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Gatti M, Faletti R, Gentile F, Soncin E, Calleris G, Fornari A, Oderda M, Serafini A, Strazzarino GA, Vissio E, Bergamasco L, Cirillo S, Papotti MG, Gontero P, Fonio P. mEPE-score: a comprehensive grading system for predicting pathologic extraprostatic extension of prostate cancer at multiparametric magnetic resonance imaging. Eur Radiol 2022; 32:4942-4953. [PMID: 35290508 PMCID: PMC9213375 DOI: 10.1007/s00330-022-08595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
Objective To investigate the diagnostic accuracy of the PI-RADS v2.1 multiparametric magnetic resonance imaging (mpMRI) features in predicting extraprostatic extension (mEPE) of prostate cancer (PCa), as well as to develop and validate a comprehensive mpMRI-derived score (mEPE-score). Methods We retrospectively reviewed all consecutive patients admitted to two institutions for radical prostatectomy for PCa with available records of mpMRI performed between January 2015 and December 2020. Data from one institution was used for investigating diagnostic performance of each mEPE feature using radical prostatectomy specimens as benchmark. The results were implemented in a mEPE-score as follows: no mEPE features: 1; capsular abutment: 2; irregular or spiculated margin: 3; bulging prostatic contour, or asymmetry of the neurovascular bundles, or tumor-capsule interface > 1.0 cm: 4; ≥ 2 of the previous three parameters or measurable extraprostatic disease: 5. The performance of mEPE features was evaluated using the five diagnostic parameters and ROC curve analysis. Results Two-hundred patients were enrolled at site 1 and 76 at site 2. mEPE features had poor sensitivities ranging from 0.08 (0.00–0.15) to 0.71 (0.59–0.83), whereas specificity ranged from 0.68 (0.58–0.79) to 1.00. mEPE-score showed excellent discriminating ability (AUC > 0.8) and sensitivity = 0.82 and specificity = 0.77 with a threshold of 3. mEPE-score had AUC comparable to ESUR-score (p = 0.59 internal validation; p = 0.82 external validation), higher than or comparable to mEPE-grade (p = 0.04 internal validation; p = 0.58 external validation), and higher than early-and-late-EPE (p < 0.0001 internal and external validation). There were no significant differences between readers having different expertise with EPE-score (p = 0.32) or mEPE-grade (p = 0.45), but there were significant differences for ESUR-score (p = 0.02) and early-versus-late-EPE (p = 0.03). Conclusions The individual mEPE features have low sensitivity and high specificity. The use of mEPE-score allows for consistent and reliable assessment for pathologic EPE. Key Points • Individual PI-RADS v2.1 mpMRI features had poor sensitivities ranging from 0.08 (0.00–0.15) to 0.71 (0.59–0.83), whereas Sp ranged from 0.68 (0.58–0.79) to 1.00. • mEPE-score is an all-inclusive score for the assessment of pEPE with excellent discriminating ability (i.e., AUC > 0.8) and Se = 0.82, Sp = 0.77, PPV = 0.74, and NPV = 0.84 with a threshold of 3. • The diagnostic performance of the expert reader and beginner reader with pEPE-score was comparable (p = 0.32). Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08595-9.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Francesco Gentile
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Enrico Soncin
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giorgio Calleris
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alberto Fornari
- Radiology Unit, Mauriziano Umberto I Hospital, 10128, Turin, Italy
| | - Marco Oderda
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessandro Serafini
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | | | - Elena Vissio
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Laura Bergamasco
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Cirillo
- Radiology Unit, Mauriziano Umberto I Hospital, 10128, Turin, Italy
| | - Mauro Giulio Papotti
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
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Tore D, Rampado O, Guarnaccia C, Mina R, Oronzio M, Santonocito A, Serafini A, Strazzarino GA, Gianusso L, Bringhen S, Fonio P, Depaoli A. Ultra-Low-Dose Whole-Body Computed Tomography Protocol Optimization for Patients With Plasma Cell Disorders: Diagnostic Accuracy and Effective Dose Analysis From a Reference Center. Front Oncol 2021; 11:769295. [PMID: 34869000 PMCID: PMC8635628 DOI: 10.3389/fonc.2021.769295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The whole-body low-dose CT (WBLDCT) is the first-choice imaging technique in patients with suspected plasma cell disorder to assess the presence of osteolytic lesions. We investigated the performances of an optimized protocol, evaluating diagnostic accuracy and effective patient dose reduction using a latest generation scanner. METHODS AND MATERIALS Retrospective study on 212 patients with plasma cell disorders performed on a 256-row CT scanner. First, WBLDCT examinations were performed using a reference protocol with acquisition parameters obtained from literature. A phantom study was performed for protocol optimization for subsequent exams to minimize dose while maintaining optimal diagnostic accuracy. Images were analyzed by three readers to evaluate image quality and to detect lesions. Effective doses (E) were evaluated for each patient considering the patient dimensions and the tube current modulation. RESULTS A similar, very good image quality was observed for both protocols by all readers with a good agreement at repeated measures ANOVA test (p>0.05). An excellent inter-rater agreement for lesion detection was achieved obtaining high values of Fleiss' kappa for all the districts considered (p<0.001). The optimized protocol resulted in a 56% reduction of median DLP (151) mGycm, interquartile range (IQR) 128-188 mGycm vs. 345 mGycm, IQR 302-408 mGycm), of 60% of CTDIvol (2.2 mGy, IQR 1.9-2.7 mGy vs. 0.9 mGy, IQR 0.8-1.2 mGy). The median E value was about 2.6 mSv (IQR 1.7-3.5 mSv) for standard protocol and about 1.5 mSv (IQR 1.4-1.7 mSv) for the optimized one. Dose reduction was statistically significant with p<0.001. CONCLUSIONS Protocol optimization makes ultra-low-dose WBLDCT feasible on latest generation CT scanners for patients with plasma cell disorders with effective doses inferior to conventional skeletal survey while maintaining excellent image quality and diagnostic accuracy. Dose reduction is crucial in such patients, as they are likely to undergo multiple whole-body CT scans during follow-up.
