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Yan Y, Liu Y, Li T, Liang Q, Thakur A, Zhang K, Liu W, Xu Z, Xu Y. Functional roles of magnetic nanoparticles for the identification of metastatic lymph nodes in cancer patients. J Nanobiotechnology 2023; 21:337. [PMID: 37735449 PMCID: PMC10512638 DOI: 10.1186/s12951-023-02100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
Staging lymph nodes (LN) is crucial in diagnosing and treating cancer metastasis. Biotechnologies for the specific localization of metastatic lymph nodes (MLNs) have attracted significant attention to efficiently define tumor metastases. Bioimaging modalities, particularly magnetic nanoparticles (MNPs) such as iron oxide nanoparticles, have emerged as promising tools in cancer bioimaging, with great potential for use in the preoperative and intraoperative tracking of MLNs. As radiation-free magnetic resonance imaging (MRI) probes, MNPs can serve as alternative MRI contrast agents, offering improved accuracy and biological safety for nodal staging in cancer patients. Although MNPs' application is still in its initial stages, exploring their underlying mechanisms can enhance the sensitivity and multifunctionality of lymph node mapping. This review focuses on the feasibility and current application status of MNPs for imaging metastatic nodules in preclinical and clinical development. Furthermore, exploring novel and promising MNP-based strategies with controllable characteristics could lead to a more precise treatment of metastatic cancer patients.
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Affiliation(s)
- Yuanliang Yan
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Yuanhong Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Tongfei Li
- Hubei Key Laboratory of Embryonic Stem Cell Research, School of Basic Medical Sciences, Hubei University of Medicine, 442000, Shiyan, Hubei, China
| | - Qiuju Liang
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Abhimanyu Thakur
- Pritzker School of Molecular Engineering, Ben May Department for Cancer Research, University of Chicago, 60637, Chicago, IL, USA
| | - Kui Zhang
- Pritzker School of Molecular Engineering, Ben May Department for Cancer Research, University of Chicago, 60637, Chicago, IL, USA
| | - Wei Liu
- Department of Pathology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, 271000, Taian, Shandong, China.
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Mingels C, Loebelenz LI, Huber AT, Alberts I, Rominger A, Afshar-Oromieh A, Obmann VC. Literature review: Imaging in prostate cancer. Curr Probl Cancer 2023:100968. [PMID: 37336689 DOI: 10.1016/j.currproblcancer.2023.100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.
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Affiliation(s)
- Clemens Mingels
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Laura I Loebelenz
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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Wu J, Xia Y, Wang X, Wei Y, Liu A, Innanje A, Zheng M, Chen L, Shi J, Wang L, Zhan Y, Zhou XS, Xue Z, Shi F, Shen D. uRP: An integrated research platform for one-stop analysis of medical images. FRONTIERS IN RADIOLOGY 2023; 3:1153784. [PMID: 37492386 PMCID: PMC10365282 DOI: 10.3389/fradi.2023.1153784] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/31/2023] [Indexed: 07/27/2023]
Abstract
Introduction Medical image analysis is of tremendous importance in serving clinical diagnosis, treatment planning, as well as prognosis assessment. However, the image analysis process usually involves multiple modality-specific software and relies on rigorous manual operations, which is time-consuming and potentially low reproducible. Methods We present an integrated platform - uAI Research Portal (uRP), to achieve one-stop analyses of multimodal images such as CT, MRI, and PET for clinical research applications. The proposed uRP adopts a modularized architecture to be multifunctional, extensible, and customizable. Results and Discussion The uRP shows 3 advantages, as it 1) spans a wealth of algorithms for image processing including semi-automatic delineation, automatic segmentation, registration, classification, quantitative analysis, and image visualization, to realize a one-stop analytic pipeline, 2) integrates a variety of functional modules, which can be directly applied, combined, or customized for specific application domains, such as brain, pneumonia, and knee joint analyses, 3) enables full-stack analysis of one disease, including diagnosis, treatment planning, and prognosis assessment, as well as full-spectrum coverage for multiple disease applications. With the continuous development and inclusion of advanced algorithms, we expect this platform to largely simplify the clinical scientific research process and promote more and better discoveries.
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Affiliation(s)
- Jiaojiao Wu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Yuwei Xia
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Xuechun Wang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Ying Wei
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Aie Liu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Arun Innanje
- Department of Research and Development, United Imaging Intelligence Co., Ltd., Cambridge, MA, United States
| | - Meng Zheng
- Department of Research and Development, United Imaging Intelligence Co., Ltd., Cambridge, MA, United States
| | - Lei Chen
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Jing Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Liye Wang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Yiqiang Zhan
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Xiang Sean Zhou
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Zhong Xue
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Dinggang Shen
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
- Shanghai Clinical Research and Trial Center, Shanghai, China
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Cheng Z, Ma J, Yin L, Yu L, Yuan Z, Zhang B, Tian J, Du Y. Non-invasive molecular imaging for precision diagnosis of metastatic lymph nodes: opportunities from preclinical to clinical applications. Eur J Nucl Med Mol Imaging 2023; 50:1111-1133. [PMID: 36443568 DOI: 10.1007/s00259-022-06056-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
Lymph node metastasis is an indicator of the invasiveness and aggressiveness of cancer. It is a vital prognostic factor in clinical staging of the disease and therapeutic decision-making. Patients with positive metastatic lymph nodes are likely to develop recurrent disease, distant metastasis, and succumb to death in the coming few years. Lymph node dissection and histological analysis are needed to detect whether regional lymph nodes have been infiltrated by cancer cells and determine the likely outcome of treatment and the patient's chances of survival. However, these procedures are invasive, and tissue biopsies are prone to sampling error. In recent years, advanced molecular imaging with novel imaging probes has provided new technologies that are contributing to comprehensive management of cancer, including non-invasive investigation of lymphatic drainage from tumors, identifying metastatic lymph nodes, and guiding surgeons to operate efficiently in patients with complex lesions. In this review, first, we outline the current status of different molecular imaging modalities applied for lymph node metastasis management. Second, we summarize the multi-functional imaging probes applied with the different imaging modalities as well as applications of cancer lymph node metastasis from preclinical studies to clinical translations. Third, we describe the limitations that must be considered in the field of molecular imaging for improved detection of lymph node metastasis. Finally, we propose future directions for molecular imaging technology that will allow more personalized treatment plans for patients with lymph node metastasis.
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Affiliation(s)
- Zhongquan Cheng
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China.,CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Jiaojiao Ma
- Department of Medical Ultrasonics, China-Japan Friendship Hospital, Yinghua East Road 2#, ChaoYang Dist., Beijing, 100029, China
| | - Lin Yin
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100080, China
| | - Leyi Yu
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China
| | - Zhu Yuan
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China.
| | - Bo Zhang
- Department of Medical Ultrasonics, China-Japan Friendship Hospital, Yinghua East Road 2#, ChaoYang Dist., Beijing, 100029, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine Science and Engineering, Beihang University, Beijing, 100191, China.
| | - Yang Du
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100080, China.
