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Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, Hernandez-Andrade E, Malinger G, Munoz H, Paladini D, Prefumo F, Sotiriadis A, Toi A, Lee W. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2022; 59:840-856. [PMID: 35592929 DOI: 10.1002/uog.24888] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Cité University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - V Berghella
- Thomas Jefferson University, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Philadelphia, PA, USA
| | - C M Bilardo
- University Medical Centre, Fetal Medicine Unit, Department of Obstetrics & Gynecology, Groningen, The Netherlands
| | - G E Chalouhi
- Maternité Necker-Enfants Malades, Université Paris Descartes, AP-HP, Paris, France
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Munoz
- University of Chile Hospital, Fetal Medicine Unit, Obstetrics & Gynecology, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Lee
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX, USA
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Pavlovich CP, Hyndman ME, Eure G, Ghai S, Caumartin Y, Herget E, Young JD, Wiseman D, Caughlin C, Gray R, Wason S, Mettee L, Lodde M, Toi A, Dujardin T, Lance R, Schatz SM, Fabrizio M, Malcolm JB, Fradet V. A multi‐institutional randomized controlled trial comparing first‐generation transrectal high‐resolution micro‐ultrasound with conventional frequency transrectal ultrasound for prostate biopsy. BJUI Compass 2020; 2:126-133. [PMID: 35474889 PMCID: PMC8988781 DOI: 10.1002/bco2.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 01/05/2023] Open
Abstract
Objectives To study high‐frequency 29 MHz transrectal side‐fire micro‐ultrasound (micro‐US) for the detection of clinically significant prostate cancer (csPCa) on prostate biopsy, and validate an image interpretation protocol for micro‐US imaging of the prostate. Materials and methods A prospective randomized clinical trial was performed where 1676 men with indications for prostate biopsy and without known prostate cancer were randomized 1:1 to micro‐US vs conventional end‐fire ultrasound (conv‐US) transrectal‐guided prostate biopsy across five sites in North America. The trial was split into two phases, before and after training on a micro‐US image interpretation protocol that was developed during the trial using data from the pre‐training micro‐US arm. Investigators received a standardized training program mid‐trial, and the post‐training micro‐US data were used to examine the training effect. Results Detection of csPCa (the primary outcome) was no better with the first‐generation micro‐US system than with conv‐US in the overall population (34.6% vs 36.6%, respectively, P = .21). Data from the first portion of the trial were, however, used to develop an image interpretation protocol termed PRI‐MUS in order to address the lack of understanding of the appearance of cancer under micro‐US. Micro‐US sensitivity in the post‐training group improved to 60.8% from 24.6% (P < .01), while specificity decreased (from 84.2% to 63.2%). Detection of csPCa in the micro‐US arm increased by 7% after training (32% to 39%, P < .03), but training instituted mid‐trial did not affect the overall results of the comparison between arms. Conclusion Micro‐US provided no clear benefit over conv‐US for the detection of csPCa at biopsy. However, it became evident during the trial that training and increasing experience with this novel technology improved the performance of this first‐generation system. In this work high‐frequency 29 MHz transrectal side‐fire micro‐ultrasound (US) for the detection of clinically significant prostate cancer on prostate biopsy is studied, and an image interpretation protocol for micro‐US imaging of the prostate is validated. The YouTube link is here: https://youtu.be/U2Svj-4Ae_k
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Affiliation(s)
- C. P. Pavlovich
- The Brady Urological Institute The Johns Hopkins School of Medicine Baltimore MD USA
| | - M. E. Hyndman
- Southern Alberta Institute of Urology and Prostate Cancer Centre Calgary AB Canada
| | - G. Eure
- Urology of Virginia Department of Urology Eastern Virginia Medical School Virginia Beach VA USA
| | - S. Ghai
- Joint Department of Medical imaging University Health NetworkUniversity of Toronto Toronto ON Canada
| | - Y. Caumartin
- Centre de Recherche en Cancérologie de l’Université Laval Quebec City QC Canada
| | - E. Herget
- Southern Alberta Institute of Urology and Prostate Cancer Centre Calgary AB Canada
| | - J. D. Young
- Urology of Virginia Department of Urology Eastern Virginia Medical School Virginia Beach VA USA
| | - D. Wiseman
- Southern Alberta Institute of Urology and Prostate Cancer Centre Calgary AB Canada
| | - C. Caughlin
- Southern Alberta Institute of Urology and Prostate Cancer Centre Calgary AB Canada
| | - R. Gray
- Southern Alberta Institute of Urology and Prostate Cancer Centre Calgary AB Canada
| | - S. Wason
- Urology of Virginia Department of Urology Eastern Virginia Medical School Virginia Beach VA USA
| | - L. Mettee
- The Brady Urological Institute The Johns Hopkins School of Medicine Baltimore MD USA
| | - M. Lodde
- Centre de Recherche en Cancérologie de l’Université Laval Quebec City QC Canada
| | - A. Toi
- Joint Department of Medical imaging University Health NetworkUniversity of Toronto Toronto ON Canada
| | - T. Dujardin
- Centre de Recherche en Cancérologie de l’Université Laval Quebec City QC Canada
| | - R. Lance
- Urology of Virginia Department of Urology Eastern Virginia Medical School Virginia Beach VA USA
| | - S. M. Schatz
- Houston Methodist Institute for Academic Medicine Houston TX USA
| | - M. Fabrizio
- Urology of Virginia Department of Urology Eastern Virginia Medical School Virginia Beach VA USA
| | - J. B. Malcolm
- Urology of Virginia Department of Urology Eastern Virginia Medical School Virginia Beach VA USA
| | - V. Fradet
- Centre de Recherche en Cancérologie de l’Université Laval Quebec City QC Canada
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Salomon LJ, Alfirevic Z, Da Silva Costa F, Deter RL, Figueras F, Ghi T, Glanc P, Khalil A, Lee W, Napolitano R, Papageorghiou A, Sotiriadis A, Stirnemann J, Toi A, Yeo G. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol 2019; 53:715-723. [PMID: 31169958 DOI: 10.1002/uog.20272] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 05/09/2023]
Abstract
INTRODUCTION These Guidelines aim to describe appropriate assessment of fetal biometry and diagnosis of fetal growth disorders. These disorders consist mainly of fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR) and often associated with small‐for‐gestational age (SGA), and large‐for‐gestational age (LGA), which may lead to fetal macrosomia; both have been associated with a variety of adverse maternal and perinatal outcomes. Screening for, and adequate management of, fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment of these conditions. The fetal biometric parameters measured most commonly are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). These biometric measurements can be used to estimate fetal weight (EFW) using various different formulae1. It is important to differentiate between the concept of fetal size at a given timepoint and fetal growth, the latter being a dynamic process, the assessment of which requires at least two ultrasound scans separated in time. Maternal history and symptoms, amniotic fluid assessment and Doppler velocimetry can provide additional information that may be used to identify fetuses at risk of adverse pregnancy outcome. Accurate estimation of gestational age is a prerequisite for determining whether fetal size is appropriate‐for‐gestational age (AGA). Except for pregnancies arising from assisted reproductive technology, the date of conception cannot be determined precisely. Clinically, most pregnancies are dated by the last menstrual period, though this may sometimes be uncertain or unreliable. Therefore, dating pregnancies by early ultrasound examination at 8–14 weeks, based on measurement of the fetal crown–rump length (CRL), appears to be the most reliable method to establish gestational age. Once the CRL exceeds 84 mm, HC should be used for pregnancy dating2–4. HC, with or without FL, can be used for estimation of gestational age from the mid‐trimester if a first‐trimester scan is not available and the menstrual history is unreliable. When the expected delivery date has been established by an accurate early scan, subsequent scans should not be used to recalculate the gestational age1. Serial scans can be used to determine if interval growth has been normal. In these Guidelines, we assume that the gestational age is known and has been determined as described above, the pregnancy is singleton and the fetal anatomy is normal. Details of the grades of recommendation used in these Guidelines are given in Appendix 1. Reporting of levels of evidence is not applicable to these Guidelines.
