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Falagario UG, Lantz A, Jambor I, Busetto GM, Bettocchi C, Finati M, Ricapito A, Luzzago S, Ferro M, Musi G, Totaro A, Racioppi M, Carbonara U, Checcucci E, Manfredi M, D'Aietti D, Porcaro AB, Nordström T, Björnebo L, Oderda M, Soria F, Taimen P, Aronen HJ, Perez IM, Ettala O, Marchioni M, Simone G, Ferriero M, Brassetti A, Napolitano L, Carmignani L, Signorini C, Conti A, Ludovico G, Scarcia M, Trombetta C, Claps F, Traunero F, Montanari E, Boeri L, Maggi M, Del Giudice F, Bove P, Forte V, Ficarra V, Rossanese M, Mucciardi G, Pagliarulo V, Tafuri A, Mirone V, Schips L, Antonelli A, Gontero P, Cormio L, Sciarra A, Porpiglia F, Bassi P, Ditonno P, Boström PJ, Messina E, Panebianco V, De Cobelli O, Carrieri G. Diagnosis of prostate cancer with magnetic resonance imaging in men treated with 5-alpha-reductase inhibitors. World J Urol 2023; 41:2967-2974. [PMID: 37787941 PMCID: PMC10632288 DOI: 10.1007/s00345-023-04634-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE The primary aim of this study was to evaluate if exposure to 5-alpha-reductase inhibitors (5-ARIs) modifies the effect of MRI for the diagnosis of clinically significant Prostate Cancer (csPCa) (ISUP Gleason grade ≥ 2). METHODS This study is a multicenter cohort study including patients undergoing prostate biopsy and MRI at 24 institutions between 2013 and 2022. Multivariable analysis predicting csPCa with an interaction term between 5-ARIs and PIRADS score was performed. Sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of MRI were compared in treated and untreated patients. RESULTS 705 patients (9%) were treated with 5-ARIs [median age 69 years, Interquartile range (IQR): 65, 73; median PSA 6.3 ng/ml, IQR 4.0, 9.0; median prostate volume 53 ml, IQR 40, 72] and 6913 were 5-ARIs naïve (age 66 years, IQR 60, 71; PSA 6.5 ng/ml, IQR 4.8, 9.0; prostate volume 50 ml, IQR 37, 65). MRI showed PIRADS 1-2, 3, 4, and 5 lesions in 141 (20%), 158 (22%), 258 (37%), and 148 (21%) patients treated with 5-ARIs, and 878 (13%), 1764 (25%), 2948 (43%), and 1323 (19%) of untreated patients (p < 0.0001). No difference was found in csPCa detection rates, but diagnosis of high-grade PCa (ISUP GG ≥ 3) was higher in treated patients (23% vs 19%, p = 0.013). We did not find any evidence of interaction between PIRADS score and 5-ARIs exposure in predicting csPCa. Sensitivity, specificity, PPV, and NPV of PIRADS ≥ 3 were 94%, 29%, 46%, and 88% in treated patients and 96%, 18%, 43%, and 88% in untreated patients, respectively. CONCLUSIONS Exposure to 5-ARIs does not affect the association of PIRADS score with csPCa. Higher rates of high-grade PCa were detected in treated patients, but most were clearly visible on MRI as PIRADS 4 and 5 lesions. TRIAL REGISTRATION The present study was registered at ClinicalTrials.gov number: NCT05078359.
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Affiliation(s)
- Ugo G Falagario
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
| | - Anna Lantz
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Jambor
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Marco Finati
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Anna Ricapito
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Umberto Carbonara
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Enrico Checcucci
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - Damiano D'Aietti
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | | | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Björnebo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marco Oderda
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Francesco Soria
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Radiology, University of Turku, Turku, Finland
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Otto Ettala
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Michele Marchioni
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Giuseppe Simone
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Mariaconsiglia Ferriero
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Aldo Brassetti
- Department of Oncologic Urology, IRCCS "Regina Elena" National Cancer Institute of Rome, Rome, Italy
| | - Luigi Napolitano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | | | | | - Giuseppe Ludovico
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | - Marcello Scarcia
- Department of Urology, Ente Ecclesiastico Miulli, Acquaviva Delle Fonti, Italy
| | | | | | | | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda-Maggiore Policlinico Hospital, Milan, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Valerio Forte
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | | | - Marta Rossanese
- Department of Urology, University of Messina, Messina, Italy
| | | | | | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Luigi Schips
- Department of Urology, Università "G.d'Annunzio", Chieti-Pescara, Italy
| | - Alessandro Antonelli
- UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy
| | - Paolo Gontero
- Department of Surgical Sciences, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, Turin, Italy
| | - Luigi Cormio
- Unit of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Ospedale L. Bonomo, Andria, Italy
| | - Alessandro Sciarra
- Department of Maternal Infant and Urological Sciences, Sapienza Rome University, Rome, Italy
| | - Francesco Porpiglia
- Department of Urology, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", University of Turin, Turin, Italy
| | - PierFrancesco Bassi
- Department of Urology, Catholic University Medical School "A. Gemelli" Hospital, Rome, Italy
| | - Pasquale Ditonno
- Department of Urology, Andrology and Kidney Transplantation, University of Bari, Bari, Italy
| | - Peter J Boström
- Department of Urology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Ottavio De Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes JL, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Roumeguere T, Faletti R, Gontero P. Accuracy of elastic fusion biopsy: Comparing prostate cancer detection between targeted and systematic biopsy. Prostate 2023; 83:162-168. [PMID: 36259316 DOI: 10.1002/pros.24449] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION When performing targeted biopsy (TBx), the need to add systematic biopsies (SBx) is often debated. Aim of the study is to evaluate the added value of SBx in addition to TBx in terms of prostate cancer (PCa) detection rates (CDR), and to test the concordance between multiparametric magnetic resonance imaging (mpMRI) findings and fusion biopsy results in terms of cancer location. METHODS We performed a retrospective, multicentric study that gathered data on 1992 consecutive patients who underwent elastic fusion biopsy between 2011 and 2020. A standardized approach was used, with TBx (2-4 cores per target) followed by SBx (12-14 cores). We assessed CDR of TBx, of SBx, and TBx+SBx for all cancers and clinically significant PCa (csPCa), defined as ISUP score ≥2. CDR was evaluated according to radiological and clinical parameters, with a particular focus on PI-RADS 3 lesions. In a subgroup of 1254 patients we tested the discordance between mpMRI findings and fusion biopsy results in terms of cancer location. Uni- and multivariable logistic regression analyses were performed to identify predictors of CDR. RESULTS CDR of TBx+SBx was 63.0% for all cancers and 38.8% of csPCa. Per-patient analysis showed that SBx in addition to TBx improved CDR by 4.5% for all cancers and 3.4% for csPCa. Patients with lesions scored as PI-RADS 3, 4, and 5 were diagnosed with PCa in 27.9%, 72.8%, and 92.3%, and csPCa in 10.7%, 43.6%, and 69.3%, respectively. When positive, PI-RADS 3 lesions were ISUP grade 1 in 61.1% of cases. Per-lesion analysis showed that discordance between mpMRI and biopsy was found in 56.6% of cases, with 710 patients having positive SBx outside mpMRI targets, of which 414 (58.0%) were clinically significant. PSA density ≥0.15 was a strong predictor of CDR. CONCLUSIONS The addition of systematic mapping to TBx contributes to a minority of per-patient diagnoses but detects a high number of PCa foci outside mpMRI targets, increasing biopsy accuracy for the assessment of cancer burden within the prostate. High PSA-density significantly increases the risk of PCa, both in the whole cohort and in PI-RADS 3 cases.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Ciccariello
- Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Dematteis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Romain Diamand
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Descotes
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Valerio Forte
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Aurel Messas
- Department of Urology, Hopitaux de Paris, Paris, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Alexandre Peltier
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Leire Rius
- Department of Urology, Galdakao Hospital, Bilbao, Spain
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Thierry Roumeguere
- Department of Urology, University Clinics of Brussels, Erasme Hospital and Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Riccardo Faletti
- Division of Radiology, Molinette Hospital, University of Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
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Sensi B, Beomonte Zobel L, Forte V, Alicata F, Procaccini C, Pavoncello D, Arcudi C, Bianciardi E, Gentileschi P. Internal herniation of small bowel through the minimizer ring after banded one anastomosis gastric bypass: Case report with diagnosis and management of a rare complication. Obes Res Clin Pract 2022; 16:349-352. [DOI: 10.1016/j.orcp.2022.06.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
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Giofrè F, Arturi F, Ventura M, Pelle M, Cloro C, Zaffina I, Forte V, Lucà S, Melina M, Clausi C, Sciacqua A. P418 CARDIOMETABOLIC ALTERATIONS IN OBESE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.403] [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: 11/14/2022]
Abstract
Abstract
Background
Obesity and Obstructive Sleep Apnea Syndrome (OSAS) has been recognized as two of the major cardiac risk factors and they often coexist in one patient. OSAS increase the risk of as myocardial infarction, heart failure and arrhythmias. On the other hand, obesity is and independent predictor of cardiovascular mortality since it causes insulin resistance, dyslipidemia, sympathetic hyperactivation, chronic inflammation and endothelial dysfunction.