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5
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Li M, Zhang Y, Ma J, Du J. Albumin-based nanoparticle for dual-modality imaging of the lymphatic system. RSC Adv 2023; 13:2248-2255. [PMID: 36741156 PMCID: PMC9838117 DOI: 10.1039/d2ra07414a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
The lymphatic system is a complex network of lymphatic vessels, lymph nodes, and lymphoid organs. The current understanding of the basic mechanism and framework of the lymphatic system is relatively limited and not ideal for exploring the function of the lymphatic system, diagnosing lymphatic system diseases, and controlling tumor metastasis. Imaging modalities for evaluating lymphatic system diseases mainly include lymphatic angiography, reactive dye lymphatic angiography, radionuclide lymphatic angiography, computed tomography, and ultrasonography. However, these are insufficient for clinical diagnosis. Some novel imaging methods, such as magnetic resonance imaging, positron emission computed tomography, single-photon emission computed tomography, contrast-enhanced ultrasonography, and near-infrared imaging with agents such as cyanine dyes, can reveal lymphatic system information more accurately and in detail. We fabricated an albumin-based fluorescent probe for dual-modality imaging of the lymphatic system. A near-infrared cyanine dye, IR-780, was absorbed into bovine serum albumin (BSA), which was covalently linked to a molecule of diethylenetriaminepentaacetic acid to chelate gadolinium Gd3+. The fabricated IR-780@BSA@Gd3+ nanocomposite demonstrates strong fluorescence and high near-infrared absorption and can be used as a T1 contrast agent for magnetic resonance imaging. In vivo dual-modality fluorescence and magnetic resonance imaging showed that IR-780@BSA@Gd3+ rapidly returned to the heart through the lymphatic circulation after it was injected into the toe webs of mice, facilitating good lymphatic imaging. The successful fabrication of the new IR-780@BSA@Gd3+ nanocomposite will facilitate the study of the mechanism and morphological structure of the lymphatic system.
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Affiliation(s)
- Mingze Li
- Jilin Provincial Key Laboratory of Lymphatic Surgical Disease, Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin UniversityChangchunJilin130031P. R. China
| | - Yundong Zhang
- Jilin Provincial Key Laboratory of Lymphatic Surgical Disease, Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin UniversityChangchunJilin130031P. R. China
| | - Jinli Ma
- Jilin Provincial Key Laboratory of Lymphatic Surgical Disease, Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin UniversityChangchunJilin130031P. R. China
| | - Jianshi Du
- Jilin Provincial Key Laboratory of Lymphatic Surgical Disease, Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin UniversityChangchunJilin130031P. R. China
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Rocco B, Eissa A, Gaia G, Assumma S, Sarchi L, Bozzini G, Micali S, Calcagnile T, Sighinolfi MC. Pelvic lymph node dissection in prostate and bladder cancers. Minerva Urol Nephrol 2022; 74:680-694. [PMID: 36197698 DOI: 10.23736/s2724-6051.22.04904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Prostate cancer and bladder cancer accounts for approximately 13.5% and 3% of all male cancers and all newly diagnosed cancers (regardless sex), respectively. Thus, these cancers represent a major health and economic burden globally. The knowledge of lymph node status is an integral part of the management of any solid tumor. In the urological field, pelvic lymph node dissection (PLND) is of paramount importance in the diagnosis, management, and prognosis of prostate and bladder cancers. However, PLND may be associated with several comorbidities. In this narrative review, the most recent updates concerning the patterns and incidence of lymph node metastasis, the role of different imaging studies and nomograms in determining patients' eligibility for PLND, and the anatomical templates of PLND in urologic patients with bladder or prostate cancer will be discussed.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Giorgia Gaia
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria C Sighinolfi
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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7
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Validating the screening criteria for bone metastases in treatment-naïve unfavorable intermediate and high-risk prostate cancer - the prevalence and location of bone- and lymph node metastases. Eur Radiol 2022; 32:8266-8275. [PMID: 35939081 DOI: 10.1007/s00330-022-08945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/12/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The European Association of Urology (EAU) recommends a bone scan for newly diagnosed unfavorable intermediate- and high-risk prostate cancer. We aimed to validate the screening criteria for bone metastases in patients with treatment-naïve prostate cancer. METHODS This single-center retrospective study included all patients with treatment-naïve unfavorable intermediate- or high-risk prostate cancer. All underwent MRI of the lumbar column (T2Dixon) and pelvis (3DT2w, DWI, and T2 Dixon). The presence and location of lymph node and bone metastases were registered according to risk groups and radiological (rad) T-stage. The risk of lymph node metastases was assessed by odds ratio (OR). RESULTS We included 390 patients, of which 68% were high-risk and 32% were unfavorable intermediate-risk. In the high-risk group, the rate of regional- and non-regional lymph node metastases was 11% and 6%, respectively, and the rate of bone metastases was 10%. In the unfavorable intermediate-risk group, the rate of regional- and non-regional lymph node metastases was 4% and 0.8%, respectively, and the rate of bone metastases was 0.8%. Metastases occurred exclusively in the lumbar column in 0.5% of all patients, in the pelvis in 4%, and the pelvis and lumbar column in 3%. All patients with bone metastases had radT3-4, and patients with radT3-4 showed a four-fold increased risk of lymph node metastases (OR 4.48, 95% CI: 2.1-9.5). CONCLUSION Bone metastases were found in 10% with high-risk prostate cancer and 0.8% with unfavorable intermediate-risk. Therefore, we question the recommendation to screen the unfavorable intermediate-risk group for bone metastases. KEY POINTS • The rate of bone metastases was 10% in high-risk patients and 0.8% in the unfavorable intermediate-risk group. • The rate of lymph-node metastases was 17% in high-risk patients and 5% in the unfavorable intermediate-risk group. • No bone metastases were seen in radiologically localized disease.
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8
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Predictive role of node-rads score in patients with prostate cancer candidates for radical prostatectomy with extended lymph node dissection: comparative analysis with validated nomograms. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00564-z. [PMID: 35732820 DOI: 10.1038/s41391-022-00564-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/24/2022] [Accepted: 06/10/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The Reporting and Data System (RADS) have been used in the attempts to standardize the results of oncological scans in different scenarios, such as lymph nodes, adding configuration criteria to size determination. We analyze the predictive value of preoperative Node-RADS determination at imaging for pelvic lymph node (PLN) involvement in cases of prostate cancer (PC) considered for radical prostatectomy (RP) with extended lymph node dissection (eLND) and we compare it with validate predictive nomograms (MSKCC, Briganti and Gandaglia). METHODS 150 patients with a histological diagnosis of PC (high risk or intermediate with an estimated risk for pN+ higher than 5% using the Briganti or 7% using the Gandaglia nomogram) submitted for RP with an ePLND from 2018 and 2021 were retrospectively examined. Node-RADS determination was performed in all cases using the preoperative magnetic resonance (MR), performed by a radiologist blinded for pathologic results and compared with the MSKCC, Briganti 2012, Gandaglia 2017 and Gandaglia 2019 nomograms. RESULTS PLN involvement at final pathology (pN+) was found in 36/150 (24.0%) of cases and the mean percentage of positive LNs in pN+ cases was 15.90 ± 13.40. The mean number of PLNs removed at RP was similar (p = 0.188) between pN0 (23.9 ± 8.0) and pN+ (25.3 ± 8.0) cases. Considering a Node RADS 4-5 positive and a Node RADS 1-2 negative, the PPV was 100% and the NPV was 79.6%. A Node RADS score 4-5 showed a lower sensitivity (0.167 versus 0.972, 1.000, 0.971, 0.960 respectively), a higher specificity (1.000 versus 0.079, 0.096, 0.138, 0.186 respectively) and a similar AUC (0.583 versus 0.591, 0.581, 0.574, 0.597 respectively) when compared to MSKCC, Briganti 2012, Gandaglia 2017 and Gandaglia 2019 nomograms. CONCLUSIONS Our evaluation suggests that Node RADS score, combining configuration criteria to size determination could improve specificity in terms of pathologic PLN prediction but a very low sensitivity has been also described.
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Michael J, Neuzil K, Altun E, Bjurlin MA. Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review. Cancer Manag Res 2022; 14:937-951. [PMID: 35256864 PMCID: PMC8898014 DOI: 10.2147/cmar.s283299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.