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Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - F Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - R L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - F Figueras
- Hospital Clinic, Obstetrics and Gynecology, Barcelona, Spain
| | - T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - P Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - R Napolitano
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Stirnemann
- Obstetrics, University Paris Descartes, Hôpital Necker Enfants Malades, Paris, France
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada
| | - G Yeo
- Department of Maternal Fetal Medicine, Obstetric Ultrasound and Prenatal Diagnostic Unit, KK Women's and Children's Hospital, Singapore
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Wang DC, Shannon P, Toi A, Chitayat D, Mohan U, Barkova E, Keating S, Tomlinson G, Glanc P. Temporal lobe dysplasia: a characteristic sonographic finding in thanatophoric dysplasia. Ultrasound Obstet Gynecol 2014; 44:588-594. [PMID: 24585534 DOI: 10.1002/uog.13337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/03/2014] [Accepted: 02/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the incidence of temporal lobe dysplasia (TLD) detected on prenatal ultrasound in thanatophoric dysplasia (TD) over an 11-year period in a tertiary referral center. METHODS An 11-year retrospective review of perinatal autopsies from 2002 to 2013 was performed to identify cases of TD. The ultrasound images and corresponding reports of all TD cases were examined for the presence of TLD. The same set of images subsequently underwent a retrospective review by a perinatal radiologist with knowledge of the features of TLD to determine whether they could be identified. RESULTS Thirty-one cases of TD underwent perinatal autopsy, and prenatal ultrasound imaging was available for review in 24 (77%). Mean gestational age at diagnosis of TD was 21.3 (range, 18-36) weeks. TLD was identified and reported in 6/24 (25%) cases; all six cases occurred after 2007. Retrospective interpretation of the ultrasound images identified features of TLD in 10 additional cases. In total, 16/24 (67%) cases displayed sonographic evidence of TLD. Temporal trends showed that TLD features were present in 50% (5/10) of all TD cases between 2002 and 2006 and in 79% (11/14) of those detected between 2007 and 2013. CONCLUSIONS At present, the detection rate of TLD by ultrasound is low but may be increased by modified brain images that enhance visualization of the temporal lobes. Prenatal identification of TLD may help in the prenatal diagnosis of TD and thus provide more accurate prenatal counseling and guide molecular investigations to confirm the specific diagnosis of TD.
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Affiliation(s)
- D C Wang
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Inbar-Feigenberg M, Meirowitz N, Nanda D, Toi A, Okun N, Chitayat D. Beals syndrome (congenital contractural arachnodactyly): prenatal ultrasound findings and molecular analysis. Ultrasound Obstet Gynecol 2014; 44:486-490. [PMID: 24585410 DOI: 10.1002/uog.13350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/24/2014] [Accepted: 02/11/2014] [Indexed: 06/03/2023]
Abstract
We report the prenatal findings in two cases of Beals syndrome. Both pregnancies presented with clinical features of arthrogryposis multiplex congenita/fetal akinesia syndrome (AMC/FAS), including clenched fists and multiple joint contractures on repeat prenatal ultrasound examinations. The first case was diagnosed as having Beals syndrome on physical examination shortly after birth and the diagnosis was confirmed by DNA analysis, shown as a point mutation in the fibrillin 2 (FBN2) gene. The second case was diagnosed with Beals syndrome following microarray analysis on amniocytes, which showed a deletion of the FBN2 gene. Although most cases with AMC/FAS carry a poor prognosis, Beals syndrome is consistent with normal cognitive development and a better prognosis. Thus, making the correct diagnosis is crucial, both pre- and postnatally, for accurate counseling and management.
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Affiliation(s)
- M Inbar-Feigenberg
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Akbari MR, Wallis CJD, Toi A, Trachtenberg J, Sun P, Narod SA, Nam RK. The impact of a BRCA2 mutation on mortality from screen-detected prostate cancer. Br J Cancer 2014; 111:1238-40. [PMID: 25101567 PMCID: PMC4453856 DOI: 10.1038/bjc.2014.428] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/29/2014] [Accepted: 07/08/2014] [Indexed: 01/07/2023] Open
Abstract
Background: Men with a BRCA2 mutation face an increased risk of prostate cancer. These cancers tend to have an aggressive nature and it has not yet been demonstrated that regular screening of BRCA2 carriers is associated with improved survival. Methods: We identified 4187 men who underwent a prostate cancer biopsy for an elevated PSA or an abnormal digital rectal examination between 1998 and 2010. We screened the BRCA2 gene in its entirety for mutations and we followed the men for death from prostate cancer until December 2012. Results: The 12-year prostate cancer-specific survival rate was 94.3% for men without a BRCA2 mutation and was 61.8% for men with a mutation (P<10−4; log-rank test). Conclusions: The survival of men with screen-detected prostate cancer and a BRCA2 mutation is much poorer than expected.
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Affiliation(s)
- M R Akbari
- 1] Women's College Research Institute, Women's College Hospital, 790 Bay St, Toronto, ON M5G 1N8, USA [2] Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, USA
| | - C J D Wallis
- 1] Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, USA [2] Division of Urology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, USA
| | - A Toi
- Division of Radiology, University of Toronto, 155 College St, Toronto, ON M5T 3M7, USA
| | - J Trachtenberg
- 1] Division of Urology, University of Toronto, 155 College St, Toronto, ON M5T 3M7, USA [2] Princess Margaret Hospital, 610 University Ave, Toronto, ON M5T 2M9, USA
| | - P Sun
- Women's College Research Institute, Women's College Hospital, 790 Bay St, Toronto, ON M5G 1N8, USA
| | - S A Narod
- 1] Women's College Research Institute, Women's College Hospital, 790 Bay St, Toronto, ON M5G 1N8, USA [2] Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, USA
| | - R K Nam
- 1] Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, USA [2] Division of Urology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, USA
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Barkova E, Mohan U, Chitayat D, Keating S, Toi A, Frank J, Frank R, Tomlinson G, Glanc P. Fetal skeletal dysplasias in a tertiary care center: radiology, pathology, and molecular analysis of 112 cases. Clin Genet 2014; 87:330-7. [PMID: 24863959 DOI: 10.1111/cge.12434] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/25/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
Abstract
Fetal skeletal dysplasias are a heterogeneous group of rare genetic disorders, affecting approximately 2.4-4.5 of 10,000 births. We performed a retrospective review of the perinatal autopsies conducted between the years 2002-2011 at our center. The study population consisted of fetuses diagnosed with skeletal dysplasia with subsequent termination, stillbirth and live-born who died shortly after birth. Of the 2002 autopsies performed, 112 (5.6%) were diagnosed with skeletal dysplasia. These 112 cases encompassed 17 of 40 groups of Nosology 2010. The two most common Nosology groups were osteogenesis imperfecta [OI, 27/112 (24%)] and the fibroblast growth factor receptor type 3 (FGFR3) chondrodysplasias [27/112 (24%)]. The most common specific diagnoses were thanatophoric dysplasia (TD) type 1 [20 (17.9%)], and OI type 2 [20 (17.9%)]. The combined radiology, pathology, and genetic investigations and grouping the cases using Nosology 2010 resulted in a specific diagnosis in 96 of 112 cases.