Aim
To evaluate cardiometabolic profile, echocardiographic alterations and the presence of arrhythmias in obese patients with Obstructive Sleep Apnea Syndrome and non obese patients.
Patients and Methods
67 obese patients (37 male/30 female) and 52 non obese patients (40 male/12 female) were enrolled. All subjects underwent anthropometrical evaluation and a venous blood sample for biochemical and hormonal determinations including fasting plasma glucose, fasting plasma insulin, Hba1c and OGTT to 5 hours. The insulin resistance was evaluated by HOMA–IR. All the patients underwent echocardiographic examination, polysomnographic evaluation, in order to diagnose the OSAS, and a simultaneous 12–lead Holter ECG to evaluate the presence of nocturnal arrhythmias.
Results
As expected, we found a better antropometrics profile in non obese patients. Obese patients display a severe OSAS compared to non–obese patient as shown by higher values of AHI (26.37 ±24.95 vs 16.58 ±14.07; P < 0.05), TC90 (19.61 ±24.45 vs 8.63 ±17.80; P < 0.05) and ODI (40.55 ±27.41 vs 21.06 ±22.78; P < 0,05). In obese patients we also found a significant reduction of both ejection fraction (55.54 ±7.97 vs 66.52 ±8.95; P < 0.05) and A–wave (0.75 ±0.17 vs 0.83 ±0.19; P < 0.05). In 20% of obese patients, 12–lead Holter ECG showed the presence of cardiac pause > 3 sec during apnea. In obese population alone we demonstrated a significant negative correlation between AHI and E–wave (r= –0.3; P = 0.04) and a positive correlation with interventricular septum (r = 0.38; P = 0.01) and left ventricular mass (r = 0.32; P = 0.02). Post–hoc analysis shown how these findings maintained statistical significance even when the obese patients were stratified in subgroups according to the severity of OSAS.
Conclusions
Our data, even if preliminary, seem to indicate that OSAS is not only linked to obesity but it also acts as a negative factor on the cardiometabolic risk.
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Affiliation(s)
- F Giofrè
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - F Arturi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Ventura
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Pelle
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - C Cloro
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - I Zaffina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - V Forte
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - S Lucà
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Melina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - C Clausi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - A Sciacqua
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
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Giofrè F, Pelle M, Zaffina I, Lucà S, Forte V, Arturi F, Cloro C, Ventura M, Trapanese V, Sciacqua A. P386 OBESITY AND CARDIOMYOPATHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.372] [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: 11/13/2022]
Abstract
Abstract
Background
Obesity cardiomyopathy is a heart failure unexplained by others etiologies that can vary from a subclinical left ventricular dysfunction to overt dilated cardiomyopathy.
Aim
To evaluate the changes in echocardiogram in both normotensive and hypertensive obese and to evaluate obesity and/or hypertension impact on cardiomyopathy.
Methods
383 subjects (236F–147M) were enrolled. They were divided into two groups based on BMI: non–obese subjects (BMI<30kg/m2) and obese subjects (BMI>30kg/m2). The obese subjects were divided in different degrees (groups) of obesity according with obesity classification: group 1= BMI >30<35, 2= BMI >35<40, 3= BMI >40 kg/m2. 208 of 383 enrolled subjects were hypertensive. All subjects underwent to an echocardiogram with evalutation of left atrial diameter (LAD), left ventricular end–diastolic diameter (LVEDD), left ventricular end–systolic diameter (LVESD), ventricular septum, cardiac mass and left ventricular mass index (LVMI).
Results
Obese subjects showed a progressive increase in left atrial diameter (LAD)(P = 0.000), left ventricular end–diastolic diameter (LVEDD)(P = 0.000), left ventricular end–systolic diameter (LVESD)(P = 0.001), ventricular septum (P = 0.000) and cardiac mass (P = 0.000) according to the degree of obesity. Subjects in the 3° group of obesity showed higher value of LAD and LVESD when compared with subjects in first two groups (P = 0.000; P = 0.032; P = 0.000; P = 0.001, respectively). Similarly, subjects in the 3° group of obesity showed higher value of ventricular septum and cardiac mass when compared with the first two groups of obesity (P = 0.005; P = 0.002; P = 0.000; P = 0.005; respectively). LAD, LVEDD, LVESD, ventricular septum and cardiac mass were positively related with the obesity degree. In order to avoid that echocardiographic modifications were caused by hypertension, data were adjusted for hypertension so linear regression documented that degree of obesity predicts echocardiographic changes (LAD, LVEDD, LVESD) better than hypertension.
Conclusions
Our data suggested that the in obese subjects the severity of cardiomyopathy is correlated with degree of obesity and that the degree of obesity is a better predictor than hypertension for echocardiographic changes.
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Affiliation(s)
- F Giofrè
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Pelle
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - I Zaffina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - S Lucà
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - V Forte
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - F Arturi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - C Cloro
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Ventura
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - V Trapanese
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - A Sciacqua
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
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6
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Ventura M, Giofrè F, Lucà S, Pelle M, Zaffina I, Forte V, Cloro C, Melina M, Miceli S, Sciacqua A, Segura Garcia C, Currò G, Arturi F. C72 THE EFFECTS OF BATRIATIC SURGERY ON CARDIO–METABOLIC PROFILE AND CARDIAC REMODELING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.070] [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: 11/12/2022]
Abstract
Abstract
Background
Obesity is associated with cardiac remodeling resulting in hypertrophy of the left ventricle (LV) with a predominantly concentric pattern. LV remodeling and fibrosis induce mechanical and electrical dysfunction of the myocardial tissue, an increase in cardiac output, an increase of myocardial workload and mean arterial pressure.
Objective
To evaluate the impact of bariatric surgery, and therefore of anthropometric and cardio–metabolic variations, on cardiac structure and function.
Methods
Twenty–six obese patients treated with bariatric surgery were enrolled. All the patients at baseline and at 6 and 12 months underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. The IR has been assessed by HOMA–IR. The patients were divided into two groups: the first group (8 patients) carried out a follow–up at 6 months post–surgery; the second group (18 patients) at 12 months post–surgery.
Results
As expected, an improvement in the anthropometric and metabolic profile in patients treated with bariatric surgery was observed. Echocardiographic data showed a significant increase in the Ejection Fraction (P < 0.001) and the E/A Ratio (P < 0.001) 6 months after bariatric surgery, a significant reduction in the Interventricular Septum thickness at 6 months (P < 0.001) and at 12 months (P < 0.002) post–surgery and a significant reduction in the Left Ventricular Mass at 6 months (P = 0.02) and at 12 months (P = 0.05) after bariatric surgery. A reduction no significant in the Left Ventricular posterior wall thickness has been observed.
Conclusions
Our data showed an increase of the systolic function, an increase of the left ventricular diastolic compliance and a reduction in subclinical cardiac organ damage. Therefore, significant weight loss obtained with bariatric surgery may lead to reverse cardiac remodeling, associated with beneficial effects on myocardial structure and systo-diastolic function.
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Affiliation(s)
- M Ventura
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - F Giofrè
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - S Lucà
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - M Pelle
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - I Zaffina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - V Forte
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - C Cloro
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - M Melina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - S Miceli
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - A Sciacqua
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - C Segura Garcia
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - G Currò
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - F Arturi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
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7
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Bertolo R, Maiorino F, Vittori M, Cipriani C, Forte V, Marani C, Bove P. Pure laparoscopic nephroureterectomy in horseshoe kidney with complex vascular anatomy. Urology Video Journal 2022. [DOI: 10.1016/j.urolvj.2021.100121] [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: 11/29/2022] Open
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8
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Cavallo AU, Troisi J, Muscogiuri E, Cavallo P, Rajagopalan S, Citro R, Bossone E, McVeigh N, Forte V, Di Donna C, Giannini F, Floris R, Garaci F, Sperandio M. Cardiac Computed Tomography Radiomics-Based Approach for the Detection of Left Ventricular Remodeling in Patients with Arterial Hypertension. Diagnostics (Basel) 2022; 12:diagnostics12020322. [PMID: 35204413 PMCID: PMC8871253 DOI: 10.3390/diagnostics12020322] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of the study is to verify the feasibility of a radiomics based approach for the detection of LV remodeling in patients with arterial hypertension. Cardiac Computed Tomography (CCT) and clinical data of patients with and without history of arterial hypertension were collected. In one image per patient, on a 4-chamber view, left ventricle (LV) was segmented using a polygonal region of interest by two radiologists in consensus. A total of 377 radiomics features per region of interest were extracted. After dataset splitting (70:30 ratio), eleven classification models were tested for the discrimination of patients with and without arterial hypertension based on radiomics data. An Ensemble Machine Learning (EML) score was calculated from models with an accuracy >60%. Boruta algorithm was used to extract radiomic features discriminating between patients with and without history of hypertension. Pearson correlation coefficient was used to assess correlation between EML score and septum width in patients included in the test set. EML showed an accuracy, sensitivity and specificity of 0.7. Correlation between EML score and LV septum width was 0.53 (p-value < 0.0001). We considered LV septum width as a surrogate of myocardial remodeling in our population, and this is the reason why we can consider the EML score as a possible tool to evaluate myocardial remodeling. A CCT-based radiomic approach for the identification of LV remodeling is possible in patients with past medical history of arterial hypertension.