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Affiliation(s)
- Jamie Michael
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Kevin Neuzil
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Correspondence: Marc A Bjurlin, Associate Professor, Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, 2nd Floor, Chapel Hill, NC, USA, Email
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10
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Yang G, Xie J, Guo Y, Yuan J, Wang R, Guo C, Peng B, Yao X, Yang B. Identifying the Candidates Who Will Benefit From Extended Pelvic Lymph Node Dissection at Radical Prostatectomy Among Patients With Prostate Cancer. Front Oncol 2022; 11:790183. [PMID: 35155191 PMCID: PMC8826072 DOI: 10.3389/fonc.2021.790183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/31/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The therapeutic effect of extended pelvic lymph node dissection (PLND) in prostate cancer (PCa) patients is still controversial. The aim of this study was to identify the PCa patients who may benefit from extended PLND based on the 2012 Briganti nomogram. MATERIALS AND METHODS PCa patients who underwent radical prostatectomy (RP) plus PLND between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The probability of lymph node invasion (LNI), determined using the 2012 Briganti nomogram, was used to stratify the patients. The endpoints were overall survival (OS) and cancer-specific survival (CSS). Propensity score matching (PSM) was performed to account for potential differences between patients with and without extended PLND. Univariable and multivariable Cox regression was used to analyze the association between the number of removed nodes (NRN) and survival. Kaplan-Meier analysis was performed to estimate OS and CSS. Extended PLND was defined as NRN >75th percentile. RESULTS A total of 27,690 patients were included in the study. NRN was not an independent predictor of OS (p = 0.564). However, in patients with probability of LNI ≥37, multivariable analyses showed that increased NRN was associated with improved OS (hazard ratio [HR] = 0.963; p = 0.002). The 5-y OS rate was significantly higher for patients with NRN ≥12 than those with NRN <12 (94.9% vs. 91.9%, respectively; p = 0.015). In the PSM cohort, among patients with probability of LNI ≥37, multivariable analyses showed that increased NRN was associated with improved OS (HR = 0.961; p = 0.004). In addition, the 5-y OS rate was significantly higher for patients with NRN ≥12 than those with NRN <12 (94.9% vs. 89.8%, respectively; p = 0.002). However, NRN was not an independent predictor of CSS in any LNI risk subgroup (all p >0.05). CONCLUSION Extensive PLND might be associated with improved survival in PCa patients with a high risk of LNI, which supports the use of extended PLND in highly selected PCa patients. The results need to be validated in prospective studies with long-term follow-up.
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Affiliation(s)
- Guanjie Yang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Xie
- Shanghai Clinical College, Anhui Medical University, Shanghai, China
| | - Yadong Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Yuan
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ruiliang Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changcheng Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Peng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Clinical College, Anhui Medical University, Shanghai, China
| | - Xudong Yao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Clinical College, Anhui Medical University, Shanghai, China
| | - Bin Yang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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11
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Daryanani A, Turkbey B. Recent Advancements in CT and MR Imaging of Prostate Cancer. Semin Nucl Med 2021; 52:365-373. [PMID: 34930627 PMCID: PMC9038642 DOI: 10.1053/j.semnuclmed.2021.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/11/2022]
Abstract
CT and MRI are both commonly used in prostate cancer (PCa) management, which includes a large spectrum from screening positive pre-diagnosis phase to metastatic disease. CT and MRI have continually evolved to meet the changing demands for PCa management. For CT, novel techniques such as dual energy CT and photon counting CT show promising results for tissue characterization and quantification. For MRI, the detection, staging, and management of prostate cancer has been significantly improved by the development of multiparametric, biparametric, and whole-body MRI techniques. Additionally, research on ultrasmall superparamagnetic particles of iron oxide contrast-enhanced MRI has revealed promising results for nodal staging of PCa. In this manuscript we aim to outline the current status and recent advancements of CT and MRI in PCa imaging.
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Affiliation(s)
- Asha Daryanani
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD.
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Zanoni L, Bianchi L, Nanni C, Pultrone C, Giunchi F, Bossert I, Matti A, Schiavina R, Fiorentino M, Romagnoli D, Fonti C, Lodi F, D'Errico A, Brunocilla E, Porreca A, Fanti S. [ 18F]-Fluciclovine PET/CT for preoperative nodal staging in high-risk primary prostate cancer: final results of a prospective trial. Eur J Nucl Med Mol Imaging 2021; 49:390-409. [PMID: 34213609 DOI: 10.1007/s00259-021-05429-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The conventional imaging flowchart for prostate cancer (PCa) staging may fail in correctly detecting lymph node metastases (LNM). Pelvic lymph node dissection (PLND) represents the only reliable method, although invasive. A new amino acid PET compound, [18F]-fluciclovine, was recently authorized in suspected PCa recurrence but not yet included in the standard staging work-up of primary PCa. A prospective monocentric study was designed to evaluate [18F]-fluciclovine PET/CT diagnostic performance for preoperative LN staging in primary high-risk PCa. METHODS Consecutive patients (pts) with biopsy-proven PCa, standard staging (including [11C]choline PET/CT), eligible for PLND, were enrolled to undergo an investigational [18F]-fluciclovine PET/CT. Nodal uptake higher than surrounding background was reported by at least two readers (blinded to [11C]choline) using a visual 5-point scale (1-2 probably negative; 4-5 probably positive; 3 equivocal); SUVmax, target-to-background (aorta-A; bone marrow-BM) ratios (TBRs), were also calculated. PET results were validated with PLND. [18F]-fluciclovine PET/CT performance using visual score and semi-quantitative indexes was analyzed both per patient and per LN anatomical region, compared to conventional [11C]choline and clinical predictive factors (to note that diagnostic performance of [18F]-fluciclovine was explored for LNM but not examined for intrapelvic or extrapelvic M1 lesions). RESULTS Overall, 94 pts underwent [18F]-fluciclovine PET/CT; 72/94 (77%) high-risk pts were included in the final analyses (22 pts excluded: 8 limited PLND; 3 intermediate-risk; 2 treated with radiotherapy; 4 found to be M1; 5 neoadjuvant hormonal therapy). Median LNM risk by Briganti nomogram was 19%. LNM confirmed on histology was 25% (18/72 pts). Overall, 1671 LN were retrieved; 45/1671 (3%) LNM detected. Per pt, median no. of removed LN was 22 (mean 23 ± 10; range 8-51), of LNM was 2 (mean 3 ± 2; range 1-10). Median LNM size was 5 mm (mean 5 ± 2.5; range 2-10). On patient-based analyses (n = 72), diagnostic performance for LNM resulted significant with [18F]-fluciclovine (AUC 0.66, p 0.04; 50% sensitivity, 81% specificity, 47% PPV, 83% NPV, 74% accuracy), but not with [11C]choline (AUC 0.60, p 0.2; 50%, 70%, 36%, 81%, and 65% respectively). Briganti nomogram (OR = 1.03, p = 0.04) and [18F]-fluciclovine visual score (≥ 4) (OR = 4.27, p = 0.02) resulted independent predictors of LNM at multivariable analyses. On region-based semi-quantitative analyses (n = 576), PET/CT performed better using TBR parameters (TBR-A similar to TBR-BM; TBR-A fluciclovine AUC 0.61, p 0.35, vs choline AUC 0.57 p 0.54; TBR-BM fluciclovine AUC 0.61, p 0.36, vs choline AUC 0.58, p 0.52) rather than using absolute LN SUVmax (fluciclovine AUC 0.51, p 0.91, vs choline AUC 0.51, p 0.94). However, in all cases, diagnostic performance was not statistically significant for LNM detection, although slightly in favor of the experimental tracer [18F]-fluciclovine for each parameter. On the contrary, visual interpretation significantly outperformed PET semi-quantitative parameters (choline and fluciclovine: AUC 0.65 and 0.64 respectively; p 0.03) and represents an independent predictive factor of LNM with both tracers, in particular [18F]-fluciclovine (OR = 8.70, p 0.002, vs OR = 3.98, p = 0.03). CONCLUSION In high-risk primary PCa, [18F]-fluciclovine demonstrates some advantages compared with [11C]choline but sensitivity for metastatic LN detection is still inadequate compared to PLND. Visual (combined morphological and functional), compared to semi-quantitative assessment, is promising but relies mainly on readers' experience rather than on unquestionable LN avidity. TRIAL REGISTRATION EudraCT number: 2014-003,165-15.