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Affiliation(s)
- E Barkova
- Department of Medical Imaging, South Shore Regional Hospital, Bridgewater, Nova Scotia, Canada
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Kinoshita N, Takemura A, Toi A, Kita A, Nishimoto Y, Adachi T, Shioura H, Kimura H. PO-0791: Changes in absorbed dose to water for high-energy electron beams by beam quality correction factor. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wong LM, Trottier G, Toi A, Lawrentschuk N, Van der Kwast TH, Zlotta A, Kulkarni G, Hamilton R, Trachtenberg J, Evans A, Timilshina N, Fleshner NE, Finelli A. Should follow-up biopsies for men on active surveillance for prostate cancer be restricted to limited templates? Urology 2013; 82:405-9. [PMID: 23735610 DOI: 10.1016/j.urology.2013.03.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/25/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate if prostate biopsy templates with fewer cores can be used during active surveillance (AS) for prostate cancer. METHODS At present, we use an AS protocol template (ASPT) consisting of 13-17 cores. We hypothesize in the setting of known cancer, sextant (6 cores) or standard extended (10-12 cores) templates, could be used with similar effect. We identified patients in our referral institution database (1997-2009) with entry prostate-specific antigen <10 ng/mL, stage ≤cT2, Gleason sum ≤6, ≤3 cores positive for cancer, <50% of single core involved, and age ≤75 years (N = 272). Patients fulfilling standard criteria for pathologic reclassification (N = 94) at any follow-up biopsy were selected for evaluation. By mapping tumor location on the pathologic reclassification determining biopsy, hypothetical scenarios of sextant or standard extended templates (SET) were compared with our ASPT and examined for frequency of cancer detection and pathologic reclassification. RESULTS For the 94 patients analyzed, the median number of cores taken was 9.7 (6-22) at baseline and 15 (14-17) for the reclassification biopsy. The median time between baseline and the pathologic reclassification determining biopsy was 15.4 months. Analysis of subgroupings showed that sextant template would identify 84% of cancers and 47.9% of the reclassification events, whereas SET detected 99% of cancers and 81.9% of patients who pathologically reclassified. When only considering Gleason sum ≥7 related progression events, SET found 16.2% less (n = 57) compared with ASPT (n = 68). CONCLUSION When monitoring patients on AS, a 13-17 core template detects more pathologic reclassification than standard sextant (18.1%) or extended (52.1%) biopsy templates.
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Affiliation(s)
- L M Wong
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Canada
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Kinoshita N, Takemura A, Nishimoto Y, Kita A, Toi A, Murai E, Adachi T, Shioura H. SU-E-T-108: Comparison of Absorbed-Dose to Water in High-Energy Photon Beams Due to Differences in Beam Quality Conversion Factor. Med Phys 2013. [DOI: 10.1118/1.4814543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41:102-13. [PMID: 23280739 DOI: 10.1002/uog.12342] [Citation(s) in RCA: 344] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Toi A. Re: Non-visualization of the cavum septi pellucidi is not synonymous with agenesis of the corpus callosum. G. Malinger, D. Lev, M. Oren and T. Lerman-Sagie. Ultrasound Obstet Gynecol 2012; 40: 165-170. Ultrasound Obstet Gynecol 2012; 40:126. [PMID: 22911622 DOI: 10.1002/uog.11224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- A Toi
- University of Toronto, Princess Margaret Hospital, 610 University Avenue, Room 4-833, Toronto, Canada.
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Fong KW, Toi A, Okun N, Al-Shami E, Menezes RJ. Retrospective review of diagnostic performance of intracranial translucency in detection of open spina bifida at the 11-13-week scan. Ultrasound Obstet Gynecol 2011; 38:630-4. [PMID: 21404357 DOI: 10.1002/uog.8994] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2011] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To evaluate diagnostic performance of intracranial translucency (IT) for detection of open spina bifida and interobserver agreement for visualization of IT during the 11-13-week scan. METHODS A retrospective study was undertaken in a tertiary referral center. Two hundred 11-13-week scans for nuchal translucency, performed by sonographers certified by The Fetal Medicine Foundation, U.K., were reviewed independently for IT by two expert observers. When IT was not seen, the observers determined whether this was due to poor IT image quality or the presence of spina bifida. Discordant cases were reviewed by a third observer and the majority decision was used for analysis. All observers were blinded to individual pregnancy outcome and the number of cases with spina bifida. RESULTS There were 191 normal fetuses, eight fetuses with open spina bifida and one with closed spina bifida (this case was excluded from analysis). IT was seen in 150 fetuses and all were normal. In six of the 49 cases in which IT was not seen, IT non-visibility was attributed to open spina bifida; among these cases, four fetuses had open spina bifida and two were normal. In the remaining 43 cases (including 39 normal fetuses), IT non-visibility was attributed to inadequate image quality. Sensitivity was 50% (4/8) and specificity was 99% (150/152). Concordance between the two observers concerning IT visibility was 79%, (κ = 0.47, representing moderate agreement). CONCLUSION There was moderate interobserver agreement for visualization of IT on images obtained for nuchal translucency measurement at 11-13 weeks. When IT was confidently seen, open spina bifida could be excluded. However, non-visibility of IT correctly diagnosed only 50% of fetuses with open spina bifida.
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Affiliation(s)
- K W Fong
- Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
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Milosevic M, Bristow RG, Menard C, Chung PW, Bayley A, McLean M, Toi A, Gospodarowicz MK, Catton C, Warde PR. Prostate cancer hypoxia as a predictor of early biochemical and local failure after radiotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
20 Background: Tumor hypoxia is an important determinant of patient outcome in many human malignancies, and has been associated with radioresistance and the development of metastases. The aim of this study was to determine the predictive effect of hypoxia in prostate cancer patients treated with RT. Methods: A total of 256 patients with clinically localized prostate cancer underwent pre-treatment, transrectal, ultrasound-guided measurement of tumor oxygen using a needle electrode. The median pO2 (mpO2) was 6.7 mm Hg and the median hypoxic proportion <10 mm Hg (HP10) was 0.63. Most patients were treated with IMRT to the prostate alone using doses in the range of 75.6-79.8 Gy. Sixty-one received neoadjuvant and concurrent hormonal therapy. The Phoenix definition of biochemical relapse was used, and the median follow-up was 5.4 years. Results: The 5-year bRFR was 78%. High PSA and Gleason score were independently associated with biochemical relapse, and formed the baseline clinical multivariate model. The effect of hypoxia was found to vary with the duration of patient follow- up. HP10, when added to the clinical multivariate model as a time-dependent variable, was a significant, independent predictor of early bRFR (p=0.015). The predictive effect of hypoxia diminished with increasing follow-up and was lost by 36 to 48 months. The relationship between hypoxia and early biochemical recurrence was more pronounced when the analysis was restricted to 144 patients with bulk tumor at the site of the oxygen measurements (p=0.008). Prostate biopsy was performed in 73 patients a median of 36 months after completing RT. Hypoxia was the only factor predictive of local recurrence in this sub-group, with the effect being greatest early in follow-up (p=0.038). Conclusions: This is the largest clinical study of prostate cancer hypoxia with direct measurement of tumor oxygen levels. It suggests that hypoxia in the index tumor increases the risk of recurrence early after completing RT but not at longer times. The results imply a complex interaction between hypoxia and local vs. distant failure, which may be better elucidated with longer follow-up. No significant financial relationships to disclose.