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Affiliation(s)
- Armando Ugo Cavallo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.D.); (R.F.); (F.G.)
- Division of Radiology, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy; (V.F.); (M.S.)
- Correspondence: ; Tel.: +39-333-903-3702
| | - Jacopo Troisi
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84100 Salerno, Italy; or
- Theoreo srl—Spin-Off Company of the University of Salerno, 84100 Salerno, Italy
| | - Emanuele Muscogiuri
- Radiology Department, Ospedale S. Andrea, Sapienza—Università di Roma, 00189 Rome, Italy;
| | - Pierpaolo Cavallo
- Department of Physics “E.R. Caianello”, University of Salerno, 84100 Salerno, Italy;
- Istituto Sistemi Complessi—Consiglio Nazionale delle Ricerche (CNR), 00185 Rome, Italy
| | - Sanjay Rajagopalan
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Cleveland, OH 44106, USA;
| | - Rodolfo Citro
- Division of Cardiology, University Hosptal “San Giovanni di Dio e Ruggi D’Aragona”, 84100 Salerno, Italy;
| | - Eduardo Bossone
- Cardiology Division, “A. Cardarelli” Hospital, 80131 Naples, Italy;
| | - Niall McVeigh
- Department of Radiology, St Vincent’s University Hospital, Merrion Road, D04 T6F4 Dublin, Ireland;
- School of Medicine, University College Dublin, D04 T6F4 Dublin, Ireland
| | - Valerio Forte
- Division of Radiology, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy; (V.F.); (M.S.)
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.D.); (R.F.); (F.G.)
| | - Francesco Giannini
- Division of Cardiology, Maria Cecilia Hospital, GVM Care and Research, 48033 Cotignola, Italy;
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.D.); (R.F.); (F.G.)
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.D.); (R.F.); (F.G.)
- San Raffaele Cassino, 03043 Cassino, Italy
| | - Massimiliano Sperandio
- Division of Radiology, San Carlo di Nancy Hospital, GVM Care and Research, 00165 Rome, Italy; (V.F.); (M.S.)
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9
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes J, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Roumeguere T, Gontero P. Improved cancer detection with targeted biopsies only: results from a multicenter series using Koelis fusion system. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00914-9] [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: 10/20/2022] Open
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10
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes J, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Thierry R, Gontero P. Correlation between MRI and biopsy for cancer location definition: results from a multicentric study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00794-1] [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: 11/29/2022] Open
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11
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Oderda M, Albisinni S, Benamran D, Calleris G, Ciccariello M, Dematteis A, Diamand R, Descotes J, Fiard G, Forte V, Giacobbe A, Marquis A, Marra G, Messas A, Muto G, Peltier A, Rius L, Simone G, Roumeguere T, Gontero P. Accuracy of Koelis fusion biopsy: Improved cancer detection with targeted biopsies only. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01332-4] [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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12
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Bertolo R, Forte V, Cipriani C, Vittori M, Cavallo A, Iacovelli V, Antonucci M, Petta F, Panei M, Sperandio M, Bove P. Performance comparison between computer-software-based fusion versus cognitive fusion technique in biopsy-naïve patients: A single-center analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01327-0] [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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13
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Forte V, Cavallo A, Bertolo R, Muscogiuri E, Cipriani C, Maiorino F, Bove P, Sperandio M. Computer tomography texture analysis: a promising tool aiding in suspecting clear cell renal carcinoma at pre-treatment imaging. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00973-8] [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: 10/20/2022]
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14
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Cavallo AU, Troisi J, Forcina M, Mari PV, Forte V, Sperandio M, Pagano S, Cavallo P, Floris R, Garaci F. Texture Analysis in the Evaluation of Covid-19 Pneumonia in Chest X-Ray Images: a Proof of Concept Study. Curr Med Imaging 2021; 17:1094-1102. [PMID: 33438548 DOI: 10.2174/1573405617999210112195450] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/24/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND One of the most challenging aspects related to Covid-19 is to establish the presence of infection in early phase of the disease. Texture analysis might be an additional tool for the evaluation of Chest X-ray in patients with clinical suspicion of Covid-19 related pneumonia. OBJECTIVE To evaluate the diagnostic performance of texture analysis and machine learning models for the diagnosis of Covid-19 interstitial pneumonia in Chest X-ray images. METHODS Chest X-ray images were accessed from a publicly available repository (https://www.kaggle.com/tawsifurrahman/covid19-radiography-database). Lung areas were manually segmented using a polygonal regions of interest covering both lung areas, using MaZda, a freely available software for texture analysis. A total of 308 features per ROI was extracted. One hundred-ten Covid-19 Chest X-ray images were selected for the final analysis. RESULTS Six models, namely NB, GLM, DL, GBT, ANN and PLS-DA were selected and ensembled. According to Youden's index, the Covid-19 Ensemble Machine Learning Score showing the highest Area Under the Curve (0.971±0.015) was 132.57. Assuming this cut-off the Ensemble model performance was estimated evaluating both true and false positive/negative, resulting in 91.8% accuracy with 93% sensitivity and 90% specificity. Moving the cut-off value to -100, although the accuracy resulted lower (90.6%), the Ensemble Machine Learning showed 100% sensitivity, with 80% specificity. CONCLUSION Texture analysis of Chest X-ray images and machine learning algorithms may help in differentiating patients with Covid-19 pneumonia. Despite several limitations, this study can lay ground for future researches in this field and help developing more rapid and accurate screening tools for these patients.