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Affiliation(s)
- Lucia Zanoni
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Lorenzo Bianchi
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Cristian Pultrone
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesca Giunchi
- Pathology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Irene Bossert
- Nuclear Medicine, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Antonella Matti
- Nuclear Medicine, IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar Di Valpolicella, (VR), Italy
| | - Riccardo Schiavina
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Specialistic Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | | | - Cristina Fonti
- Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Filippo Lodi
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Antonietta D'Errico
- Pathology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Stefano Fanti
- Nuclear Medicine, Istituto Di Ricovero E Cure a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- DIMES, University of Bologna, Bologna, Italy
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Hu JC, Wang SS, Chou YE, Chiu KY, Li JR, Chen CS, Hung SC, Yang CK, Ou YC, Cheng CL, Lin CY, Yang SF. Associations between LncRNA MALAT1 Polymorphisms and Lymph Node Metastasis in Prostate Cancer. Diagnostics (Basel) 2021; 11:diagnostics11091692. [PMID: 34574033 PMCID: PMC8468695 DOI: 10.3390/diagnostics11091692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Current evidence elucidates that long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) could regulate genetic expression and play a crucial role in both the diagnosis and prognosis of prostate cancer. Single-nucleotide polymorphisms (SNPs) of MALAT1 could alter the oncogenesis in various cancers. However, the associations between MALAT1 SNPs and prostate cancer have barely been investigated to date. This study included 579 patients with prostate cancer who received robotic-assisted radical prostatectomy at Taichung Veterans General Hospital from 2012 to 2017. Three SNPs of MALAT1 were analyzed to identify the impacts of SNPs on the clinicopathologic features in Taiwanese prostate cancer. Our results show that patients with a polymorphic G allele at rs619586 had a significantly higher risk of being in an advanced Gleason grade group (AOR: 1.764; 95% CI: 1.011–3.077; p = 0.046). Moreover, individuals with at least one polymorphic A allele at MALAT1 rs1194338 in the PSA >10 ng/mL group were positively associated with node-positive prostate cancer. In conclusion, MALAT1 SNPs are significantly associated with the susceptibility to both advanced Gleason grade and nodal metastasis in prostate cancer. The presence of MALAT1 SNPs rs619586 and rs1194338 seems to enhance oncogenesis in prostate cancer.
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Affiliation(s)
- Ju-Chuan Hu
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
- Division of Urology, Department of Surgery, Chiayi Branch, Taichung Veterans General Hospital, Chiayi 600, Taiwan
| | - Shian-Shiang Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
- Department of Applied Chemistry, National Chi Nan University, Nantou 545, Taiwan
| | - Ying-Erh Chou
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
- Department of Applied Chemistry, National Chi Nan University, Nantou 545, Taiwan
| | - Jian-Ri Li
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
- Department of Medicine and Nursing, Hung Kuang University, Taichung 433, Taiwan
| | - Chuan-Shu Chen
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
| | - Sheng-Chun Hung
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
| | - Yen-Chuan Ou
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
- Department of Urology, Tung’s Taichung MetroHarbor Hospital, Taichung 433, Taiwan
| | - Chen-Li Cheng
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
| | - Chia-Yen Lin
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; (K.-Y.C.); (C.-K.Y.)
- Correspondence: (C.-Y.L.); (S.-F.Y.)
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-C.H.); (S.-S.W.); (Y.-E.C.); (J.-R.L.); (C.-S.C.); (S.-C.H.); (Y.-C.O.); (C.-L.C.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-Y.L.); (S.-F.Y.)
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Elsholtz FHJ, Asbach P, Haas M, Becker M, Beets-Tan RGH, Thoeny HC, Padhani AR, Hamm B. Introducing the Node Reporting and Data System 1.0 (Node-RADS): a concept for standardized assessment of lymph nodes in cancer. Eur Radiol 2021; 31:6116-6124. [PMID: 33585994 PMCID: PMC8270876 DOI: 10.1007/s00330-020-07572-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/04/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022]
Abstract
"Node-RADS" addresses the lack of consensus in the radiologic assessment of lymph node involvement by cancer and meets the increasing demand for structured reporting on the likelihood of disease involvement. Node Reporting and Data System 1.0 (Node-RADS) systematically classifies the degree of suspicion of lymph node involvement based on the synthesis of established imaging findings. Straightforward definitions of imaging findings for two proposed scoring categories "size" and "configuration" are combined into assessment categories between 1 ("very low likelihood") and 5 ("very high likelihood"). This scoring system is suitable for assessing likely involvement of lymph nodes on CT and MRI scans. It can be applied at any anatomical site, and to regional and non-regional lymph nodes in relation to a primary tumor location. Node-RADS will improve communication with referring physicians and promote the consistency of reporting for primary staging and in response assessment settings. KEY POINTS: • Node-RADS standardizes reporting of possible cancer involvement of regional and distant lymph nodes on CT and MRI. • Node-RADS proposes the scoring categories "size" and "configuration" for assigning the 5-point Node-RADS score from 1 ("very low likelihood") to 5 ("very high likelihood"). • Node-RADS aims to increase consensus among radiologists for primary staging and in response assessment settings.
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Affiliation(s)
- Fabian H J Elsholtz
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Minerva Becker
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harriet C Thoeny
- Department of Diagnostic and Interventional Radiology, Fribourg Cantonal Hospital, Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
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15
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Tseng JR, Yu KJ, Liu FY, Yang LY, Hong JH, Yen TC, Pang ST, Wang LJ. Comparison between 68Ga-PSMA-11 PET/CT and multiparametric magnetic resonance imaging in patients with biochemically recurrent prostate cancer following robot-assisted radical prostatectomy. J Formos Med Assoc 2021; 120:688-696. [DOI: 10.1016/j.jfma.2020.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/13/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
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Cheung DC, Fleshner N, Sengupta S, Woon D. A narrative review of pelvic lymph node dissection in prostate cancer. Transl Androl Urol 2020; 9:3049-3055. [PMID: 33457278 PMCID: PMC7807357 DOI: 10.21037/tau-20-729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pelvic lymph node dissection (PLND) is an important component in the staging and prognostication of prostate cancer. We performed a narrative review to assess the literature surrounding PLND: (I) the current guideline recommendations and contemporary utilization, (II) the calculation of patient-specific risk to perform PLND using available nomograms, (III) to review the extent of dissection, and its associated outcomes and complications. Due to the improved lymph node yield, better staging, and theoretical improvement in the control of micro-metastatic disease, guidelines have supported the use of (extended-) PLND in patients deemed to be at intermediate or high risk of lymph node involvement (often at a threshold of 5% on modern risk nomograms). However, in practice, real-world utilization of PLND varies considerably due to multiple reasons. Conflicting evidence persists with no clear oncological benefit to PLND, and a small, but important, risk of morbidity. Complications are rare, but include lymphoceles; thromboembolic events; and more rarely, obturator nerve, vascular, and ureteric injury. Furthermore, changing disease incidence and stage migration in the context of earlier detection overall have led to a decreased risk of nodal disease. The trade-offs between the benefits, harms, and risk tolerance/threshold must be carefully considered between each patient and their clinician.
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Affiliation(s)
| | - Neil Fleshner
- Division of Urology, University of Toronto, Toronto, Canada
| | - Shomik Sengupta
- Eastern Health Clinical School, Monash University, Melbourne, Australia.,Urology Unit, Eastern Health, Victoria, Australia
| | - Dixon Woon
- Urology Unit, Eastern Health, Victoria, Australia
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Bilusic M, Einstein DJ, Karzai FH, Dahut WL, Gulley JL, Aragon-Ching JB, Madan RA. The Potential Role for Immunotherapy in Biochemically Recurrent Prostate Cancer. Urol Clin North Am 2020; 47:457-467. [PMID: 33008496 PMCID: PMC8177734 DOI: 10.1016/j.ucl.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biochemically recurrent prostate cancer represents a stage of prostate cancer where conventional (continued on next page) computed tomography and technetium Tc 99m bone scan imaging are unable to detect disease after curative intervention despite rising prostate-specific antigen. There is no clear standard of care and no systemic therapy has been shown to improve survival. Immunotherapy-based treatments potentially are attractive options relative to androgen deprivation therapy due to the generally more favorable side-effect profile. Biochemically recurrent prostate cancer patients have a low tumor burden and likely lymph node-based disease, which may make them more likely to respond to immunotherapy.