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Affiliation(s)
- M. Milosevic
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - R. G. Bristow
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - C. Menard
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - P. W. Chung
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Bayley
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - M. McLean
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Toi
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | | | - C. Catton
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - P. R. Warde
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
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Bowes D, Crook JM, Wallace K, Evans A, Toi A, Finelli A, Jewett MA. Use of a surgically derived nomogram to predict high likelihood of Gleason score upgrading for favorable-risk prostate cancer treated with permanent seed brachytherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
114 Background: Crook et al have reported a 7-year disease-free survival (DFS) of 95.2% in 1,111 men with prostate cancer treated with Iodine-125 permanent seed brachytherapy (BT) at Princess Margaret Hospital. Two nomograms have been developed that estimate the likelihood of Gleason score (GS) upgrading for patients with favorable risk prostate cancer undergoing radical prostatectomy (RP). The purpose of this project was to apply these nomograms to a cohort treated with BT. Methods: Records were examined for all men receiving prostate BT in 2006-7. 217 had favorable risk disease. The likelihood of GS upgrading was predicted using RP-derived nomograms created by Kulkarni et al (PMH, 2007) and Budaus et al (2010). Clinical and pathologic information were available on 208 patients to allow completion of the Kulkarni nomogram, and on 193 patients for the Budaus nomogram. Results: The median age of the BT cohort was 62 years (range 44–77), and the median PSA level 4.68 ng/ml. Clinical stage was T1 in 65%, and 47.6% had positive findings on transrectal ultrasound. Median prostate volume was 33.3 cc (15.0–72.3). Uro-pathology review was available for 93%. 84.1% had extended biopsies, with 40.9% showing prostatic intraepithelial neoplasia and 10.1% inflammation. The median % of positive cores was 25%, with a median maximum % involvement per core of 20%. Two men received androgen deprivation therapy for prostate downsizing. The median predicted likelihood of GS upgrading was 51.6% using the Kulkarni nomogram, and 43.6% using the Budaus nomogram. The median PSA after 3.2 years median follow-up is 0.18 ng/mL. Conclusions: In a population of men with favorable risk prostate cancer treated with BT, the estimated likelihood of GS upgrading using two surgical nomograms was substantial. The study cohort was taken from a larger population of patients treated over 10 years for whom 7-year DFS is 95.2%. This suggests that permanent seed brachytherapy is a highly effective treatment option for patients with favorable risk disease despite unfavorable clinical and pathologic factors. Patients should not be discouraged from brachytherapy on the basis of a high likelihood of GS upgrading. No significant financial relationships to disclose.
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Affiliation(s)
- D. Bowes
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - J. M. Crook
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - K. Wallace
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Evans
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Toi
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Finelli
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - M. A. Jewett
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
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Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G, Munoz H, Prefumo F, Toi A, Lee W. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011; 37:116-26. [PMID: 20842655 DOI: 10.1002/uog.8831] [Citation(s) in RCA: 602] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Chung HYB, Chu L, Forrest C, Silver R, Toi A, Blaser S, Viero S, Taylor G, Chitayat D. Fetal forehead hemangiopericytoma: prenatal diagnosis and postnatal outcome. Ultrasound Obstet Gynecol 2010; 36:121-124. [PMID: 20217893 DOI: 10.1002/uog.7624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Kavsak P, MacRae A, Toi A, Davies G, Chodirker B, Minett J, Palomaki G, Knight G, Chitayat D, Van Caeseele P. Factors affecting screen completion in two forms of integrated prenatal screening for Down syndrome in the safer study. Clin Biochem 2010. [DOI: 10.1016/j.clinbiochem.2010.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Milosevic M, Bristow R, Ménard C, Panzarella T, Chung P, Toi A, Warde P, Catton C, Hill R. Hypoxia is Associated with Early Biochemical Failure after Radiotherapy in Patients with Prostate Cancer. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rohrbach M, Chitayat D, Maegawa G, Shanske S, Davidzon G, Chong K, Clarke J, Toi A, Tarnopolsky M, Robinson B, Blaser S. Intracerebral Periventricular Pseudocysts in a Fetus with Mitochondrial Depletion Syndrome: An Association or Coincidence. Fetal Diagn Ther 2009; 25:177-82. [DOI: 10.1159/000209385] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 04/07/2008] [Indexed: 11/19/2022]
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Chopra S, Menard C, Bristow R, Toi A, Milosevic M, Haider M. Correlation of BOLD MRI with measures of tumor hypoxia in prostate cancer. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-0028-1085911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nam RK, Zhang WW, Loblaw DA, Klotz LH, Trachtenberg J, Jewett MAS, Stanimirovic A, Davies TO, Toi A, Venkateswaran V, Sugar L, Siminovitch KA, Narod SA. A genome-wide association screen identifies regions on chromosomes 1q25 and 7p21 as risk loci for sporadic prostate cancer. Prostate Cancer Prostatic Dis 2007; 11:241-6. [PMID: 17876339 DOI: 10.1038/sj.pcan.4501010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We conducted a genome-wide association study of 3090 sporadic prostate cancer patients and controls using the Affymetrix 10 000 SNP GeneChip. Initial screening of 40 prostate cancer cases and 40 non-cancer controls revealed 237 SNPs to be associated with prostate cancer (P<0.05). Among these SNPs, 33 were selected for further association analysis of 2069 men who had undergone a cancer-screening prostate biopsy. Results identified five loci as being significantly associated with increased prostate cancer risk in this larger sample (rs 1930293, OR=1.7, P=0.03; rs 717809-2p12, OR=1.3, P=0.03; rs 494770-4q34, OR=1.3, P=0.01; rs 2348763-7p21, OR=1.5, P=0.01; rs 1552895-9p22, OR=1.5, P=0.002). To validate these association data, 61 additional HapMap tagSNPs spanning the latter five loci were genotyped in this subject cohort and an additional 1021 men (total subject number=3090). This analysis revealed tag SNP rs 4568789 (chromosome 1q25) and tag SNP rs 13225697 (chromosome 7p21) to be significantly associated with prostate cancer (P-values 0.009 and 0.008, respectively). Haplotype analysis revealed significant associations of prostate cancer with two allele risk haplotypes on both chromosome 1q25 (adjusted OR of 2.7 for prostate cancer, P=0.0003) and chromosome 7p21 (adjusted OR of 1.3, P=0.0004). As linkage data have identified a putative prostate cancer gene on chromosome 1q25 (HPC1), and microarray data have revealed the ETV1 oncogene to be overexpressed in prostate cancer tissue, it appears that chromosome 1q25 and 7p21 may be sites of gene variants conferring risk for sporadic and inherited forms of prostate cancer.
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Affiliation(s)
- R K Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Ben-Neriah Z, Withers S, Thomas M, Toi A, Chong K, Pai A, Velscher L, Vero S, Keating S, Taylor G, Chitayat D. OEIS complex: prenatal ultrasound and autopsy findings. Ultrasound Obstet Gynecol 2007; 29:170-7. [PMID: 17221944 DOI: 10.1002/uog.3874] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To describe prenatal ultrasound and autopsy findings in fetuses with OEIS (omphalocele, bladder exstrophy, imperforate anus, spina bifida) complex. METHODS This was a retrospective study of the nine cases with OEIS complex diagnosed at our center using detailed fetal ultrasound during the last 10 years. We summarized the fetal ultrasound findings that led to the diagnosis and compared them with the autopsy results. RESULTS All affected fetuses were diagnosed using detailed fetal ultrasound after 16 weeks' gestation. The main prenatal findings were omphalocele, skin-covered lumbosacral neural tube defect, non-visualized bladder and limb defects. Prenatal sonography failed to detect the abnormal genitalia, bladder exstrophy and anal atresia. All cases had abnormalities in a 'diaper distribution', which helped in making the prenatal diagnosis. Eight of the nine couples chose to terminate the pregnancies following multidisciplinary counseling. The pregnancy that was continued was a case with dizygotic twins discordant for OEIS, and the affected fetus died in utero. CONCLUSIONS The combination of the following ultrasound findings: ventral wall defect, spinal defect and a non-visualized bladder with or without limb defects, are characteristic of OEIS complex. Diagnosis can be made with confidence as early as 16 weeks' gestation, although earlier diagnosis may be possible.