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Affiliation(s)
- Armando Ugo Cavallo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome,. Italy
| | - Jacopo Troisi
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno,. Italy
| | - Marco Forcina
- Division of Radiology, Policlinico Militare Celio, Rome,. Italy
| | - Pier-Valerio Mari
- Division of Internal Medicine, San Carlo di Nancy Hospital, GVM Care and Research, Rome,. Italy
| | - Valerio Forte
- Division of Radiology, San Carlo di Nancy Hospital, GVM Care and Research, Rome,. Italy
| | | | - Sergio Pagano
- Department of Physics "E.R. Caianello", University of Salerno, Salerno,. Italy
| | - Pierpaolo Cavallo
- Department of Physics "E.R. Caianello", University of Salerno, Salerno,. Italy
| | - Roberto Floris
- Radiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome,. Italy
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome,. Italy
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Bertolo R, Vittori M, Cipriani C, Maiorino F, Forte V, Iacovelli V, Petta F, Sperandio M, Marani C, Panei M, Travaglia S, Bove P. Diagnostic pathway of the biopsy-naïve patient suspected for prostate cancer: Real-life scenario when multiparametric Magnetic Resonance Imaging is not centralized. Prog Urol 2021; 31:739-746. [PMID: 33431200 DOI: 10.1016/j.purol.2020.12.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to compare the pathway including multi-parametric Magnetic Resonance Imaging (mpMRI) versus the one without mpMRI in detection of prostate cancer (PCa) when mpMRI is not centralized. MATERIALS January 2019-March 2020: prospective data collection of trans-perineal prostate biopsies. Group A: biopsy-naïve patients who underwent mpMRI (at any institution) versus Group B: patients who did not. Within Group A, patients were stratified into those with negative mpMRI (mpMRI-, PIRADS v2.1=1-3, with PSA density <0.15 if PIRADS 3) who underwent standard biopsy (SB), versus those with positive mpMRI (mpMRI+, when PIRADS 3-5, with PSA density>0.15 if PIRADS 3) who underwent cognitive fusion biopsy. RESULTS Two hundred and eighty one biopsies were analyzed. 153 patients underwent mpMRI (Group A). 98 mpMRI+ underwent fusion biopsy; 55 mpMRI- underwent SB. 128 Group B patients underwent SB. Overall PCa detection rate was 52.3% vs. 48.4% (Group A vs. B, P=0.5). Non-clinically-significant PCa was detected in 7.8 vs. 13.3% (Group A vs. B, P=0.1). Among the 98 mpMRI+ Group A patients only 2 had non clinically-significant disease. In 55 mpMRI- patients who underwent SB, 10 (18.2%) had clinically-significant PCa. Prostate volume predicted detection of PCa. In Group B, age and PSA predicted PCa. Sensitivity of mpMRI was 75.0% for all PCa, 85.3% for clinically-significant PCa. CONCLUSION Higher detection of PCa and lower detection of non-clinically-significant PCa favored mpMRI pathway. A consistent number of clinically-significant PCa was diagnosed after a mpMRI-. Thus, in real-life scenario, mpMRI- does not obviate indication to biopsy when mpMRI is not centralized. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- R Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
| | - M Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - C Cipriani
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - F Maiorino
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - V Forte
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - V Iacovelli
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - F Petta
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - M Sperandio
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - C Marani
- Department of Anatomo-Pathology, San Carlo di Nancy Hospital, Rome, Italy
| | - M Panei
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - S Travaglia
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - P Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
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Forte V, Cavallo AU, Bertolo R, de Soccio V, Sperandio M, Bove P, Ciccariello M. PI-RADS score v.2 in predicting malignancy in patients undergoing 5α-reductase inhibitor therapy. Prostate Cancer Prostatic Dis 2020; 24:150-155. [PMID: 32681155 DOI: 10.1038/s41391-020-0256-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND To investigate if the PI-RADS score represents an effective tool in detecting prostate cancer in patients treated with a 5α-reductase inhibitor (dutasteride) and to identify dedicated total serum PSA and PSA density thresholds. METHODS Between April 2015 and March 2018, 75 patients under dutasteride treatment underwent multi-parametric magnetic resonance imaging (mpMRI) scans and US/MRI fusion prostate biopsy. Lesions were classified into two groups: Group 1 included PI-RADS 4 and 5 lesions, whilst Group 2 included PI-RADS 3-4-5 lesions. Lesions in groups 1 and 2 were further divided according to the patients' history of previous prostate biopsy. RESULTS Ninety-seven lesions were detected. In PI-RADS 4-5 group, mpMRI showed a sensitivity of 78.0% and a specificity of 78.7%. The positive predictive value (PPV) was 79.6% and the negative predictive value (NPV) 77.1%. In PI-RADS 3-4-5 group, sensitivity was 100%, specificity 21.3%, PPV 57.5%, NPV 100%. In PI-RADS 4-5 biopsy-naive group sensitivity was 71.4%, specificity 75.0%. PPV 78.9% and NPV 66.7%. In PI-RADS 4-5 non-biopsy-naive group sensitivity was 82.8%, specificity 80.6%, PPV 80%, and NPV 83.3%. PI-RADS 3-4-5 biopsy-naive group showed sensitivity 100%, specificity 31.3%, PPV 65.6%, NPV 100%. PI-RADS 3-4-5 non-biopsy-naive group showed sensitivity 100%, specificity 16.1%, PPV 52.7%, and NPV 100%. ROC curve analysis indicated a serum total PSA threshold of 6 ng/ml (AUC: 0.71-95% confidence interval: 0.60-0.81) and a PSA density >0.22 (AUC: 0.70-95% confidence interval: 0.6-0.81) as optimal cut-offs for recommending prostate biopsy. CONCLUSIONS In our experience the PI-RADS score proved to be sufficiently accurate in predicting prostate cancer in patients under dutasteride therapy.
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Affiliation(s)
- V Forte
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy.
| | - A U Cavallo
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy.,University Hospital Policlinico "Tor Vergata", Rome, Italy
| | - R Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - V de Soccio
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | - M Sperandio
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - P Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - M Ciccariello
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
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17
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Cattarino S, Forte V, Salciccia S, Drudi FM, Cantisani V, Sciarra A, Fasulo A, Ciccariello M. MRI ultrasound fusion biopsy in prostate cancer detection: Are randomized clinical trials reproducible in everyday clinical practice? Urologia 2019; 86:9-16. [PMID: 30890102 DOI: 10.1177/0391560319834490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION: The aim of this study was to evaluate the performance of multiparametric magnetic resonance imaging (mpMRI)-ultrasound (US) fusion-targeted biopsies (TB) in men with primary and repeated biopsies comparing the cancer detection rate (CDR) of random biopsies (RB) + TB versus only TB. METHODS: The present study is a real-life study on patients with primary and prior negative prostate biopsies with suspicious PCa. A total of 130 men with prostate-specific antigen (PSA) value >2.5 ng/dL and/or abnormal digital rectal examination (DRE) were included in the study and subjected to mpMRI. Patients with >2 previous biopsies and/or with ⩾3 suspected lesions on MRI and/or prostate imaging-reporting and data system (PIRADS) value ⩾4 (n:30 pts) were subjected only to TB on the areas indicated by mpMRI. All the other patients (n:70 pts) were subjected to standard random laterally directed 10-core plus TB on the areas indicated by mpMRI. RESULTS: The overall CDR was 53% (53/100). In relation to PIRADS score, the overall CDR was 0, 40% (12/30), 56.83% (29/51), and 84% (11/13) for PIRADS 2, 3, 4, and 5, respectively. According to biopsy modality, CDR for RB + TB was 50% (35/70) and CDR for TB was 60% (18/30) with a p-value of 0.3632. DISCUSSION: MRI-US fusion biopsy is associated with a high CDR of clinically significant PCa (csPCa). MRI-US fusion biopsy could be a reasonable approach in patients with previous negative biopsy and high PIRADS score on MRI, to ensure a high CDR of csPCa and to reduce the diagnosis of clinically insignificant tumors.
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Affiliation(s)
| | - Valerio Forte
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Maria Drudi
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Valerio Cantisani
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Mauro Ciccariello
- 2 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
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Caswell-Jin JL, McNamara K, Reiter JG, Sun R, Hu Z, Ma Z, Suarez CJ, Tilk S, Raghavendra A, Forte V, Chin SF, Bardwell H, Provenzano E, Caldas C, Lang J, West R, Tripathy D, Press MF, Curtis C. Abstract P3-06-01: Clonal evolution and heterogeneity in breast tumors treated with neoadjuvant HER2-targeted therapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-06-01] [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: 11/16/2022]
Abstract
Abstract
Background: Understanding to what extent a breast tumor's genetic composition may change over the course of a few months of neoadjuvant therapy has implications for optimal therapeutic approach. However, genomic changes observed across treatment may result from either treatment-induced clonal evolution or geographically disparate sampling of a heterogeneous tumor. We sought to characterize the geographic heterogeneity in primary breast tumors, and to incorporate this information into analysis of clonal evolution with neoadjuvant therapy.
Methods: We assembled the largest cohort to date of multi-region (n=2-3) whole-exome sequenced (WES) or whole-genome sequenced untreated primary breast tumors with matched normal and adequate tumor purity for analysis: four tumors with data generated for this study and five tumors compiled from three previous studies. We also generated the first cohort of multi-region (n=2-6) WES breast tumors post-neoadjuvant HER2-targeted therapy and chemotherapy, sequencing one region from a pre-treatment diagnostic specimen, multiple regions from the post-treatment surgical specimen, and matched normal for five HER2+ breast tumors that did not achieve a pathologic complete response. We used an agent-based model of spatial tumor growth to investigate whether the mutational patterns we observed with treatment were consistent with pre-existing heterogeneity or treatment-induced selection.
Results: In untreated primary breast tumors, on average 30% (range 1-70%) of apparently clonal mutations from a single region were absent or rare in a second, spatially disparate region (high-frequency regional, or HFR). Intra-tumor heterogeneity was similar post-treatment (HFR 28%, range 10-54%), and was higher in breast tumors than in previously analyzed colon, brain, lung, and esophageal tumors. Simulation studies confirmed that with high heterogeneity as observed in breast tumors, analysis of one pre-treatment and one post-treatment region could not distinguish treatment-induced clonal evolution from pre-existing heterogeneity; however, obtaining at least two post-treatment regions allowed for detection of clonal shifts with treatment. Analysis of multi-region data revealed that clonal replacement occurred with neoadjuvant therapy in two of the five tumors. Candidate causes of therapeutic resistance included amplifications in CCND1, ERBB4, and MYC in one subclone, and functional protein-altering mutations in ERCC2, SMO, and WT1 in another. Mathematical modeling suggested that these putative resistant subclones comprised 0.02-12.5% of the overall pre-treatment cell population, substantially larger than previous estimates of resistant tumor clone size.