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Affiliation(s)
- Marijo Bilusic
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, 13n240b, Bethesda, MD 20892, USA
| | - David J Einstein
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Fatima H Karzai
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, 13n240b, Bethesda, MD 20892, USA
| | - William L Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, 13n240b, Bethesda, MD 20892, USA
| | - James L Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, 13n240b, Bethesda, MD 20892, USA
| | | | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, 13n240b, Bethesda, MD 20892, USA.
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Overall survival comparison between androgen deprivation therapy (ADT) plus external beam radiation therapy (EBRT) vs ADT plus EBRT with brachytherapy boost in clinically node-positive prostate cancer. Brachytherapy 2020; 19:557-566. [PMID: 32624405 DOI: 10.1016/j.brachy.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Optimal therapy for clinically node-positive, nonmetastatic (cN1) prostate cancer (PC) patients remains controversial, ranging from aggressive local therapy to palliative systematic therapy alone. Despite guideline support, it is unclear if a brachytherapy (BT) boost should be considered for cN1 patients as these patients were excluded from randomized trials establishing its benefit. Herein, we compare definitive radiation therapy (RT) with or without a BT boost in cN1 PC. METHODS AND MATERIALS The National Cancer Database was used to identify men with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy between 2004 and 2013. Overall survival (OS) was compared between those who received external beam RT (EBRT) or combination EBRT plus BT boost (EBRT + BT) using Kaplan-Meier with propensity score matching and Cox proportional hazards. RESULTS With a median followup of 48.5 months, 1,650 patients were eligible for this analysis, 103 (6.2%) of whom received EBRT + BT. Younger age, no medical comorbidities, and Gleason score of six were associated with higher likelihood of receiving EBRT + BT over EBRT alone. The mean (median) OS for EBRT and EBRT + BT was 99.0 (110.6) months vs 109.2 (not reached) months, respectively (p = 0.048). However, no significance difference in OS was observed between the groups after propensity score matching. On multivariable analysis, EBRT + BT was not significantly associated with improved OS (adjusted HR 0.67, 95% CI, 0.41-1.07, p = 0.098). CONCLUSIONS In this retrospective, observational study of patients with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy, EBRT + BT had an unadjusted improvement in OS compared with EBRT alone that lost statistical significance after multivariable adjustment and propensity score matching.
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Pesapane F, Downey K, Rotili A, Cassano E, Koh DM. Imaging diagnosis of metastatic breast cancer. Insights Imaging 2020; 11:79. [PMID: 32548731 PMCID: PMC7297923 DOI: 10.1186/s13244-020-00885-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Numerous imaging modalities may be used for the staging of women with advanced breast cancer. Although bone scintigraphy and multiplanar-CT are the most frequently used tests, others including PET, MRI and hybrid scans are also utilised, with no specific recommendations of which test should be preferentially used. We review the evidence behind the imaging modalities that characterise metastases in breast cancer and to update the evidence on comparative imaging accuracy.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO - European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milano, MI, Italy.
| | - Kate Downey
- Department of Breast Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Anna Rotili
- Breast Imaging Division, IEO - European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milano, MI, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO - European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milano, MI, Italy
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK.,Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
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20
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Lebastchi AH, Gupta N, DiBianco JM, Piert M, Davenport MS, Ahdoot MA, Gurram S, Bloom JB, Gomella PT, Mehralivand S, Turkbey B, Pinto PA, George AK. Comparison of cross-sectional imaging techniques for the detection of prostate cancer lymph node metastasis: a critical review. Transl Androl Urol 2020; 9:1415-1427. [PMID: 32676426 PMCID: PMC7354341 DOI: 10.21037/tau.2020.03.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Conventional staging for prostate cancer (PCa) is performed for men diagnosed with unfavorable-intermediate or higher risk disease. Computed tomography (CT) of the abdomen and pelvis and whole body bone scan remains the standard of care for the detection of visceral, nodal, and bone metastasis. The implementation of the 2012 United States Preventive Services Task Force recommendation against routine prostate specific antigen (PSA) screening resulted in a rise of metastatic PCa at the time of diagnosis, emphasizing the importance of effective imaging modalities for evaluating metastatic disease. CT plays a major role in clinical staging at the time of PCa diagnosis, but multi-parametric magnetic resonance imaging (MRI) is now integrated into many prostate biopsy protocols for the detection of primary PCa, and may be a surrogate for CT for nodal staging. Current guidelines incorporate both CT and MRI as appropriate cross-sectional imaging modalities for the identification of nodal metastasis in indicated patients. There is an ongoing debate about the utility of traditional cross-sectional imaging modalities as well as advanced imaging modalities in detection of both organ-confined PCa detection and nodal involvement.
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Affiliation(s)
- Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nikhil Gupta
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - John M DiBianco
- Department of Urology, George Washington University Medical School, Washington D.C., USA
| | - Morand Piert
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael A Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Patrick T Gomella
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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21
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Hatano K, Tanaka J, Nakai Y, Nakayama M, Kakimoto KI, Nakanishi K, Nishimura K. Utility of index lesion volume assessed by multiparametric MRI combined with Gleason grade for assessment of lymph node involvement in patients with high-risk prostate cancer. Jpn J Clin Oncol 2020; 50:333-337. [PMID: 31829421 DOI: 10.1093/jjco/hyz170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We examined the potential predictors of lymph node involvement and evaluated whether index lesion volume assessed using multiparametric magnetic resonance imaging is associated with lymph node involvement among patients with high-risk prostate cancer. METHODS Extended pelvic lymph node dissection was used to evaluate patients with lymph node involvement. We retrospectively analyzed consecutive 102 patients with high-risk prostate cancer who underwent extended pelvic lymph node dissection at our institution between 2011 and 2017. To evaluate the index lesion volume at multiparametric magnetic resonance imaging (mrV), lesions were manually contoured on each T2-weighted axial slice in combination with diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging and integrated using image analysis software. Logistic regression analysis was performed to identify predictors of lymph node involvement. RESULTS The median mrV was 1.4 ml (range 0-30.1 ml), and the median number of resected lymph nodes was 14 (range 7-38). Among 102 patients, 28 (28%) had lymph node involvement. Multivariate analysis identified significant predictors of lymph node involvement as follows: biopsy Gleason-grade group 5 (odds ratio = 17.2; 95% confidence interval, 2.1-299.0; P = 0.005), preoperative mrV (odds ratio = 1.14; 95% confidence interval, 1.02-1.30; P = 0.025) and percentage of positive cores with highest Gleason-grade group (odds ratio = 1.05; 95% confidence interval, 1.01-1.10; P = 0.005). Lymph node involvement was prevalent (69%) among tumors with Gleason-grade group 5 and mrV ≥3.4 ml, but was infrequently (10%) present among tumors with Gleason-grade group ≤4 and mrV <3.4 ml. CONCLUSIONS The combination of biopsy Gleason-grade and mrV may serve as a useful tool to stratify patients according to their risk of nodal metastases.