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Affiliation(s)
- Z Ben-Neriah
- The Department of Human Genetics, Hadassah Medical Center, The Hebrew University, Jerusalem, Israel
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Asada Y, Fuji H, Numano M, Saida T, Kawashima I, Toi A, Yamashita H, Urakabe E, Murayama S. 2716. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Simchen MJ, Toi A, Silver M, Smith CR, Hornberger LK, Taylor G, Chitayat D. Fetal cardiac calcifications: report of four prenatally diagnosed cases and review of the literature. Ultrasound Obstet Gynecol 2006; 27:325-30. [PMID: 16485251 DOI: 10.1002/uog.2689] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Fetal cardiac calcifications are defined as diffuse hyperechogenicities in the different layers of the heart. This is an uncommon fetal ultrasound finding associated with significant myocardial dysfunction. We report four cases with massive fetal myocardial calcifications detected on prenatal ultrasound at 18-22 weeks' gestation and associated, in all cases, with significant cardiac dysfunction. Detailed fetal echocardiographic evaluation, chromosome analysis, and an extensive search for intrauterine infection as a cause of these abnormalities, were carried out on all cases. A thorough autopsy was performed on all deceased fetuses and postnatal investigation of the sole survivor was performed. Two of our patients chose to interrupt their pregnancies, one fetus suffered intrauterine demise, and one child was born alive. In all of our cases the karyotypes were normal, and no specific infectious etiology or maternal autoantibody was noted. Histopathology findings in the non-survivors included myo- and epicardial calcification maximal at the base of the heart. The living child has findings suggestive of an intrauterine infection, although no infectious entity was identified. Long-term follow-up showed sensorineural hearing loss and severe developmental delay.
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Affiliation(s)
- M J Simchen
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
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Nichol A, Chung P, Lockwood G, Rosewall T, Divanbiegi L, Sweet J, Toi A, Bayley A, Crook J, Gospodarowicz M, McLean M, Milosevic M, Warde P, Catton C. 10 A Prospective Study of Localised Prostate Cancer Treated to 75.6 Gy Using 3D Conformal Radiotherapy. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wiltshire K, Haider M, Kirilova A, Toi A, Catton C, Bayley A, Gospodarowicz M, Warde P, Menard C. 111 Accurate and non-invasive localization of the urethral anastomosis after radical prostatectomy using MRI. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)80272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cho JY, Lee YH, Toi A, Macdonald B. Prenatal diagnosis of horseshoe kidney by measurement of the renal pelvic angle. Ultrasound Obstet Gynecol 2005; 25:554-8. [PMID: 15909318 DOI: 10.1002/uog.1904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the usefulness of measurement of the angle between bilateral renal pelves on axial views in the prenatal ultrasonographic diagnosis of horseshoe kidney. METHODS We retrospectively measured the renal pelvic angle in 19 fetuses with horseshoe and 20 fetuses with normal kidneys in the second and third trimesters. Renal pelvic angle was defined as the angle between the long axis of the renal pelves on the axial view of the abdomen. We compared the renal pelvic angles of horseshoe and normal kidneys with unpaired t-test. Taking 140 degrees as a cut-off value, we calculated the sensitivity, specificity and accuracy of pelvic angle measurement for the prenatal diagnosis of horseshoe kidney. RESULTS The mean pelvic angles in the fetuses with horseshoe kidney were 116 degrees and 110 degrees in the second and third trimester, respectively. In the normal fetuses, the equivalent angles were 172 degrees and 161 degrees. The difference between the two groups was statistically significant (P < 0.01). Using 140 degrees as the discriminating criterion, the sensitivity, specificity and accuracy of renal pelvic angle measurement for the prenatal diagnosis of horseshoe kidney were all 100%. Fifteen of 19 fetuses with horseshoe kidney had no other abnormality. Four (21%) fetuses had severe complex abnormalities which were associated with trisomy 18 in three cases. CONCLUSION Observation and measurement of the renal pelvic angle is a simple and useful method in the prenatal diagnosis of the horseshoe kidney.
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Affiliation(s)
- J Y Cho
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Cho JY, Kim KW, Lee YH, Toi A. Measurement of nuchal skin fold thickness in the second trimester: influence of imaging angle and fetal presentation. Ultrasound Obstet Gynecol 2005; 25:253-257. [PMID: 15736211 DOI: 10.1002/uog.1847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the effect of imaging angle and fetal presentation on the measurement of nuchal skin fold thickness (NFT) in the second trimester. METHODS Fetal NFT was prospectively measured in 921 women at 18-21 weeks' gestation. The population was divided into two groups according to fetal presentation. Group A comprised 643 fetuses in cephalic or transverse presentation and Group B comprised 278 fetuses in breech presentation. To determine whether there was a difference in NFT depending on imaging angle, in Group A the NFT was measured on the standard axial horizontal images and then on images obtained after moving the transducer about 30 degrees toward the occiput. In Group B an assessment was made as to whether NFT changed with fetal presentation. Initial measurements were made with the fetuses in breech presentation. Repeat NFT measurements were made after 15 min in 64 fetuses that had converted to cephalic or transverse presentation. Statistical analysis was performed using a paired t-test. RESULTS The mean NFT on the standard horizontal image was 5.2 mm, while that on the 30 degrees occiput image was 4.0 mm. The difference was significant (P < 0.001). One hundred and twenty-three (19.1%) fetuses had a NFT greater than 6 mm on the standard image, but only two (0.3%) had an NFT of > 6 mm on the 30 degrees occiput image. There were no chromosomal or structural abnormalities in the 123 fetuses in which the NFT was > 6 mm. The mean NFT of 64 fetuses in the breech presentation was 4.4 mm, while it was 3.9 mm when they had converted to other presentations. The difference was statistically significant (P = 0.001). In breech presentation, 13/64 (20.3%) fetuses had a NFT greater than 6 mm compared to only one (1.6%) fetus in the other presentations. There were no structural or chromosomal abnormalities in any fetus with a NFT > 6 mm in either group. CONCLUSIONS In this study the NFT measurement varied with scan direction and fetal presentation. To avoid falsely thickened NFT measurements the scan should be directed to image the posterior surface of the occipital bone. This can be achieved by scanning from a 30 degrees occipital direction. Also, NFT is greater in fetuses in a breech presentation. Attention to these details can reduce false-positive NFT measurements.
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Affiliation(s)
- J Y Cho
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Fong KW, Ghai S, Toi A, Blaser S, Winsor EJT, Chitayat D. Prenatal ultrasound findings of lissencephaly associated with Miller-Dieker syndrome and comparison with pre- and postnatal magnetic resonance imaging. Ultrasound Obstet Gynecol 2004; 24:716-723. [PMID: 15586369 DOI: 10.1002/uog.1777] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To report on the prenatal ultrasound findings in fetuses with lissencephaly associated with Miller-Dieker syndrome (MDS) and to compare these findings with those of magnetic resonance imaging (MRI). METHODS Cases of MDS confirmed by postnatal chromosome microdeletion analysis were identified through review of patient records. Prenatal ultrasound scans were reviewed retrospectively by two radiologists. For cerebral cortical development, the Sylvian, parieto-occipital and calcarine fissures, and the cingulate sulcus and sulci over the cerebral convexity were evaluated. If one or more of these fissures or sulci were not visualized at the expected gestational age or their appearance was abnormal for gestational age, cortical development was considered delayed. Prenatal and postnatal MRI examinations were reviewed by a pediatric neuroradiologist. RESULTS There were seven cases of MDS. In three cases, the prenatal diagnosis of agyria/lissencephaly was prospectively suspected by ultrasound at 23, 26 and 30 weeks, and subsequently confirmed by prenatal MRI. When we retrospectively reviewed the prenatal ultrasound scans of all fetuses, all had delayed cortical development identified on ultrasound performed after 23 weeks' gestation. In all cases the Sylvian fissure was abnormal on both ultrasound and MRI. In one fetus, a normal cortical appearance for gestational age was seen at the initial 20-week ultrasound examination, but delayed cortical development was identified at a 24-week scan. Mild ventriculomegaly was seen in six fetuses and dysgenesis of the corpus callosum in one. Extracranial abnormalities were detected in five fetuses. Delayed cortical development was seen in two fetuses with mild ventriculomegaly, but no other fetal anomalies. CONCLUSIONS In fetuses with MDS, delayed cortical development can be suspected on ultrasound as early as 23 weeks' gestation. This finding warrants further investigations including MRI and FISH analysis for chromosome 17p13.3 deletion.
