESUR criteria, prostate-specific antigen, cT, prostate volume, and capsule contact length were included in the EPE-RM. Calibration of the EPE-RM was good (error 0.018). The ROC area under the curve for the EPE-RM was larger (0.87) compared with cT (0.66), Memorial Sloan Kettering Cancer Center nomogram (0.73), Steuber nomogram (0.70), novel clinical nomogram (0.79), and ESUR classification (0.81). Based on LR and Vuong tests, the EPE-RM's model fit was significantly better than that of cT, all clinical models, and ESUR classification alone (p<0.001). Limitations include monocentric design and expert reading of MRI. CONCLUSIONS This novel EPE-RM, incorporating clinical and MRI parameters, performed better than contemporary clinical RMs and MRI predictors, therefore providing an accurate patient-tailored preoperative risk stratification of side-specific EPE. PATIENT SUMMARY Extraprostatic extension of prostate cancer can be predicted accurately using a combination of magnetic resonance imaging and clinical parameters. This novel risk model outperforms magnetic resonance imaging and clinical predictors alone and can be useful when planning nerve-sparing radical prostatectomy.
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Affiliation(s)
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bertram Hitthaler
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Dieffenbacher
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maya Mueller-Wolf
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wilfried Roth
- Institute of Pathology Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Roethke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Kozikowski M, Powroźnik J, Malewski W, Kawecki S, Piotrowicz S, Michalak W, Nyk Ł, Gola M, Dobruch J. 3.0-T multiparametric magnetic resonance imaging modifies the template of endoscopic, conventional radical prostatectomy in all cancer risk categories
. Arch Med Sci 2018; 14:1387-1393. [PMID: 30393494 PMCID: PMC6209726 DOI: 10.5114/aoms.2018.77222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/23/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the diagnostic performance of 3.0-T multiparametric magnetic resonance imaging (mpMRI) in preoperative staging of prostate cancer (PCa) and its influence on the extent of resection during endoscopic radical prostatectomy (ERP) among cancer risk groups. MATERIAL AND METHODS The data of 154 patients with PCa in whom mpMRI was performed prior to ERP between 2011 and 2015 were included. The initial decision whether to perform neurovascular bundle (NVB) sparing surgery was based on EAU guidelines. mpMRI images were reevaluated prior to prostatectomy to modify the surgical template. Imaging was compared with pathological reports to investigate the diagnostic performance of mpMRI. RESULTS The surgical template was modified in 69 (44.8%) patients after reevaluation of mpMRI. More preserving NVB sparing was attempted in 17 (11.0%) men, in whom NVB would have been resected if mpMRI had not been available. More aggressive NVB resection was performed in 52 (33.8%) men, in whom innervation would have been spared if basing solely based on guidelines. Among all PCa risk groups mpMRI had an impact on the surgical template with more aggressive surgery in 63.0% and 33.3% of men in the low- and intermediate-risk group, respectively, and more preserving in 21.4% of the high-risk patients. The change in extent of resection was not correlated with a higher risk of positive surgical margins (p = 0.196). CONCLUSIONS Preoperative mpMRI exerts a significant impact on decision making concerning the extent of resection during ERP irrespective of the PCa risk group.
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Affiliation(s)
- Mieszko Kozikowski
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Jan Powroźnik
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Wojciech Malewski
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Szymon Kawecki
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Sebastian Piotrowicz
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Wojciech Michalak
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Łukasz Nyk
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
| | - Magdalena Gola
- Department of Diagnostic Imaging, European Health Centre – Otwock, Poland
| | - Jakub Dobruch
- Urology Clinic, Centre of Postgraduate Medical Education, Department of Urology, European Health Centre – Otwock, Poland
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Tavukçu HH, Aytaç Ö, Balcı NC, Kulaksızoğlu H, Atuğ F. The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan? Turk J Urol 2017; 43:470-475. [PMID: 29201510 DOI: 10.5152/tud.2017.35589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022]
Abstract
Objective We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. Material and methods We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. Results There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Conclusion Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.