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Affiliation(s)
- Koji Hatano
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Junichiro Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken-Ichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
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22
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Mattei A, Würnschimmel C, Baumeister P, Hyseni A, Afferi L, Moschini M, Mordasini L, Grande P. Standardized and Simplified Robot-assisted Superextended Pelvic Lymph Node Dissection for Prostate Cancer: The Monoblock Technique. Eur Urol 2020; 78:424-431. [PMID: 32327264 DOI: 10.1016/j.eururo.2020.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extended pelvic lymph node dissection (ePLND) remains the most accurate procedure for lymph node staging in intermediate- and high-risk prostate cancer (PCa) patients undergoing radical prostatectomy (RP). A superextended pelvic lymph node dissection (sePLND) can be considered in selected very-high-risk PCa patients. OBJECTIVE To demonstrate a reproducible robot-assisted technique for sePLND at the time of RP for PCa. DESIGN, SETTING, AND PARTICIPANTS From June 2016 to August 2019, 41 consecutive patients with localized PCa and very high risk for lymph node invasion (LNI) received a robot-assisted RP and a standardized 10-step monoblock ePLND, followed by a 5-step monoblock sePLND. Very high risk for LNI was defined as ≥30% risk for LNI, as calculated by the Briganti 2017 nomogram. SURGICAL PROCEDURE After performing the ePLND template resection (harvesting lymph nodes from the obturator region, external and internal iliac vessels, and common iliac vessels up to the ureter crossing), the 5-step monoblock sePLND approach was performed. The sePLND template was tailored to the common iliac vessels up to the aortic and caval bifurcation as well as the presacral region. MEASUREMENTS Lymph node yield, perioperative complications. RESULTS AND LIMITATIONS Overall, 41 patients received sePLND, reporting a median (interquartile range [IQR]) number of nodes removed of 23 (19-29). Median operative time (including RP, ePLND, and sePLND) was 256 min. Median preoperative prostate-specific antigen was 12 ng/mL (IQR 6.45-17.6). Disease stage pT <3 was found in 10 (24.4%) patients, pT3a in nine (22%) patients, pT3b in 21 (51.2%) patients, and pT4 in one (2.4%) patient. Of the treated patients, 54% revealed LNI: five (4.9%) in a solitary node, five (4.9%) in two to five nodes, and 12 (29.3%) in more than five nodes. Considering perioperative complications, three (7.3%) patients experienced Clavien I-II and four (9.7%) experienced Clavien ≥ III complications. Median hospital stay was 6 d. No patient underwent postoperative blood transfusion. CONCLUSIONS The 5-step sePLND approach is a reproducible and feasible technique for PCa patients at a very high risk of LNI. PATIENT SUMMARY In our study, we aimed to provide surgeons with a step-by-step technique for lymph node dissection, which aims to collect possibly metastatic lymph nodes of prostate cancer in an even more extended version ("superextended") than a standard ("extended") lymph node dissection.
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Affiliation(s)
- Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
| | | | | | - Ajet Hyseni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Luca Afferi
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Pietro Grande
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
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23
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Tanaka T, Yang M, Froemming AT, Bryce AH, Inai R, Kanazawa S, Kawashima A. Current Imaging Techniques for and Imaging Spectrum of Prostate Cancer Recurrence and Metastasis: A Pictorial Review. Radiographics 2020; 40:709-726. [PMID: 32196428 DOI: 10.1148/rg.2020190121] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Relapsing level of prostate-specific antigen (PSA) after initial curative-intent local therapy for organ-confined prostate cancer is often the first sign of recurrence. However, PSA level recurrence does not enable accurate differentiation of locally recurrent tumor from metastatic disease or a combination of both. Metastatic prostate cancer most frequently involves bones and lymph nodes, followed by other organs such as the liver, lung, pleura, adrenal gland, ureter, peritoneum, penis, testis, and meninges. Conventional imaging including CT and bone scintigraphy has long been the standard of care but has limited sensitivity in depicting early local recurrence or metastatic disease. Multiparametric MRI has been shown to be more sensitive in detecting locally recurrent tumor in the prostatectomy bed as well as in situ recurrence in a prostate gland that has been treated with radiation therapy or thermal ablation. In addition, lesions detected with multiparametric MRI may be amenable to targeted biopsy for definitive diagnosis of recurrence. PET/CT or PET/MRI using the U.S. Food and Drug Administration (FDA)-approved tracers carbon 11 choline or fluorine 18 fluciclovine has demonstrated markedly increased sensitivity and specificity for diagnosis of early metastatic disease such as small-volume lymph node metastasis, as have a range of investigational gallium 68 prostate-specific membrane antigen (PSMA) radioactive PET tracers. With recent advances in imaging modalities and techniques, more accurate early detection, localization, and characterization of recurrent prostate cancer have become possible. The authors present a contemporary review of the strengths and limitations of conventional and advanced imaging modalities in evaluation of patients with recurrent prostate cancer and a systematic review of the clinical and imaging features of locally recurrent and metastatic disease.©RSNA, 2020See discussion on this article by Barwick and Castellucci.
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Affiliation(s)
- Takashi Tanaka
- From the Department of Radiology (T.T., M.Y., A.K.) and Department of Hematology and Medical Oncology (A.H.B.), Mayo Clinic, Scottsdale, Ariz; Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan (T.T., R.I., S.K.); and Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.)
| | - Ming Yang
- From the Department of Radiology (T.T., M.Y., A.K.) and Department of Hematology and Medical Oncology (A.H.B.), Mayo Clinic, Scottsdale, Ariz; Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan (T.T., R.I., S.K.); and Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.)
| | - Adam T Froemming
- From the Department of Radiology (T.T., M.Y., A.K.) and Department of Hematology and Medical Oncology (A.H.B.), Mayo Clinic, Scottsdale, Ariz; Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan (T.T., R.I., S.K.); and Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.)
| | - Alan H Bryce
- From the Department of Radiology (T.T., M.Y., A.K.) and Department of Hematology and Medical Oncology (A.H.B.), Mayo Clinic, Scottsdale, Ariz; Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan (T.T., R.I., S.K.); and Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.)
| | - Ryota Inai
- From the Department of Radiology (T.T., M.Y., A.K.) and Department of Hematology and Medical Oncology (A.H.B.), Mayo Clinic, Scottsdale, Ariz; Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan (T.T., R.I., S.K.); and Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.)
| | - Susumu Kanazawa
- From the Department of Radiology (T.T., M.Y., A.K.) and Department of Hematology and Medical Oncology (A.H.B.), Mayo Clinic, Scottsdale, Ariz; Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan (T.T., R.I., S.K.); and Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.)
| | - Akira Kawashima
- From the Department of Radiology (T.T., M.Y., A.K.) and Department of Hematology and Medical Oncology (A.H.B.), Mayo Clinic, Scottsdale, Ariz; Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan (T.T., R.I., S.K.); and Department of Radiology, Mayo Clinic, Rochester, Minn (A.T.F.)
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24
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Hague C, O'Connor LP, Wang AZ, Gomella PT, Yerram NK, Merino MJ, Pinto PA. MRI-guided pelvic lymph node biopsy via transrectal approach in prostate cancer. Urol Case Rep 2020; 30:101129. [PMID: 32071877 PMCID: PMC7013174 DOI: 10.1016/j.eucr.2020.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/20/2022] Open
Abstract
Lymph node assessment in prostate cancer is most commonly performed at the time of radical prostatectomy. We present the case of pre-operative pelvic lymph node sampling with the use of MRI/TRUS fusion-guided biopsy at the time of prostate biopsy. Lymph node pathology revealed metastatic, poorly differentiated prostate cancer, concurrent with Gleason 4 + 5 disease showing perineural invasion. The use of MRI fusion guided biopsy for nodal sampling may be an effective method pre-operative staging and treatment planning for prostate adenocarcinoma.