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Affiliation(s)
- K W Fong
- Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Toi A, Lister WS, Fong KW. How early are fetal cerebral sulci visible at prenatal ultrasound and what is the normal pattern of early fetal sulcal development? Ultrasound Obstet Gynecol 2004; 24:706-715. [PMID: 15586358 DOI: 10.1002/uog.1802] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the time of appearance and pattern of development of fetal cerebral sulci at prenatal ultrasound. METHODS We studied 50 normal fetuses for visibility of cerebral sulci, especially sulci which appear early in anatomical studies, namely the parieto-occipital fissure, calcarine sulcus, cingulate sulcus, convexity sulci and insula/Sylvian fissure. The gestational ages of the fetuses studied ranged from 15.6 to 29.6 weeks. RESULTS Sulci could be seen by transabdominal ultrasound as early as 18.5 weeks. Medial hemispheric sulci and the insula were visible earlier and more confidently than convexity sulci. The earliest gestational ages at which specific sulci could be seen in any fetus were as follows: parieto-occipital fissure 18.5 weeks, calcarine sulcus 18.5 weeks, cingulate sulcus 23.2 weeks and convexity sulci 23.2 weeks. In the present series, the gestational ages at which these sulci were always visible were as follows: parieto-occipital fissure >20.5 weeks, calcarine sulcus >21.9 weeks, cingulate sulcus >24.3 weeks and convexity sulci >27.9 weeks. The insula and its margin (the circular sulcus) and the overgrowing opercula undergo characteristic maturation. The circular sulcus at the margin of the insula was initially smooth but started becoming angular after about 17 weeks as it started to be overgrown by the parietal and temporal lobe opercula. Initially the insula/operculum angle was obtuse. An acute angle was first evident at 23.2 weeks and in all fetuses older than 24.5 weeks. Our ultrasound data were consistent with anatomical studies and fetal magnetic resonance imaging findings. CONCLUSIONS Some cerebral sulci can be seen at prenatal ultrasound as early as 18.5 weeks. Familiarity with the normal pattern of sulcal development and the discriminating gestational ages for the appearance of different sulci may allow early suspicion of lissencephaly.
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Affiliation(s)
- A Toi
- Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
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Taussky D, Toi A, McLean M, Yeung I, Williams T, Pearson S, Pond G, Crook J. Sequential evaluation of prostate edema following permanent seed prostate brachytherapy using CT-MRI fusion. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sgro M, Rossetti S, Barozzino T, Toi A, Langer J, Harris PC, Harvey E, Chitayat D. Caroli's disease: prenatal diagnosis, postnatal outcome and genetic analysis. Ultrasound Obstet Gynecol 2004; 23:73-76. [PMID: 14971004 DOI: 10.1002/uog.943] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Caroli's disease is a rare autosomal recessive condition characterized by cystic dilatation of the intrahepatic bile ducts and infantile polycystic kidney disease. We report a case with Caroli's disease detected prenatally at 33 weeks' gestation with fetal ultrasound findings of a cystic liver mass and echogenic kidneys. Postnatal investigation confirmed enlarged and echogenic kidneys with dilatation of the intrahepatic bile ducts consistent with the diagnosis of Caroli's disease. Genetic analysis of the gene, PKHD1, associated with autosomal recessive polycystic kidney disease (ARPKD) showed that the patient had compound heterozygous mutations, confirming that this early onset Caroli's disease was part of the spectrum of ARPKD. To our knowledge this is the third case of Caroli's disease detected prenatally and the first in which the infant survived.
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Affiliation(s)
- M Sgro
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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deRuiter WK, Toi A, Wong PY, Hay J, Faught BE. #7-S the efficacy of the digital rectal examination, total prostate specific antigen, and prostate specific antigen ratio algorithm in diagnosing prostate cancer. Ann Epidemiol 2002. [DOI: 10.1016/s1047-2797(02)00295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-Maghrabi J, Vorobyova L, Toi A, Chapman W, Zielenska M, Squire JA. Identification of numerical chromosomal changes detected by interphase fluorescence in situ hybridization in high-grade prostate intraepithelial neoplasia as a predictor of carcinoma. Arch Pathol Lab Med 2002; 126:165-9. [PMID: 11825111 DOI: 10.5858/2002-126-0165-ionccd] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT High-grade prostate intraepithelial neoplasia (HPIN) is the most likely precursor of prostate cancer. The condition of many patients with a diagnosis of HPIN in prostate needle core biopsy could, if left untreated, progress to invasive cancer. Currently there is no available clinical, immunohistochemical, or morphologic criteria that are predictive of this progression. OBJECTIVE To determine whether chromosomal instability in these precursor lesions could increase their predictive value for cancer detection. DESIGN Dual-color interphase fluorescence in situ hybridization analysis was performed on archived prostate needle core biopsies from 54 patients with initial diagnosis of isolated HPIN and follow-up of 3 years or more. We used commercially available centromere probes for chromosomes 4, 7, 8, and 10. We had interpretable results in 44 patients as follows: (1) group A: 24 HPIN patients with persistent HPIN and/or benign lesions in the follow-up biopsies, and (2) group B: 20 HPIN patients with progression to prostate carcinoma. RESULTS Twenty-five percent of the patients in group B displayed numeric chromosomal aberrations. Only 8.3% of the patients from group A had chromosomal abnormalities (P =.1). The observed overall chromosomal changes in HPIN were higher than those in normal or hyperplastic epithelium, with a statistically significant difference (P <.05). All aberrations were detected in the form of chromosomal gain. Overall, the commonest aberration was gain of chromosome 8, followed by gains of chromosomes 7 and 10. CONCLUSION These results indicated that although no single numeric chromosomal abnormality could be assigned as a predictor of HPIN progression to carcinoma, the overall level of numeric chromosomal abnormalities shows a trend of elevation in HPIN patients whose condition subsequently progressed to carcinoma.
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Affiliation(s)
- Jaudah Al-Maghrabi
- Ontario Cancer Institute, Princess Margaret Hospital, 610 University Ave, Toronto, Ontario, Canada M5G 2M9
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Wu J, Haycocks T, Alasti H, Ottewell G, Middlemiss N, Abdolell M, Warde P, Toi A, Catton C. Positioning errors and prostate motion during conformal prostate radiotherapy using on-line isocentre set-up verification and implanted prostate markers. Radiother Oncol 2001; 61:127-33. [PMID: 11690677 DOI: 10.1016/s0167-8140(01)00452-2] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate treatment errors from set-up and inter-fraction prostatic motion with port films and implanted prostate fiducial markers during conformal radiotherapy for localized prostate cancer. METHODS Errors from isocentre positioning and inter-fraction prostate motion were investigated in 13 men treated with escalated dose conformal radiotherapy for localized prostate cancer. To limit the effect of inter-fraction prostate motion, patients were planned and treated with an empty rectum and a comfortably full bladder, and were instructed regarding dietary management, fluid intake and laxative use. Field placement was determined and corrected with daily on-line portal imaging. A lateral portal film was taken three times weekly over the course of therapy. From these films, random and systematic placement errors were measured by matching corresponding bony landmarks to the simulator film. Superior-inferior and anterior-posterior prostate motion was measured from the displacement of three gold pins implanted into the prostate before planning. A planning target volume (PTV) was derived to account for the measured prostate motion and field placement errors. RESULTS From 272 port films the random and systematic isocentre positioning error was 2.2 mm (range 0.2-7.3 mm) and 1.4 mm (range 0.2-3.3 mm), respectively. Prostate motion was largest at the base compared to the apex. Base: anterior, standard deviation (SD) 2.9 mm; superior, SD 2.1 mm. Apex: anterior, SD 2.1 mm; superior, SD 2.1 mm. The margin of PTV required to give a 99% probability of the gland remaining within the 95% isodose line during the course of therapy is superior 5.8 mm, and inferior 5.6 mm. In the anterior and posterior direction, this margin is 7.2 mm at the base, 6.5 mm at the mid-gland and 6.0 mm at the apex. CONCLUSIONS Systematic set-up errors were small using real-time isocentre placement corrections. Patient instruction to help control variation in bladder and rectal distension during therapy may explain the observed small SD for prostate motion in this group of patients. Inter-fraction prostate motion remained the largest source of treatment error, and observed motion was greatest at the gland base. In the absence of real-time pre-treatment imaging of prostate position, sequential portal films of implanted prostatic markers should improve quality assurance by confirming organ position within the treatment field over the course of therapy.