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Affiliation(s)
- Hasan Hüseyin Tavukçu
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ömer Aytaç
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Numan Cem Balcı
- Department of Radiology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Haluk Kulaksızoğlu
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Fatih Atuğ
- Department of Urology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
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Sauer M, Weinrich JM, Fraune C, Salomon G, Tennstedt P, Adam G, Beyersdorff D. Accuracy of multiparametric MR imaging with PI-RADS V2 assessment in detecting infiltration of the neurovascular bundles prior to prostatectomy. Eur J Radiol 2017; 98:187-192. [PMID: 29279161 DOI: 10.1016/j.ejrad.2017.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/17/2017] [Accepted: 11/26/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the accuracy of assessment of neurovascular bundle (NVB) infiltration using multiparametric magnetic resonance imaging (mpMRI) and PI-RADS V2 prior to prostatectomy. METHODS The ethics committee approved this retrospective study with waiver of informed consent. N=198 consecutive patients with biopsy proved cancer underwent standardized mpMRI at 3T prior to surgery. NVB infiltration was assessed for each side (a total of 396). Maximum PI-RADS V2 scores were determined for the posterolateral areas adjacent to the NVBs. Imaging results were correlated with postoperative pathology and standard descriptive statistics were calculated. RESULTS Overall T-staging sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of mpMRI were 64.4%, 89.2%, 82.4%, 76.2% and 78.3%, respectively. In 396 cases NVB infiltration was predicted with 75.3%, 94.0%, 80.2%, 92.1 % and 89.4 % sensitivity, specificity, PPV, NPV and accuracy, respectively. Analyses of 396 NVB and their adjacent PI-RADS V2 scores with pathology revealed significantly more NVB-infiltrations in suspect scores of 5 and 4 vs. uncertain scores of 3-1 (81/264 vs. 16/132, p=0.0001). Considering scores higher than 3 as a criterion of infiltration demonstrated moderate sensitivity and poor specificity (83.5% and 38.8%, respectively). Interobserver agreement of a second reading of a random sample was good (κ=0.64) for NVB infiltrations and moderate (κ=0.59) for PI-RADS V2. CONCLUSIONS Assessment of infiltration of the neurovascular bundles using mpMRI has valuable diagnostic performance, yet PI-RADS V2 Scores demonstrate limited eligibility. Combined findings offer crucial information for the planning of prostatectomy.
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Affiliation(s)
- Markus Sauer
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.
| | - Julius M Weinrich
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Gerhard Adam
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Dirk Beyersdorff
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
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Miyamoto H. Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought? Int J Urol 2016; 24:25-31. [PMID: 27862367 DOI: 10.1111/iju.13247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/05/2016] [Indexed: 12/18/2022]
Abstract
Despite significant advances in patient selection as well as surgical technique over the past few decades, it is still not uncommon for patients with urological malignancy and positive surgical margins to be observed. Meanwhile, intraoperative pathology consultation with frozen section assessment, which generally provides useful information for the optimal procedure, has been widely utilized for the assessment of surgical margins during urological surgeries. Thus, it remains unanswered whether intraoperative frozen section assessment has an impact on final surgical margin status as well as long-term oncological outcomes. The present review summarizes and discusses available data assessing the utility of frozen section assessment of the surgical margins during urological surgeries, such as radical prostatectomy, partial nephrectomy and radical cystectomy. The current findings suggest that select patients might benefit from the routine frozen section assessment.