Conclusions: WES data from multiple regions of untreated and treated primary breast tumors revealed considerable heterogeneity that remained present throughout treatment with chemotherapy and HER2-targeted therapy, even while major clonal sweeps took place in a minority of tumors. Obtaining at least two samples for analysis from breast tumors post-neoadjuvant therapy may reveal the tumor's evolutionary path and, especially as increasing numbers of molecular and immune therapeutic targets are identified, inform new clinical strategies.
Citation Format: Caswell-Jin JL, McNamara K, Reiter JG, Sun R, Hu Z, Ma Z, Suarez CJ, Tilk S, Raghavendra A, Forte V, Chin S-F, Bardwell H, Provenzano E, Caldas C, Lang J, West R, Tripathy D, Press MF, Curtis C. Clonal evolution and heterogeneity in breast tumors treated with neoadjuvant HER2-targeted therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-06-01.
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Affiliation(s)
- JL Caswell-Jin
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - K McNamara
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - JG Reiter
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - R Sun
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Z Hu
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Z Ma
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - CJ Suarez
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S Tilk
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - A Raghavendra
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - V Forte
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S-F Chin
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - H Bardwell
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - E Provenzano
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - C Caldas
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - J Lang
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - R West
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - D Tripathy
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - MF Press
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - C Curtis
- Stanford University School of Medicine, Stanford, CA; The University of Texas MD Anderson Cancer Center, Houston, TX; Norris Comprehensive Cancer Center, Los Angeles, CA; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Di Leo N, Venturini L, de Soccio V, Forte V, Lucchetti P, Cerone G, Alagna G, Caratozzolo M, Messineo D, Di Gioia C, Di Marzo L, Fresilli D, De Vito C, Pugliese G, Cantisani V, D'Ambrosio F. Multiparametric ultrasound evaluation with CEUS and shear wave elastography for carotid plaque risk stratification. J Ultrasound 2018; 21:293-300. [PMID: 30378007 PMCID: PMC6237715 DOI: 10.1007/s40477-018-0320-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/10/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To assess the diagnostic effectiveness of Multiparametric ultrasound (MPUS), which includes color Doppler ultrasound (CDUS), CEUS and Shear wave elastography (SWE), for evaluating carotid plaque as compared with CT-angiography (CTA) and histology. MATERIALS AND METHODS Forty-three consecutive patients scheduled to undergo carotid endarterectomy underwent MPUS. Then, after periods ranging from 2 days to 2 weeks, all underwent CTA. Each plaque was classified by means of dedicated scores for CEUS and SWE as compared with CTA features. At surgery, each plaque was removed in a single fragment to facilitate histological analysis, which evaluated 4 features: extension of the lipid core, thickness of the fibrous cap, inflammatory infiltrate (CD68 + and CD3 + markers) and the presence of intraplaque microvessels. For the CEUS, SWE and CTA, the following values for identifying plaque vulnerability were evaluated: sensitivity, specificity, accuracy, negative predictive value (NPV), positive predictive value (PPV) and Area under the curve (AUC). Cohen's kappa was used to evaluate the concordance between measurements in the different imaging methods. A p < 0.05 was considered statistically significant. RESULTS At histology, 31 out of 43 plaques were identified as vulnerable because of the presence of at least one of the following criteria: fibrous cap < 200 μm, lipid core, intraplaque hemorrhage, inflammatory infiltrate or intraplaque neovascularization. CTA showed a sensitivity of 87.1%, a specificity of 100%, a PPV of 100%, an NPV of 75% and an AUC of 93.5%. SWE showed a sensitivity of 87.1%, a specificity of 66.7%, a PPV of 87.1%, an NPV of 66.7% and an AUC of 76.9%. CEUS showed a sensitivity of 87.1%, a specificity of 58.3%, a PPV of 84.4%, an NPV of 63.6% and an AUC of 72.7%. CONCLUSIONS Multiparametric ultrasound is an effective modality to obtain comprehensive information on carotid plaques. Further studies are needed to determine whether it can be considered a diagnostic standard.
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Affiliation(s)
- N Di Leo
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy.
| | - L Venturini
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - V de Soccio
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - V Forte
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - P Lucchetti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - G Cerone
- Biomedicine and Prevention Department, University Tor Vergata of Rome, Rome, Italy
| | - G Alagna
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - M Caratozzolo
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - D Messineo
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - C Di Gioia
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - L Di Marzo
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - D Fresilli
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - C De Vito
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - G Pugliese
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - V Cantisani
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
| | - F D'Ambrosio
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Policlinico Umberto I Roma, Viale del Policlinico 155, 00161, Rome, RM, Italy
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20
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Oderda M, Marra G, Albisinni S, Altobelli E, Baco E, Beatrici V, Cantiani A, Carbone A, Ciccariello M, Descotes JL, Dubreuil-Chambardel M, Eldred-Evans D, Fasolis G, Ferriero M, Fiard G, Forte V, Giacobbe A, Kumar P, Lacetera V, Mozer P, Muto G, Papalia R, Pastore A, Peltier A, Piechaud T, Simone G, Roche JB, Roupret M, Rouviere O, Van Velthoven R, Gontero P. Accuracy of elastic fusion biopsy in daily practice: Results of a multicenter study of 2115 patients. Int J Urol 2018; 25:990-997. [PMID: 30187529 DOI: 10.1111/iju.13796] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 05/29/2018] [Accepted: 08/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice. METHODS We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2-4) and random cores (usually 10-14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables. RESULTS The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate-specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer. CONCLUSIONS Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate-specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate.
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Affiliation(s)
- Marco Oderda
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy.,Department of Urology, San Lazzaro Hospital, Alba, Italy
| | - Giancarlo Marra
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy
| | - Simone Albisinni
- Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | | | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Mauro Ciccariello
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jean-Luc Descotes
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Marine Dubreuil-Chambardel
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | | | | | | | - Gaelle Fiard
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Valerio Forte
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Pardeep Kumar
- Department of Urology, Royal Marsden Hospital, London, UK
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Pierre Mozer
- Department of Urology, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, Paris, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University, Rome, Italy
| | - Antonio Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Morgan Roupret
- Department of Urology, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, Paris, France
| | - Olivier Rouviere
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | - Roland Van Velthoven
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Paolo Gontero
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy
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Isidori AM, Cantisani V, Giannetta E, Diacinti D, David E, Forte V, Elia D, De Vito C, Sbardella E, Gianfrilli D, Monteleone F, Pepe J, Minisola S, Ascenti G, D'Andrea V, Catalano C, D'Ambrosio F. Multiparametric ultrasonography and ultrasound elastography in the differentiation of parathyroid lesions from ectopic thyroid lesions or lymphadenopathies. Endocrine 2017; 57:335-343. [PMID: 27709473 DOI: 10.1007/s12020-016-1116-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/06/2016] [Accepted: 09/07/2016] [Indexed: 12/16/2022]
Abstract
To evaluate the accuracy of ultrasound elastography with ElastoscanTM Core Index in the differential diagnosis of parathyroid lesions from ectopic thyroid nodules and lymph nodes. Seventy nine patients with repeatedly high levels of circulating intact parathyroid hormone, normal vitamin D and renal function tests, with an ultrasound scan showing a neck lesion, sharply demarcated from the thyroid lobules, were consecutively enrolled. Ultrasound with and without Color Doppler and ultrasound elastography were performed before histological examination. All ultrasound features, vascularization and ultrasound elastography diagnostic performance were assessed using ROC curves. Histological examination confirmed 47 parathyroid lesions, 18 thyroid ectopic nodules and 14 reactive lymph nodes. In distinguishing parathyroid from thyroid nodules, shape had a 100 % sensitivity (95 % CI 92.4-100) and 50 % specificity (95 % CI 37.2-64.7), cleavage had a 85.1 % sensitivity (95 % CI 72.3-92.6) and 77.8 % specificity (95 % CI 65.1-88) while peripheral vascularization had a sensitivity of 91.5 (95 % CI 79.6-97.6) and specificity of 72.2 (95 % CI 46.5-90.3). An ElastoscanTM Core Indexof 1.28 was 46 % sensitive (95 % CI 33.4-58.7) and 77 % specific (95 % CI 66.2-89.1) in discriminating parathyroid lesions from thyroid nodules. An ElastoscanTM Core Index of 1.0 was 78 % sensitive (95 % CI 65.1-88) and 71 % specific (95 % CI 56-81.3) in discriminating parathyroid lesions from lymph nodes (p = 0.045). An ElastoscanTM Core Index greater than 2.58 had a 100 % sensitivity (95 % CI 43.8-100) and 95.4 % specificity (95 % CI 38.3-99.7) in discriminating malignant from benign parathyroid nodules. ElastoscanTM Core Index was significantly higher in thyroid nodules than in reactive lymph nodes (1.18 ± 0.62, p = 0.008). The ultrasound features of cleavage and peripheral vascularization help to differentiate parathyroid from thyroid nodules. ElastoscanTM Core Index can improve ultrasound discrimination of parathyroid lesions from lymph nodes. The ElastoscanTM Core Index is significantly higher in malignant than in benign parathyroid lesions.