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Affiliation(s)
- J Wu
- The Princess Margaret Hospital, Toronto, Canada
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Parker C, Milosevic M, Toi A, Sweet J, Panzarella T, Syed A, Bristow R, Catton C, Hill R, Warde P. A polarographic electrode study of tumor oxygenation in localized prostate cancer. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)01968-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sherar MD, Gertner MR, Yue CK, O'Malley ME, Toi A, Gladman AS, Davidson SR, Trachtenberg J. Interstitial microwave thermal therapy for prostate cancer: method of treatment and results of a phase I/II trial. J Urol 2001; 166:1707-14. [PMID: 11586207 DOI: 10.1016/s0022-5347(05)65658-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Interstitial microwave thermal therapy is experimental treatment for prostate cancer with the goal of curing disease, while causing fewer complications than standard treatment options. We present a method for delivering interstitial microwave thermal therapy using microwave radiating helical antennae inserted percutaneously under transrectal ultrasound guidance. We report the results of a trial of this method in 25 patients in whom primary external beam radiation therapy had previously failed. This patient group currently has limited curative options that are associated with a high complication rate. However, these recurrent tumors often remain localized to the prostate, and so they may be amenable to localized therapy. MATERIALS AND METHODS Patients with proved prostatic adenocarcinoma were candidates for treatment when prostate specific antigen (PSA) was 15 ng./ml. or less and prostate volume was 50 cc. or less. Followup included PSA measurement, digital rectal examination, urinalysis, and documentation of adverse events at 4, 8, 12 and 24 weeks. Sextant biopsy was performed at week 24. The procedure involved the insertion of 5 antennae percutaneously through a modified brachytherapy template. The antenna arrangement was determined based on computer simulated predictions of temperature throughout the prostate. The prostate was dissected away from the rectum by an injection of sterile saline to provide a thermal barrier that protected the rectum from thermal damage. Temperatures were monitored using interstitial mapping thermistor probes that were also inserted through the template. A minimum peripheral target temperature of 55C but less than 70C was maintained for 15 to 20 minutes, while the urethra, rectum and hydrodissection space remained below 42C. The urethra and rectum were actively cooled in addition to hydrodissection. RESULTS Peripheral target temperatures of 55C were achieved. The urethra and rectum remained at a safe temperature. The procedure, including setup and treatment, required approximately 2.5 hours of operating room time. At 24 weeks the PSA nadir was 0.5 ng./ml. or less in 52% of patients and 0.51 to 4 ng./ml. was achieved in an additional 40%. The negative biopsy rate at 24 weeks was 64%, assuming that 3 patients lost to followup would have had positive results. No major complications were observed and in most cases minor complications resolved within 3 months. CONCLUSIONS Interstitial microwave thermal therapy for prostate cancer was developed to heat the prostate safely to a cytotoxic temperature. Experience with 25 patients in whom external beam radiation therapy for prostate cancer had failed indicates that the treatment is safe. Although our series indicates that this therapy may be effective, further studies and longer followup are required in larger patient groups to confirm the potential role of this therapy as an option for recurrent and primary prostate cancer.
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Affiliation(s)
- M D Sherar
- Division of Medical Physics, Ontario Cancer Institute/Princess Margaret Hospital, Ontario, Canada
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Nam RK, Toi A, Vesprini D, Ho M, Chu W, Harvie S, Sweet J, Trachtenberg J, Jewett MA, Narod SA. V89L polymorphism of type-2, 5-alpha reductase enzyme gene predicts prostate cancer presence and progression. Urology 2001; 57:199-204. [PMID: 11164181 DOI: 10.1016/s0090-4295(00)00928-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The valine (V) to leucine (L) polymorphism of the SRD5A2 gene is associated with 5-alpha reductase-2 activity; patients with the V allele have high activity and patients with the L allele have low activity. We examined whether this polymorphism predicts the presence of prostate cancer in 320 men without cancer who underwent biopsy and cancer progression in 318 men who underwent radical prostatectomy. METHODS The effect of the SRD5A2 gene in predicting the presence of prostate cancer was examined using logistic regression analysis, controlling for established risk factors. The effect of the SRD5A2 gene in predicting prostate cancer progression was examined using a nested, matched, case-control design. Most of the participants were white. RESULTS Of the 320 men, 158 (49.4%) were found on biopsy to have prostate cancer. The overall distribution of the V/V, V/L, and L/L genotypes was 47.5%, 42.5%, and 10.0%, respectively. The adjusted odds ratio for having prostate cancer for patients with at least one V allele was 2.53 compared with patients with the L/L genotype (P = 0.03). Of the 318 patients with cancer, 80 had biochemically detected recurrence and 238 had no evidence of recurrence. The odds ratio for progression for patients with at least one V allele was 3.32 (95% confidence interval 1.67 to 6.62, P = 0.0006) compared with patients with the L/L genotype. CONCLUSIONS Men who have the V allele of the SRD5A2 gene have a twofold increase in the risk of prostate cancer development and an additional twofold increase in the risk of progression compared with men with the L/L genotype.
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Affiliation(s)
- R K Nam
- Division of Urology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Kennedy D, Silver MM, Winsor EJ, Toi A, Provias J, Macha M, Precht K, Ledbetter DH, Chitayat D. Inverted duplication of the distal short arm of chromosome 3 associated with lobar holoprosencephaly and lumbosacral meningomyelocele. Am J Med Genet 2000; 91:167-70. [PMID: 10756335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A fetus with lobar holoprosencephaly and lumbosacral meningomyelocele associated with duplication of the short arm of chromosome 3 is reported. The anomalies were detected on fetal ultrasound at 20 weeks' gestation and the autopsy findings correlated well with the prenatal findings. The fetal karyotype was 46,XY,der(3)del(3)(p26) dup(3)(p26p21.3). The association of holoprosencephaly with duplication 3p is well known, but to the best of our knowledge this is the first reported association of meningomyelocele with 3p duplication. These findings suggest that a gene or genes with a crucial role in central nervous system development are located on the short arm of chromosome 3.
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Affiliation(s)
- D Kennedy
- Prenatal Diagnosis Program, University Health Network, The University of Toronto, Toronto, Ontario, Canada
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Nam RK, Diamandis EP, Toi A, Trachtenberg J, Magklara A, Scorilas A, Papnastasiou PA, Jewett MA, Narod SA. Serum human glandular kallikrein-2 protease levels predict the presence of prostate cancer among men with elevated prostate-specific antigen. J Clin Oncol 2000; 18:1036-42. [PMID: 10694554 DOI: 10.1200/jco.2000.18.5.1036] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We hypothesize that serum human glandular kallikrein-2 (hK2) levels predict the presence of prostate cancer among men prescreened by prostate-specific antigen (PSA). PATIENTS AND METHODS We conducted a cross-sectional study of 324 men who had no history of prostate cancer and who were referred for prostate biopsy. PSA and hK2 levels were measured using specific nonisotopic immunometric techniques. Cases were patients who were diagnosed with adenocarcinoma of the prostate from biopsy, and controls were patients who had no evidence of cancer from biopsy. The odds ratio for detection of prostate cancer was determined for hK2 measurements, controlling for age, total-PSA level, digital rectal examination, and symptoms of urinary obstruction. RESULTS Of 324 men, 159 (49.1%) had cancer. Mean hK2 levels and hK2:free-PSA ratios were significantly higher in cases than in controls (1.18 v 0.53 ng/mL, respectively, for hK2, P =.0001; 1.17 v 0.62 for hK2:free-PSA ratio, P =.0001). The crude odds ratio for prostate cancer detection for patients in the highest quartile of hK2 level was 5.83 (95% confidence interval [CI], 2.8 to 12.1; P =.0001) compared with patients in the lowest quartile. The adjusted odds ratio was 6.72 (95% CI, 2.9 to 15.6; P =.0001). Similarly, the crude and adjusted odds ratios for prostate cancer detection using the hK2:free-PSA ratio were 7.36 (95% CI, 3.6 to 15.1; P =.0001) and 8.06 (95% CI, 3. 7 to 17.4; P =.0001), respectively. These odds ratios were higher than that observed for prostate cancer detection by total-PSA level (2.73; P =.03). CONCLUSION Among men prescreened with PSA for prostate cancer, patients with high hK2 measurements have a five- to eight-fold increase in risk for prostate cancer, adjusting for PSA level and other established risk factors. hK2 measurements may be a useful adjunct to PSA in improving patient selection for prostate biopsy.