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Affiliation(s)
- Christian Hague
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alex Z Wang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Patrick T Gomella
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nitin K Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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25
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Turkbey B, Czarniecki M, Shih JH, Harmon SA, Agarwal PK, Apolo AB, Citrin DE, Gulley JL, Harisinghani M, Madan RA, Metwalli AR, Paquette E, Pinto PA, Rais-Bahrami S, Rowe LS, Wood BJ, Jacobs PM, Lindenberg L, Dahut W, Choyke PL. Ferumoxytol-Enhanced MR Lymphography for Detection of Metastatic Lymph Nodes in Genitourinary Malignancies: A Prospective Study. AJR Am J Roentgenol 2020; 214:105-113. [PMID: 31613660 PMCID: PMC8258657 DOI: 10.2214/ajr.19.21264] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE. The objective of our study was to evaluate the utility of ferumoxytol-enhanced MR lymphography (MRL) in detection of metastatic lymph nodes (LNs) in patients with prostate, bladder, and kidney cancer. SUBJECTS AND METHODS. This phase 2 single-institution study enrolled patients with confirmed prostate (arm 1), bladder (arm 2), and kidney (arm 3) cancer and evidence of suspected LN involvement. Participants underwent ferumoxytol-enhanced MRL 24 and 48 hours after IV injection of 7.5 mg Fe/kg of ferumoxytol. A retrospective quantitative analysis was performed to determine the optimal timing for ferumoxytol-enhanced MRL using percentage change in normalized signal intensity (SI) from baseline to 24 and 48 hours after injection, which were estimated using the linear mixed-effects model in which time (24 vs 48 hours), diseases status, and time and disease status interaction were the fixed-effects independent variables. Differences in normalized SI values between subgroups of lesions were estimated by forming fixed-effects contrasts and tested by the Wald test. RESULTS. Thirty-nine patients (n = 30, arm 1; n = 6, arm 2; n = 3, arm 3) (median age, 65 years) with 145 LNs (metastatic, n = 100; benign, n = 45) were included. LN-based sensitivity, specificity, positive predictive value, and negative predictive value of ferumoxytol-enhanced MRL was 98.0%, 64.4%, 86.0%, and 93.5%, respectively. Sensitivity and specificity of ferumoxytol-enhanced MRL did not vary by LN size. Metastatic LNs showed a significantly higher percentage decrease of normalized SI on MRL at 24 hours after ferumoxytol injection than at 48 hours after ferumoxytol injection (p = 0.023), whereas the normalized SI values for nonmetastatic LNs were similar at both imaging time points (p = 0.260). CONCLUSION. Ferumoxytol-enhanced MRL shows high sensitivity in the detection of metastatic LNs in genitourinary cancers independent of LN size. The SI difference between benign and malignant LNs on ferumoxytol-enhanced MRL appears similar 24 and 48 hours after ferumoxytol injection, suggesting that imaging can be performed safely within 1 or 2 days of injection. Although ferumoxytol-enhanced MRL can be useful in settings without an available targeted PET agent, issues of iron overload and repeatability of ferumoxytol-enhanced MRL remain concerns for this method.
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Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), 10 Center Dr, Rm B3B85, Bethesda, MD 20892
| | - Marcin Czarniecki
- Molecular Imaging Program, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), 10 Center Dr, Rm B3B85, Bethesda, MD 20892
| | - Joanna H Shih
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, NCI, NIH, Rockville, MD
| | - Stephanie A Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, (Sponsored by the National Cancer Institute), Frederick, MD
| | | | - Andrea B Apolo
- Genitourinary Malignancies Branch, CCR, NCI, NIH, Bethesda, MD
| | | | - James L Gulley
- Genitourinary Malignancies Branch, CCR, NCI, NIH, Bethesda, MD
| | - Mukesh Harisinghani
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, CCR, NCI, NIH, Bethesda, MD
| | - Adam R Metwalli
- Department of Surgery, Division of Urology, Howard University Hospital, Washington, DC
| | - Edmond Paquette
- Inova Medical Group Urology, Inova Fairfax Hospital, Fairfax, VA
| | - Peter A Pinto
- Urologic Oncology Branch, CCR, NCI, NIH, Bethesda, MD
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Bradford J Wood
- Center for Interventional Oncology, CCR, NCI, NIH, Bethesda, MD
| | | | - Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), 10 Center Dr, Rm B3B85, Bethesda, MD 20892
| | - William Dahut
- Genitourinary Malignancies Branch, CCR, NCI, NIH, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), 10 Center Dr, Rm B3B85, Bethesda, MD 20892
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26
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Perez-Lopez R, Tunariu N, Padhani AR, Oyen WJG, Fanti S, Vargas HA, Omlin A, Morris MJ, de Bono J, Koh DM. Imaging Diagnosis and Follow-up of Advanced Prostate Cancer: Clinical Perspectives and State of the Art. Radiology 2019; 292:273-286. [PMID: 31237493 DOI: 10.1148/radiol.2019181931] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The management of advanced prostate cancer has changed substantially with the availability of multiple effective novel treatments, which has led to improved disease survival. In the era of personalized cancer treatments, more precise imaging may help physicians deliver better care. More accurate local staging and earlier detection of metastatic disease, accurate identification of oligometastatic disease, and optimal assessment of treatment response are areas where modern imaging is rapidly evolving and expanding. Next-generation imaging modalities, including whole-body MRI and molecular imaging with combined PET and CT and combined PET and MRI using novel radiopharmaceuticals, create new opportunities for imaging to support and refine management pathways in patients with advanced prostate cancer. This article demonstrates the potential and challenges of applying next-generation imaging to deliver the clinical promise of treatment breakthroughs.
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Affiliation(s)
- Raquel Perez-Lopez
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Nina Tunariu
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Anwar R Padhani
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Wim J G Oyen
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Stefano Fanti
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Hebert Alberto Vargas
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Aurelius Omlin
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Michael J Morris
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Johann de Bono
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
| | - Dow-Mu Koh
- From the Radiomics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain (R.P.L.); Departments of Radiology (N.T., D.M.K.) and Nuclear Medicine (W.J.G.O.), Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.R.P.); Divisions of Radiotherapy and Imaging (W.J.G.O., D.M.K.) and Clinical Studies & Prostate Cancer Targeted Therapy Group (J.d.B.), Institute of Cancer Research, Sutton, England; Departments of Radiology (S.F.) and Genitourinary Oncology Service and Medicine (M.J.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland (H.A.V., A.O.); Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland (H.A.V., A.O.); and Department of Medicine, Weill Cornell Medicine, New York, NY (M.J.M.)
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Abstract
PURPOSE OF REVIEW In recent years, a large number of reports have been published on prostate-specific membrane antigen (PSMA)/PET in prostate cancer (PCa). This review highlights advances in PSMA PET in PCa during the past year. RECENT FINDINGS PSMA PET/computed tomography (CT) is useful in detection of biochemical recurrence, especially at low prostate-specific antigen (PSA) values. The detection rate of PSMA PET is influenced by PSA level. For primary PCa, PSMA PET/CT shows promise for tumour localization in the prostate, especially in combination with multiparametric MRI (mpMRI). For primary staging, PSMA PET/CT can be used in intermediate and high-risk PCa. Intraoperative PSMA radioligand guidance seems promising for detection of malignant lymph nodes. While the use of PSMA PET/MRI in primary localized disease is limited to high and intermediate-risk patients and localized staging, in the recurrence setting, PET/MRI can be particularly helpful when the lesions are subtle. PSMA PET/CT is superior to choline PET/CT and other conventional imaging modalities. SUMMARY Molecular imaging with PSMA PET continues to pave the way for personalized medicine in PCa.However, large prospective clinical studies are still needed to fully evaluate the role of PSMA PET/CT and PET/MRI in the clinical workflow of PCa.