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Affiliation(s)
- Andrea M Isidori
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy.
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Daniele Diacinti
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele David
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Valerio Forte
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Elia
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Emilia Sbardella
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine Sapienza University of Rome, Rome, Italy
| | - Francesco Monteleone
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines Sapienza University of Rome, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines Sapienza University of Rome, Rome, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ferdinando D'Ambrosio
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
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Porras TB, Bains PK, Ring A, Carrasco S, Forte V, Punj V, Lang JE. Abstract P1-01-11: Something from nothing? The case for quality control in liquid biopsy studies. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-01-11] [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: 11/16/2022]
Abstract
Abstract
Background: Circulating tumor cells (CTCs) as a liquid biopsy strategy are currently being studied as a surrogate biomarker that may reflect metastatic tumor biology. Given the rarity of CTCs, target enrichment is commonly used to profile the gene signatures of valuable clinical samples to evaluate for multiplexed gene panels of interest. The aim of our study was to evaluate if the NanoString PAM50 could be used for accurate gene expression profiling of CTCs and controls using the research-use-only probeset.
Methods: We collected two 7.5mL EDTA tubes of blood from 12 healthy female volunteers. CTC assays were performed using the ANGLE Parsortix system as a microfluidics filter that separates cells based on size and deformability. The cell lines Hs578T (basal-like) and SK-BR-3 (HER2 amplified) were used to spike 20 cells into n=6 blood tubes per cell line (termed spiked samples). N=12 7.5mL tubes of blood (termed unspiked samples) and n=12 spiked samples were processed using Parsortix for CTC harvesting and lysis using a 10 micron cassette. From each lysate, 5uL was taken for cDNA amplification, multiple target enrichment for 14 cycles, followed by NanoString PAM50 assays. From each of the 12 peripheral blood (PB) samples, we extracted RNA and used 100ng for NanoString PAM50 assays. For cell line controls, 100ng of Hs578T or SK-BR-3 were subjected to NanoString Assays.
Results: Low PAM50 gene expression was observed in all 12 PB samples. Unspiked PB harvested from the CTC assay showed a higher level of PAM50 gene expression compared to PB, suggesting that the target enrichment amplification produces false positive detection of expected breast cancer related transcripts. On ANOVA testing, 10/12 (83%) of unspiked, sorted, target enriched samples had significant differential expression (p<0.0001) of the mean log normalized counts for the PAM50 genes compared to PB.
In spiked experiments using n=20 cells in 7.5mL of PB, sorted Hs578T were found to be triple negative in only 3/6 (50%) while sorted SK-BR-3 were found to be HER2 positive in only 3/6 (50%). On ANOVA testing, the spiked/sorted and bulk were found to have a difference among the mean log normalized counts for the PAM50 genes across all samples for both cell lines (p<0.0001). However, 3/6 (50%) samples had a difference in mean PAM50 gene expression when compared to bulk Hs578t on multiple comparison testing while 2/6 (33%) were statistically significantly different when comparing spiked, sorted SK-BR-3 versus bulk cell line.
Conclusions: Unspiked blood processed via a CTC assay and subjected to target enrichment showed high expression of genes in the NanoString PAM50 assay, likely due to amplification bias. When working with enriched but not ultra-pure CTC samples, amplified gene expression of background leukocytes may influence read counts. This is important to consider in assays that enrich for CTCs but retain a leukocyte background. Further studies will address the effect of the CTC assay procedure and number of leukocytes on accuracy of gene expression of rare CTC mimics. This study emphasizes the importance of selecting genes that are not expressed in PB or performing background subtraction or normalization as strategies for accurate gene expression profiling of CTCs.
Citation Format: Porras TB, Bains PK, Ring A, Carrasco S, Forte V, Punj V, Lang JE. Something from nothing? The case for quality control in liquid biopsy studies [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-11.
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Affiliation(s)
- TB Porras
- University of Southern California Norris Cancer Center, Los Angeles, CA
| | - PK Bains
- University of Southern California Norris Cancer Center, Los Angeles, CA
| | - A Ring
- University of Southern California Norris Cancer Center, Los Angeles, CA
| | - S Carrasco
- University of Southern California Norris Cancer Center, Los Angeles, CA
| | - V Forte
- University of Southern California Norris Cancer Center, Los Angeles, CA
| | - V Punj
- University of Southern California Norris Cancer Center, Los Angeles, CA
| | - JE Lang
- University of Southern California Norris Cancer Center, Los Angeles, CA
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Miranda M, Martinez LS, Franco R, Forte V, Barlattani A, Bollero P. Differences between warfarin and new oral anticoagulants in dental clinical practice. Oral Implantol (Rome) 2017; 9:151-156. [PMID: 28042443 DOI: 10.11138/orl/2016.9.3.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The oral anticoagulant therapy is used for the cure and the prevention of thromboembolic diseases. In the last fifty years the warfarin has been considered the oral anticoagulant of choice. However, its use is limited by a narrow therapeutic index and by a complex pharmacodynamics, which requires regular adjustments and monitoring of the dose. Recently, three new oral anticoagulant - dabigatran etexilato (direct thrombin inhibitor), rivaroxaban and apixaban (Xa factor direct inhibitor) - have been approved for use in europe. Increasing the number of patients taking these drugs, it is important that the dentist knows these new oral anticoagulants, their indications and methods of action, in particular for the management of patients, who require invasive treatments. With regard to the management of the patient threated with the new oral anticoagulants (NAO), there have been new significant changes in the procedure compared to the one followed by patients treated with warfarin. This led to the development of new guidelines that the dentist has to follow in order to ensure a safe and appropriate dental treatment and reduce any postoperative complications. The aim of this work is to evaluate the effectiveness of the new oral anticoagulants compared to warfarin, especially in terms of risks of bleeding events and intra and postoperative complications, in patients requiring multiple dental extractions.
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Affiliation(s)
- M Miranda
- Department of Systems Medicine, Medical School, University of "Tor Vergata", Rome, Italy
| | - L S Martinez
- Department of Systems Medicine, Medical School, University of "Tor Vergata", Rome, Italy
| | - R Franco
- Department of Systems Medicine, Medical School, University of "Tor Vergata", Rome, Italy
| | - V Forte
- Department of Systems Medicine, Medical School, University of "Tor Vergata", Rome, Italy
| | - A Barlattani
- Department of Clinical Sciences and Translational Medicine, University of "Tor Vergata", Rome, Italy
| | - P Bollero
- Department of Systems Medicine, Medical School, University of "Tor Vergata", Rome, Italy
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Panebianco V, Barchetti F, Musio D, Forte V, Pace A, De Felice F, Barchetti G, Tombolini V, Catalano C. Metabolic atrophy and 3-T 1H-magnetic resonance spectroscopy correlation after radiation therapy for prostate cancer. BJU Int 2014; 114:852-9. [PMID: 24180518 DOI: 10.1111/bju.12553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To correlate 3-T magnetic resonance spectroscopic imaging (MRSI) with prostate-specific antigen (PSA) levels in patients with prostate cancer treated with external beam radiation therapy to assess the potential advantages of MRSI. MATERIALS AND METHODS A total of 50 patients (age range 65-83 years) underwent PSA and MRSI surveillance before and at 3, 6, 12, 18 and 24 months after radiotherapy. RESULTS Of the 50 patients examined, 13 patients completely responded to therapy showing metabolic atrophy (MA), defined as a choline-plus-creatine/citrate (CC/C) ratio <0.2, at 3 months; in this group none had biochemical relapse (PSA nadir + 2 ng/mL) by the end of the follow-up. Of the 50 patients, 35 showed a partial response to therapy (CC/C ratio between 0.2 and 0.8) at 3 and 6 months and, of these 35 patients, 30 reached MA at 12 months, while five developed a recurrence (CC/C ratio >0.8). Three of those patients with recurrence had a biochemical relapse at 18 months and the other two at 24 months. Two of the 50 patients did not respond to the treatment, showing persistent disease from the 3rd month (CC/C ratio >0.8); one patient had biochemical relapse at 6 and the other at 12 months. CONCLUSIONS MRSI was shown to have a greater potential than PSA level in monitoring patients after radiotherapy, because it anticipates PSA nadir, and biochemical relapse in particular.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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Barchetti F, Stagnitti A, Al Ansari N, De Marco V, Montechiarello S, Forte V, Noce V, Glorioso M, Sorrentino V, Barchetti G, Pasqualitto E, Marini A, Marini M. Densitometric kneecap changes after unilateral knee arthroplasty. Eur Rev Med Pharmacol Sci 2014; 18:1224-1228. [PMID: 24817299] [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: 06/03/2023]
Abstract
PURPOSE To assess bone density of kneecaps in subjects with femoro-tibial prosthesis before and after surgery by means of DEXA examination. SUBJECTS AND METHODS We examined 34 patients with unilateral femoro-tibial prosthesis, 20 healthy subjects of the same age and non-carriers of knee replacement and 14 healthy young adult subjects. All the data sets were analysed by two radiologists (AS and AM). The coincidence of the results between the two specialists was evaluated by means of Cohen's Kappa index and the results were considered statistically significative if p value is < of 0.05. RESULTS The values of patellar BMD in the group of 34 patients, were: a minimum of 0.386 g/cm(2) (K = 0.879, p = 0.0012), a maximum 1.707 g/cm(2) (K = 0.886, p = 0.0016). The comparison between the left and right knee showed the following data: minimum difference 0.034 g/cm2 (K = 0.901, p = 0.0015), maximum difference of 0.622 g/cm(2) (K = 0.908, p = 0.0017), the average was found to be of 0.277 g/cm(2) (K = 0.894, p = 0.0018). But this difference tends to decrease 6 months after surgery. In the group of healthy young adults, we obtained the following values: a minimum of 0.782 g/cm(2) (K = 0.907, p = 0.0025), maximum 1.503 g/cm(2) (K = 0.932, p = 0.0012). Between both knees, the difference was minimal 0.006 g/cm(2) (K = 0.951, p = 0.0035) and maximum 0.096 g/cm(2) (K = 0.926, p = 0.0007) with an average difference of 0.058 g/cm(2) (K = 0.954, p = 0.0026). In the group of healthy subjects of the same age and non-carriers of knee replacement the values were average higher. A maximum value of 1.134 g/cm(2) (K = 0.894, p = 0.0028) and a minimum value of 0.944 g/cm(2) (K = 0.892, p = 0.0023) were found; between both knees a minimum difference of 0.010 g/cm(2) (K = 0.918, p = 0.0047) and a maximum of 0.090 g/cm(2) (K = 0.937, p = 0.0017) were found, with an average difference of 0.052 g/cm(2) (K = 0.956, p = 0.0024). CONCLUSIONS DEXA examination of the patellar is recommended as a supplementary study to the clinical and radiological standard exams because it is able to provide additional information to determine when to intervene surgically, on the basis of patellar bone density values.