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Affiliation(s)
- R K Nam
- Division of Urology, Department of Diagnostic Imaging, Princess Margaret Hospital, University Health Network, University of Toronto, Ontario, Canada
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Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R, Johnston D, Chen M. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 2000; 163:152-7. [PMID: 10604335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE The 3 tumor locations unsampled by conventional sextant biopsies that have been identified on composite 3-dimensional reconstruction of 180 radical prostatectomy specimens are the anterior transition zone, midline peripheral zone and inferior portions of the anterior horn in the peripheral zone. We evaluated an 11-core multisite directed biopsy scheme incorporating these alternate areas and conventional sextant biopsies in 362 patients from 2 institutions. MATERIALS AND METHODS Patients without a prior diagnosis of cancer underwent ultrasound guided 11-core biopsies which included conventional sextant and 3 alternate sites. All specimens were separated for specific location identification. Biopsy was performed in 183 patients at MD Anderson Cancer Center (group 1) and in 179 at Toronto General Hospital (group 2). All group 2 and 54% of group 1 patients (98 of 183) had a prior biopsy negative for cancer. RESULTS Median prostate specific antigen was higher in group 2 than in group 1 patients (11.5 versus 9.5 ng./ml., p = 0.016). Overall a 33% increase (36 of 110 patients) in cancer detection was observed when biopsy technique included the alternate areas (p = 0.0021). The anterior horn was the most frequently positive biopsy site followed by the transition zone and midline sites. The 11-core technique had significantly better cancer detection rates when digital rectal examination and transrectal ultrasound were normal, and in men with serum prostate specific antigen between 4.1 and 10 ng./ml. CONCLUSIONS Biopsies of the alternate sites suggested by our simulation studies are feasible and reproducible. This new strategy significantly enhanced (p = 0.0075) prostate cancer detection compared to conventional sextant biopsies in men undergoing a repeat procedure.
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Affiliation(s)
- R J Babaian
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA
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Chen JC, Moriarty JA, Derbyshire JA, Peters RD, Trachtenberg J, Bell SD, Doyle J, Arrelano R, Wright GA, Henkelman RM, Hinks RS, Lok SY, Toi A, Kucharczyk W. Prostate cancer: MR imaging and thermometry during microwave thermal ablation-initial experience. Radiology 2000; 214:290-7. [PMID: 10644139 DOI: 10.1148/radiology.214.1.r00ja06290] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous interstitial microwave thermoablation of locally recurrent prostate carcinoma was continually guided with magnetic resonance (MR) imaging. Phase images and data were obtained with a rapid gradient-echo technique and were used to derive tissue temperature change on the basis of proton-resonance shift. Thermally devitalized regions correlated well with the phase image findings. MR imaging-derived temperatures were linearly related to the fluoroptic tissue temperatures. MR imaging can be used to guide thermoablation.
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Affiliation(s)
- J C Chen
- Department of Medical Imaging, Toronto Hospital and the University of Toronto, Ontario, Canada
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Sgro M, Barozzino T, Toi A, Johnson J, Sermer M, Chitayat D. Prenatal detection of cerebral lesions in a fetus with tuberous sclerosis. Ultrasound Obstet Gynecol 1999; 14:356-359. [PMID: 10623997 DOI: 10.1046/j.1469-0705.1999.14050356.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We report a newborn, diagnosed prenatally with both cardiac rhabdomyomas and a brain tumor. To the best of our knowledge, this is the first report of central nervous system (CNS) lesions detected prenatally in a child with tuberous sclerosis with term follow-up. At 36 months, the child has normal growth and is developing appropriately. Thus the finding of CNS tumors on fetal ultrasound examination can help in the prenatal diagnosis of tuberous sclerosis but does not necessarily indicate a poor prognosis.
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Affiliation(s)
- M Sgro
- Department of Pediatrics, Toronto Hospital-General Division, University of Toronto, Ontario, Canada
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Abstract
BACKGROUND Measurement of the free fraction of total prostate-specific antigen (fPSA%) has been proposed as a useful addition to total PSA for the detection of prostate cancer. METHODS We assessed the performance of fPSA% in differentiating men with prostate cancer from men without cancer in a group of 1,709 subjects studied in five institutions. RESULTS On the basis of PSA testing, digital rectal examination, and ultrasound examination conducted at one or more visits, 229 cancers were diagnosed. The mean fPSA% in men with cancer was 9.1% compared to 18.9% in men without cancer. The fPSA% varied by age, with men under 60 having a mean fPSA of 13.9% compared to 17.5% in men 60-69 years old and 19.8% in men over age 70. Significant associations of fPSA% with gland volume and PSA level were also observed. The sensitivity, specificity, and positive predictive value of different fPSA% cutoff levels were assessed in 513 men who underwent sextant biopsy. Sensitivity of 85.4%, 32.1% specificity, and a 39.2% positive predictive value were observed using an fPSA cutoff of 15% in men with PSA in the 4.0-9.9 ng/ml range. Sensitivity of 96.9%, 12.3% specificity, and a 36.2% positive predictive value were observed using an fPSA cutoff of 20% in the same men. If 15% fPSA had been used as a biopsy criterion in men with PSA of 4.0-9.9 ng/ml, the number of biopsies performed could have been reduced by 21.2%, with a concomitant reduction in cancer detection of 14.6%. Using a 20% fPSA criterion, biopsies would have been reduced 12.7%, with a 3.1% reduction in cancer detection. CONCLUSIONS These results provide some evidence that the detection of prostate cancer is enhanced by measuring fPSA% in addition to the established measure of total PSA level. Further research is needed to identify other markers that have better sensitivity and specificity.
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Affiliation(s)
- C Mettlin
- Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA
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Abstract
We report a female patient with congenital toxoplasmosis who presented with hydrops fetalis and cerebral abnormalities, detected on fetal ultrasound. Following prenatal treatment, the hydrops fetalis resolved and at four months of age she has normal growth and development. This case emphasizes the potential good prognosis in cases with congenital toxoplasmosis detected and treated prenatally.
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Affiliation(s)
- S Friedman
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
The conventional treatment for localized prostate cancer can be associated with significant morbidity and cost. Interstitial microwave thermoablation is a minimally invasive procedure used experimentally to treat selected patients with failed radiation therapy of prostate cancer at our institution. Preliminary results in these patients suggest that this treatment might be a useful alternative in selected patients with previously untreated localized prostate cancer. In this report we describe the first use of percutaneous transperineal interstitial microwave thermoablation to treat a case of primary prostate cancer. There were no treatment complications. At 18 months the patient's serum prostate-specific antigen remains undetectable, and his prostate biopsy shows no evidence of malignancy. These very preliminary but exciting results in this single patient suggest that this experimental technique should be explored further.
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Affiliation(s)
- C Lancaster
- Department of Medical Imaging, University of Toronto, Ontario, Canada
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Affiliation(s)
- R Rahmani
- ATR Laboratories, Toronto, Ontario, Canada
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