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Added value of diffusion-weighted MRI for nodal radiotherapy planning in pelvic malignancies. Clin Transl Oncol 2019; 21:1383-1389. [DOI: 10.1007/s12094-019-02068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/15/2019] [Indexed: 02/08/2023]
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Abstract
Accurate tumor detection and establishment of disease extent are important for optimal management of prostate cancer. Disease stage, beginning with identification of the index prostate lesion, followed by primary tumor, lymph node, and distant metastasis evaluation, provide crucial clinical information that not only have prognostic and predictive value, but guide patient management. A wide array of radiological imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging have been used for the purpose of prostate cancer staging with variable diagnostic performance. Especially, the last years have seen remarkable technological advances in magnetic resonance imaging technology, enabling referring clinicians and radiologists to obtain even more valuable data regarding staging of prostate cancer. Marked improvements have been seen in detection of the index prostate lesion and evaluation of extraprostatic extension while further improvements are still needed in identifying metastatic lymph nodes. Novel approaches such as whole-body MRI are emerging for more accurate and reproducible assessment of bone metastasis. Post-treatment assessment of prostate cancer using radiological imaging is a topic with rapidly changing clinical context and special consideration is needed for the biochemical setting, that is, the relatively high serum prostate-specific antigen levels in studies assessing the value of radiological imaging for post-treatment assessment and emerging therapeutic approaches such as early salvage radiation therapy. The scope of this review is to provide the reader insight into the various ways radiology contribute to staging of prostate cancer in the context of both primary staging and post-treatment assessment. The strengths and limitations of each imaging modality are highlighted as well as topics that warrant future research.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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30
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Smith CP, Laucis A, Harmon S, Mena E, Lindenberg L, Choyke PL, Turkbey B. Novel Imaging in Detection of Metastatic Prostate Cancer. Curr Oncol Rep 2019; 21:31. [DOI: 10.1007/s11912-019-0780-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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31
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Olsson LE, Johansson M, Zackrisson B, Blomqvist LK. Basic concepts and applications of functional magnetic resonance imaging for radiotherapy of prostate cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 9:50-57. [PMID: 33458425 PMCID: PMC7807726 DOI: 10.1016/j.phro.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/27/2018] [Accepted: 02/08/2019] [Indexed: 12/30/2022]
Abstract
Recently, the interest to integrate magnetic resonance imaging (MRI) in radiotherapy for prostate cancer has increased considerably. MRI can contribute in all steps of the radiotherapy workflow from diagnosis, staging, and target definition to treatment follow-up. Of particular interest is the ability of MRI to provide a wide range of functional measures. The complexity of MRI as an imaging modality combined with the growing interest of the application to prostate cancer radiotherapy, emphasize the need for dedicated education within the radiation oncology community. In this context, an overview of the most common as well as a few upcoming functional MR imaging techniques is presented: the basic methodology and measurement is described, the link between the functional measures and the underlying biology is established, and finally relevant applications of functional MRI useful for prostate cancer radiotherapy are given.
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Affiliation(s)
- Lars E Olsson
- Department of Medical Radiation Physics, Translational Medicine, Lund University, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | | | | | - Lennart K Blomqvist
- Department of Radiology, Molecular Medicine and Surgery, Karolinska University, Sweden
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32
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Caglic I, Barrett T. Diffusion-weighted imaging (DWI) in lymph node staging for prostate cancer. Transl Androl Urol 2018; 7:814-823. [PMID: 30456184 PMCID: PMC6212625 DOI: 10.21037/tau.2018.08.04] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In patients with prostate cancer, the presence of lymph node (LN) metastases is a critical prognostic factor and is essential for treatment planning. Conventional cross-sectional imaging performs poorly for nodal staging as both computed tomography (CT) and magnetic resonance imaging (MRI) are mainly dependent on size and basic morphological criteria. Therefore, extended pelvic LN dissection (ePLND) remains the gold standard for LN staging, however, it is an invasive procedure with its own drawbacks, thus creating a need for accurate preoperative imaging test. Incorporating functional MRI by using diffusion-weighted MRI has proven superior to conventional MRI protocol by means of both qualitative and quantitative assessment. Currently, the increased diagnostic performance remains insufficient to replace ePLND and the future role of DWI may be through combination with MR lymphangiography or with novel positron emission tomography (PET) tracers. In this article, the current state of data supporting DWI in LN staging of patients with prostate cancer is discussed.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, 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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33
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Mehralivand S, van der Poel H, Winter A, Choyke PL, Pinto PA, Turkbey B. Sentinel lymph node imaging in urologic oncology. Transl Androl Urol 2018; 7:887-902. [PMID: 30456192 PMCID: PMC6212622 DOI: 10.21037/tau.2018.08.23] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022] Open
Abstract
Lymph node (LN) metastases in urological malignancies correlate with poor oncological outcomes. Accurate LN staging is of great importance since patients can benefit from an optimal staging, accordingly aligned therapy and more radical treatments. Current conventional cross-sectional imaging modalities [e.g., computed tomography (CT) and magnetic resonance imaging (MRI)] are not accurate enough to reliably detect early LN metastases as they rely on size criteria. Radical lymphadenectomy, the surgical removal of regional LNs, is the gold standard of invasive LN staging. The LN dissection is guided by anatomic considerations of lymphatic drainage pathways of the primary tumor. Selection of patients for lymphadenectomy heavily relies on preoperative risk stratification and nomograms and, as a result a considerable number of patients unnecessarily undergo invasive staging with associated morbidity. On the other hand, due to individual variability in lymphatic drainage, LN metastases can occur outside of standard lymphadenectomy templates leading to potential understaging and undertreatment. In theory, metastases from the primary tumor need to pass through the chain of LNs, where the initial node is defined as the sentinel LN. In theory, identifying and removing this LN could lead to accurate assessment of metastatic status. Radiotracers and more recently fluorescent dyes and superparamagnetic iron oxide nanoparticles (SPION) are injected into the primary tumor or peritumoral and the sentinel LNs are identified intraoperatively by a gamma probe, fluorescent camera or a handheld magnetometer. Preoperative imaging [e.g., single-photon emission computed tomography (SPECT)/CT or MRI] after tracer injection can further improve preoperative planning of LN dissection. While sentinel LN biopsy is an accepted and widely used approach in melanoma and breast cancer staging, its use in urological malignancies is still limited. Most data published so far is in penile cancer staging since this cancer has a typical echelon-based lymphatic metastasizing pattern. More recent data is encouraging with low false-negative rates, but its use is limited to centers with high expertise. Current guidelines recommend sentinel LN biopsy as an accepted alternative to modified inguinal lymphadenectomy in patients with pT1G2 disease and non-palpable inguinal LNs. In prostate cancer, a high diagnostic accuracy could be demonstrated for the sentinel approach. Nevertheless, due to lack of data or high false-negative rates in other urological malignancies, sentinel LN biopsy is still considered experimental in other urological malignancies. More high-level evidence and longitudinal data is needed to determine its final value in those malignancies. In this manuscript, we will review sentinel node imaging for urologic malignancies.
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Affiliation(s)
- Sherif Mehralivand
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henk van der Poel
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Alexander Winter
- University Hospital for Urology, Oldenburg Hospital, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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34
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Pesapane F, Czarniecki M, Suter MB, Turkbey B, Villeirs G. Imaging of distant metastases of prostate cancer. Med Oncol 2018; 35:148. [DOI: 10.1007/s12032-018-1208-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023]
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35
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Czarniecki M, Pesapane F, Wood BJ, Choyke PL, Turkbey B. Ultra-small superparamagnetic iron oxide contrast agents for lymph node staging of high-risk prostate cancer. Transl Androl Urol 2018; 7:S453-S461. [PMID: 30363485 PMCID: PMC6178308 DOI: 10.21037/tau.2018.05.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Ultrasmall superparamagnetic particles of iron oxide (USPIOs) imaged with magnetic resonance imaging (MRI) have been proposed as an experimental method for visualizing lymph node (LN) metastases. The method does not require ionizing radiation, yet can detect small nodes that are involved with metastases. USPIOs are naturally taken up by macrophages that deposit in the normal LN creating a low signal region in normal areas; areas within the node that do not show this loss of signal are likely involved by tumor although there can be other causes (fibrosis or inflammation). However, the lack of approved USPIOs that are clinically available hinders adoption and larger studies. The proposed indications for USPIO MRI, including specific compounds and imaging methods are discussed.
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Affiliation(s)
- Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Filippo Pesapane
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.,Center for Interventional Oncology, NCI and Radiology Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, NCI and Radiology Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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