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Affiliation(s)
- F Barchetti
- Department of Radiology, Sapienza University of Rome, Rome, Italy.
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Panebianco V, Iacovelli R, Barchetti F, Altavilla A, Forte V, Sciarra A, Cortesi E, Catalano C. Dynamic contrast-enhanced magnetic resonance imaging in the early evaluation of anti-angiogenic therapy in metastatic renal cell carcinoma. Anticancer Res 2013; 33:5663-5666. [PMID: 24324114] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To evaluate the efficacy of dynamic contrast-enhanced magnetic resonance (DCE-MR) in the response to anti-angiogenic-targeted agents in patients with metastatic renal cell cancer (mRCC). PATIENTS AND METHODS Twenty-eight consecutive patients with sub-diaphragmatic metastases from mRCC were included in the protocol after signed informed consent. Baseline characteristics were collected and patients were first evaluated with a baseline computed tomography (CT) and DCE-MR, subsequently with a new DCE-MRI after 28 days of therapy and followed-up with CT until progression. Treatments were administered at standard doses. The changes of peak enhancement (ΔPE) and of the sum of longest tumor diameters (ΔLTD) were related to progression-free survival (PFS) and overall survival (OS). RESULTS The median PFS was 11.4 months [95% Confidence Interval (CI): 7.9-14.7 months) and the parametric two-tailed Pearson's test showed a positive correlation between the median ΔPE and the median PFS (rp=0.809; p=0.015); no significant correlation was found between the median ΔLTD and the median PFS (rp=-0.446; p=0.27). The median OS was 23.3 months (95% CI: 13.6-33.0 months) and no significant correlation was found with the median ΔPE (rp=0.218; p=0.60) or with the median ΔLTD (rp=0.012; p=0.98). CONCLUSION The ΔPE but not the ΔLTD was found to be significantly related to PFS; these preliminary results suggest extending the number of patients and investigating the possible relationship with other tumor characteristics and MRI parameters.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza, University of Rome, Viale Regina Elena 324, 00161, Rome, Italy,
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Nayak PP, Sheth J, Cox PN, Davidson L, Forte V, Manlhiot C, McCrindle BW, Schwartz SM, Solomon M, Van Arsdell GS, Sivarajan VB. Predictive value of bronchoscopy after infant cardiac surgery: a prospective study. Intensive Care Med 2012; 38:1851-7. [PMID: 23011533 DOI: 10.1007/s00134-012-2702-1] [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: 09/02/2011] [Accepted: 08/13/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Airway evaluation following infant cardiac surgery often reveals evidence of tracheobronchial narrowing. We studied the association between airway narrowing and extubation failure (EF) in this population. METHODS Prospective cohort study of infants (age ≤6 months) from March-September 2009. Flexible bronchoscopy (FB) evaluations were obtained using a standardised protocol after operative intervention. The primary endpoint was the development of extubation failure (EF; defined as the need for invasive mechanical ventilation ≤48 h after primary extubation) and several secondary endpoints. RESULTS Fifty-three patients were evaluated at a median age of 81 [interquartile range (IQR) 13-164] days and weight of 4.2 (IQR 3.2-6.0) kg; 13 (25 %) of the patients had single ventricle palliations and two subsequently underwent heart transplantation. Significant airway narrowing was noted in 15 of 30 [50 %, 95 % confidence interval (CI) 31-69 %] patients who underwent FB; ten of the 53 patients (19 %, 95 %CI 10-32 %) subsequently developed EF. Narrowed airway calibre on bronchoscopy had a sensitivity and specificity of 50 % (95 %CI 28-71 %) and 50 % (95 %CI 28-71 %), respectively, for EF. The single greatest predictor of EF by univariate analysis was the need for preoperative ventilation [odds ratio (OR) 6.5, 95 %CI 1.3-33.2, p = 0.03]. Patients with EF had a greater likelihood of intensive care readmission (OR 4.8, 95 %CI 1.1-21, p < 0.04) during the same hospital admission. CONCLUSIONS Airway narrowing on FB is noted frequently after infant cardiac surgery. Overall assessment and presence of narrowing on bronchoscopy had poor sensitivity and specificity for EF in our cohort. Expert assessment of tracheobronchial narrowing on FB has poor to moderate inter-rater reliability.
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Affiliation(s)
- P P Nayak
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Panebianco V, Sciarra A, Marcantonio A, Forte V, Biondi T, Laghi A, Catalano C. Conventional imaging and multiparametric magnetic resonance (MRI, MRS, DWI, MRP) in the diagnosis of prostate cancer. Q J Nucl Med Mol Imaging 2012; 56:331-342. [PMID: 23013663] [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: 06/01/2023]
Abstract
The evaluation and management of prostate cancer (PCa) are based mainly on parameters such as the serum prostate-specific antigen level, clinical stage, and pathologic findings at biopsy or after surgery. The aim of this paper was to review the current roles of conventional imaging and multiparametric magnetic resonance imaging (mpMRI) techniques in the diagnosis of PCa. A non systematic literature search using the Medline and Cochrane Library databases was performed up to January 2012. Bibliographies of retrieved articles and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review (i.e., diagnosis, staging) were selected. The advent of a high performance (1.5T) and higher fields strength (3T), and thus, higher spatial resolution, increased the potentiality and the diffusion of MR examinations. Intense research has focused on the use of complementary techniques to improve the detection, characterization, and staging of PCa by MRI. This review article is divided into two major parts: the first one considers the technical aspects of mpMRI; the second part is intended to provide the impact of this technique on patients with PCa. Published data indicate an emerging role for MRI (particularly mpMRI combining T2 weighted imaging, diffusion weighted imaging, contrast enhanced MR, and spectroscopy) as the most sensitive and specific tool available for imaging PCa. MpMRI can provide metabolic information, characterize tissue and tumor vascularity, as well as tissue cellularity and correlate with tumor aggressiveness.
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Affiliation(s)
- V Panebianco
- Department of Radiological Sciences, Oncology and Anatomical Pathology, La Sapienza University, Rome, Italy.