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Affiliation(s)
- Hiroshi Miyamoto
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bianchi R, Cozzi G, Petralia G, Alessi S, Renne G, Bottero D, Brescia A, Cioffi A, Cordima G, Ferro M, Matei DV, Mazzoleni F, Musi G, Mistretta FA, Serino A, Tringali VML, Coman I, De Cobelli O. Multiparametric magnetic resonance imaging and frozen-section analysis efficiently predict upgrading, upstaging, and extraprostatic extension in patients undergoing nerve-sparing robotic-assisted radical prostatectomy. Medicine (Baltimore) 2016; 95:e4519. [PMID: 27749525 PMCID: PMC5059027 DOI: 10.1097/md.0000000000004519] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the role of multiparametric magnetic resonance imaging (mpMRI) in predicting upgrading, upstaging, and extraprostatic extension in patients with low-risk prostate cancer (PCa). MpMRI may reduce positive surgical margins (PSM) and improve nerve-sparing during robotic-assisted radical prostatectomy (RARP) for localized prostate cancer PCa.This was a retrospective, monocentric, observational study. We retrieved the records of patients undergoing RARP from January 2012 to December 2013 at our Institution. Inclusion criteria were: PSA <10 ng/mL; clinical stage <T3a; biopsy Gleason score <7; prostate mpMRI performed preoperatively at our Institution; intraoperative FSA of the posterolateral aspects of the specimen.All the identified lesions were scored according to the Prostate Imaging Reporting and Data System (PIRADS). We considered the lesion with the highest PIRADS score as index lesion. All the included patients underwent nerve-sparing RARP. During surgery, the specimen was sent for FSA of the posterolateral aspects. The surgeon, according to the localization scheme provided by the mpMRI, inked the region of the posterolateral aspect of the prostate that had to be submitted to FSA.We evaluated association between clinical features and PSM, upgrading, upstaging, and presence of unfavorable disease.Two hundred fifty-four patients who underwent nerve-sparing RARP were included. PSM rate was 29.13% and 15.75% at FSA and final pathology respectively. Interestingly, the use of FSA reduced PSM rate in pT3 disease (25.81%). Higher PIRADS scores demonstrated to be related to high probability of upgrading and upstaging. This significativity remains even when considering PIRADS 2-3 versus 4 versus 5 and PIRADS 2-3 versus 4-5. Also PSM at FSA were associated with higher probability of upgrading and upstaging.PIRADS score and FSA resulted to be strictly related to grading and staging, thus being able to predict upgrading and/or upstaging at final pathology.
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Affiliation(s)
| | - Gabriele Cozzi
- Division of Urology
- Correspondence: Gabriele Cozzi, Division of Urology, European Institute of Oncology, Via Ripamonti, 435-20141 Milan, Italy (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ioan Coman
- Department of Urology “Iuliu Hatieganu,” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ottavio De Cobelli
- Division of Urology
- Università degli Studi di Milano, Milan, Italy
- Department of Urology “Iuliu Hatieganu,” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Padhani AR, Petralia G, Sanguedolce F. Finding Minimal Extraprostatic Disease: Who Cares? Eur Urol 2016; 70:246-7. [DOI: 10.1016/j.eururo.2015.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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Ueno Y, Tamada T, Bist V, Reinhold C, Miyake H, Tanaka U, Kitajima K, Sugimura K, Takahashi S. Multiparametric magnetic resonance imaging: Current role in prostate cancer management. Int J Urol 2016; 23:550-7. [PMID: 27184019 DOI: 10.1111/iju.13119] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/07/2016] [Indexed: 12/31/2022]
Abstract
Digital rectal examination, serum prostate-specific antigen screening and transrectal ultrasound-guided biopsy are conventionally used as screening, diagnostic and surveillance tools for prostate cancer. However, they have limited sensitivity and specificity. In recent years, the role of multiparametric magnetic resonance imaging has steadily grown, and is now part of the standard clinical management in many institutions. In multiparametric magnetic resonance imaging, the morphological assessment of T2-weighted imaging is correlated with diffusion-weighted imaging, dynamic contrast-enhanced imaging perfusion and/or magnetic resonance spectroscopic imaging. Multiparametric magnetic resonance imaging is currently regarded as the most sensitive and specific imaging technique for the evaluation of prostate cancer, including detection, staging, localization and aggressiveness evaluation. This article presents an overview of multiparametric magnetic resonance imaging, and discusses the current role of multiparametric magnetic resonance imaging in the different fields of prostate cancer management.
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Affiliation(s)
- Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Vipul Bist
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Utaru Tanaka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Radtke JP, Hadaschik BA, Wolf MB, Freitag MT, Schwab C, Alt C, Roth W, Duensing S, Pahernik SA, Roethke MC, Schlemmer HP, Hohenfellner M, Teber D. The Impact of Magnetic Resonance Imaging on Prediction of Extraprostatic Extension and Prostatectomy Outcome in Patients with Low-, Intermediate- and High-Risk Prostate Cancer: Try to Find a Standard. J Endourol 2015; 29:1396-405. [DOI: 10.1089/end.2015.0358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Boris A. Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maya B. Wolf
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin T. Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Schwab
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wilfried Roth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sascha A. Pahernik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias C. Roethke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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