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Affiliation(s)
- Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Osvaldo Rampado
- Medical Physics Unit, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carla Guarnaccia
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Mina
- Myeloma Unit, Division of Hematology, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Oronzio
- Medical Physics Unit, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ambra Santonocito
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Serafini
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giulio Antonino Strazzarino
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laura Gianusso
- Medical Physics Unit, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sara Bringhen
- Oncohematology and Multiple Myeloma Clinical Trials Unit, Department of Oncology, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Depaoli
- Radiology Unit, Department of Surgical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Turin, Italy
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Boretto P, Depaoli A, Conrotto F, Omedè P, De Filippo O, Serafini A, Strazzarino GA, Fonio P, De Ferrari GM, D'Ascenzo F. "Pressure Pressing Down on Me": Importance of Intracoronary Physiology and Inotropic Challenge for Myocardial Bridge. JACC Cardiovasc Interv 2021; 14:e157-e159. [PMID: 33992545 DOI: 10.1016/j.jcin.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Paolo Boretto
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Città Della Salute e della Scienza, Turin, Italy.
| | - Alessandro Depaoli
- University Radiodiagnostic Unit, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Città Della Salute e della Scienza, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Città Della Salute e della Scienza, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Città Della Salute e della Scienza, Turin, Italy
| | - Alessandro Serafini
- University Radiodiagnostic Unit, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Paolo Fonio
- University Radiodiagnostic Unit, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Città Della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Città Della Salute e della Scienza, Turin, Italy
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Calandri M, Gazzera C, Giurazza F, Yevich S, Strazzarino GA, Brino J, Marra P, Contegiacomo A, Bargellini I, Cariati M, Fonio P, Veltri A. Oligometastatic Colorectal Cancer Management: A Survey of the Italian College of Interventional Radiology. Cardiovasc Intervent Radiol 2020; 43:1474-1483. [PMID: 32449016 DOI: 10.1007/s00270-020-02516-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
AIM European Society for Medical Oncology (ESMO) and National Comprehensive Cancer Network guidelines (NCCN) have recently included interventional procedures among the standard treatments for the management of colorectal cancer (CRC) oligometastatic disease (OMD). This study overviews the practice of Interventional Radiology (IR) in Italian centers. METHODS A practice focused questionnaire on locoregional treatments of CRC-OMD was submitted to all Italian IR centers to assess practice patterns. RESULTS Thirty-three IR centers completed the questionnaire. The majority reported practice was established within a tumor board (97%), which included input from hepatobiliary surgery (94%). When considering the number of percutaneous ablation and liver-directed trans-arterial therapies performed for all tumor types, 33.5% and 13.4% were performed to specifically treat CRC-OMD. Lung ablations for CRC OMD were performed in 45.5% of centers. Regarding liver ablation, The most common technology was the microwave ablation (68.1%), which was typically performed under US guidance (78%) with conscious sedation used as the most common anaesthesia method (81%). While indication for percutaneous IR treatments was heterogeneous, 51% were performed in combination with chemotherapy in unresectable OMD. Despite new ESMO and NCCN guidelines, 59% of centers did not subjectively appreciate any change in the perception of IR treatments by other specialists; however, 63%of respondents believe that IR will have a more relevant role in the CRC-OMD management in the future. CONCLUSION CRC-OMD treatment represents a relevant part of the everyday clinical practice of the IR Italian centers with promising future prospects. Heterogeneity persists in clinical indications, requiring more robust evidence to set indications and to diffuse clinical applications.
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Affiliation(s)
- Marco Calandri
- Department of Oncology, University of Torino, Regione Gonzole 10, Orbassano, TO, Italy.
- Radiology Unit, A.O.U. San Luigi Gonzaga Di Orbassano, Regione Gonzole 10, Orbassano, TO, Italy.
| | - Carlo Gazzera
- Radiology Unit, A.O.U. Città Della Salute E Della Scienza, Presidio Molinette, Via Genova 3, Torino, TO, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Cardarelli 9, Napoli, Italy
| | - Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Giulio Antonino Strazzarino
- Radiology Unit, A.O.U. Città Della Salute E Della Scienza, Presidio Molinette, Via Genova 3, Torino, TO, Italy
| | - Jacopo Brino
- Radiology Unit, A.O.U. San Luigi Gonzaga Di Orbassano, Regione Gonzole 10, Orbassano, TO, Italy
| | - Paolo Marra
- Radiology Department, IRCCS Ospedale San Raffaele E Università Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Andrea Contegiacomo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
| | - Irene Bargellini
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Maurizio Cariati
- Diagnostic-Therapeutic Advanced Technology Department, ASST Santi Paolo E Carlo, Via Pio II 3, 20153, Milan, Italy
| | - Paolo Fonio
- Radiology Unit, A.O.U. Città Della Salute E Della Scienza, Presidio Molinette, Via Genova 3, Torino, TO, Italy
- Department of Surgical Sciences, University of Torino, Via Genova 3, Torino, Italy
| | - Andrea Veltri
- Department of Oncology, University of Torino, Regione Gonzole 10, Orbassano, TO, Italy
- Radiology Unit, A.O.U. San Luigi Gonzaga Di Orbassano, Regione Gonzole 10, Orbassano, TO, Italy
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