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Pandey A, Forte V, Abdallah M, Alickaj A, Mahmud S, Asad S, McFarlane SI. Diabetes mellitus and the risk of cancer. MINERVA ENDOCRINOL 2011; 36:187-209. [PMID: 22019750] [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: 05/31/2023]
Abstract
Although diabetes has been known to increase the risk of cancer for over a century, it was not until recently when this area gained momentum and generated a lot of interest. That is in- part because of the rising global diabetes epidemic and the wide spread use of insulin analogues, metformin and other anti-diabetic agents, providing hypothesis generating data on the cancer risk in the diabetic population. Type 2 diabetes is associated with increased risk of breast, colon, pancreatic and other types of cancer, while type 1 diabetes is associated with increase in stomach, pancreatic, endometrial and cervical cancer. Mechanisms postulated for increased cancer risk in diabetes include hyperglycemia, hyperinsulinemia with stimulation of IGF-1 axis, obesity that serves as a common soil hypothesis for both cancer and diabetes as well as other factors such as increased cytokine production. More recently some antidiabetic agents have been thought to increase cancer risk such as insulin glargine, while metformin appears to lower cancer risk. In this review, we present the evidence for the link between diabetes and cancer highlighting the general mechanisms proposed for such a link as well as specific hypotheses for individual cancer. We will also discuss the role of insulin, metformin and other antidiabetic agents in cancer risk.
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Affiliation(s)
- A Pandey
- Department of Medicine, SUNY Downstate Medical Centre, New York, USA
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Abdulkader F, Tirado Y, Campisi P, Estrada M, Propst E, Forte V. Sus Scrofa Piglet
s as a Surgical Airway Training Model for Pediatric Otolaryngology Trainees. Laryngoscope 2011. [DOI: 10.1002/lary.22292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Alshail E, Rutka JT, Drake JM, Hoffman HJ, Humphreys R, Phillips J, Cusimano M, Forte V, Papsin B, Holowka S. Utility of frameless stereotaxy in the resection of skull base and Basal cerebral lesions in children. Skull Base Surg 2011; 8:29-38. [PMID: 17171040 PMCID: PMC1656657 DOI: 10.1055/s-2008-1058588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Since 1991, we have performed nearly 300 stereotactic procedures using the ISG viewing wand on a variety of cranial lesions in patients under 22 years of age. Of these, 38 procedures were performed on 34 patients for basal cerebral and skull base lesions. Our patients ranged in age from 3.5 months to 22 years with a mean age of 9.45 years. There were 18 females and 16 males. Twenty-one patients had basal cerebral lesions located in the thalamus (10), basal ganglia (2), third ventricle (2), and hypothalamus (7). Thirteen patients had skull base lesions located within the anterior optic apparatus (3), sella turcica (4), middle and posterior cranial fossae (4), and craniocervical region (2). Preoperative CT and/or MRI scan images were taken as a volume acquisition and transferred to the computer workstation utilizing the ISG Wand software. This workstation was transferred to the operating room where it was calibrated to a faro Surgicom arm which interfaces with the patient and the three-dimensional radiological image. The ISG Wand was utilized to plan the scalp and bone flaps and to select the optional trajectory to lesion. The surgical approaches which were specifically used in this series with the ISG Wand included transcallosal (15), pterional (5), frontal (3), subtemporal (4), transsphenoidal (3), temporal (3), tumor cyst shunt insertion (1), burr hole drainage (1), transoral (2), bifrontal (1), bifrontal mid facial (1), and transnasal (1). Although brain shift occurred following craniotomy and with brain retraction, the relative immobility of these lesions at the skull or cerebral base permitted an accurate targeting of all lesions with an error range of 1.0-2.5 mm throughout the entire procedure. This relatively precise intraoperative feedback led to more accurate recognition of tumor landmarks. It is the authors' impression that a more aggressive resection of these lesions was achieved than could be without the device. We conclude that a frameless stereotactic device such as the ISG Wand is particularly valuable in the approach to skull base and basal cerebral tumors in children.
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Thomas B, Shroff M, Forte V, Blaser S, James A. Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies. AJNR Am J Neuroradiol 2009; 31:755-60. [PMID: 20007720 DOI: 10.3174/ajnr.a1902] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is wide discrepancy between common clinical and radiologic presentations of branchial sinuses arising from the pyriform fossa and the theoretic course of third and fourth branchial arch anomalies. The purpose of this study was to revisit the clinical presentations and imaging features of such anomalies in children. MATERIALS AND METHODS A retrospective review of institutional and diagnostic imaging data bases from 1998 to 2008 for reported cases of third and fourth branchial cleft anomalies was conducted. Clinical presentation, pharyngoscopy results, and imaging features in all the patients were evaluated. Surgical and histopathology correlation in patients who underwent excision of the tract was also obtained. RESULTS Twenty reported cases described as third or fourth branchial apparatus anomalies were identified. There were 12 females and 8 males with a mean age of 84.6 months. The most common presentation was an inflammatory neck mass (18/20, 90%) almost always involving the thyroid gland. Most lesions were on the left side (16/20, 80%). Pharyngoscopy showed a sinus opening at the piriform fossa in 18/20 (90%) cases. None of the cases followed the classic theoretic pathway of third and fourth arch remnants. Histopathology showed tracts lined with pseudostratified squamous epithelium or ciliated columnar epithelium often associated with inflammatory changes in 17 surgically resected cases. CONCLUSIONS Branchial sinuses arising from the pyriform fossa often present with an inflammatory neck mass involving the thyroid lobe, most often on the left side. Imaging and surgical findings suggest that they arise from the embryonal thymopharyngeal duct of the third branchial pouch, because they do not follow the hypothetic course of third or fourth arch fistulas.
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Affiliation(s)
- B Thomas
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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Herrera P, Caldarone C, Forte V, Campisi P, Holtby H, Chait P, Chiu P, Cox P, Yoo SJ, Manson D, Kim PCW. The current state of congenital tracheal stenosis. Pediatr Surg Int 2007; 23:1033-44. [PMID: 17712567 DOI: 10.1007/s00383-007-1945-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2007] [Indexed: 10/22/2022]
Abstract
Congenital tracheal stenosis (CTS) is an uncommon condition that has challenged pediatric surgeons for decades. Patients with CTS can present with a wide spectrum of symptoms and varying degrees of severity. In addition, a variety of techniques have been devised to repair this malformation. A review of these procedures and our suggestions for clinical standards and practice guidelines will be presented in this paper. A retrospective review of the literature on CTS from 1964 to 31 March, 2006. There is not one standard technique for the repair of CTS, as individualized approach to each patient and airway lesion is necessary to optimize patient management; nevertheless there is a consensus about segmental resection and anastomosis being best for short segment stenosis while slide tracheoplasty is most effective for the long-segment ones. Conservative management is also an option for select group of patients with careful and close follow up. Survival following surgery over the years has improved, but mortality remained high, particularly in a specific subset of patients presenting at the age less than 1 month with associated cardiac malformations. In conclusion, CTS remains a significant challenge for pediatric surgeons. Additional research is required to improve our understanding of the pathogenesis of CTS, and to develop evidence-based treatment protocols for the entire spectrum of presentation including conservative management.
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Affiliation(s)
- P Herrera
- The Airway Reconstruction Team, The Hospital for Sick Children, 555 University Avenue, Room 1286, Toronto, ON, Canada M5G 1X8.
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Rachmiel M, Charron M, Gupta A, Hamilton J, Wherrett D, Forte V, Daneman D. Evidence-based review of treatment and follow up of pediatric patients with differentiated thyroid carcinoma. J Pediatr Endocrinol Metab 2006; 19:1377-93. [PMID: 17252690 DOI: 10.1515/jpem.2006.19.12.1377] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Childhood onset differentiated thyroid cancer (DTC) is distinct from the adult-onset disease being more aggressive at the time of initial evaluation with a higher risk category for disease recurrence; however, it is ultimately less lethal. International groups have outlined consensus statements detailing follow up and management guidelines for adult DTC, but since disease progression and markers are significantly different in childhood DTC compared to adults, management protocols may differ. Unfortunately, there is no consensus regarding the means of follow up, timing and management strategy regarding pediatric DTC. We performed an evidence-based review of DTC in children targeted to address the following questions: What is the most appropriate initial treatment? What is the goal of thyroid hormone replacement management? What is the approach to follow-up of childhood DTC? and, How should tumor recurrence/persistence be assessed and treated? We conducted a literature search using PubMed, Cochrane databases, guidelines from various international groups, and studies pertaining to pediatric DTC management and outcome in order to answer these questions. We suggest a pre-set algorithm and approach for the management of children with DTC according to our review.
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Affiliation(s)
- M Rachmiel
- Division of Endocrinology, Hospital for Sick Children, Toronto, Canada.
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Tzifa KT, Maxwell EL, Chait P, James AL, Forte V, Ein SH, Friedburg J. Endoscopic treatment of congenital H-Type and recurrent tracheoesophageal fistula with electrocautery and histoacryl glue. Int J Pediatr Otorhinolaryngol 2006; 70:925-30. [PMID: 16325276 DOI: 10.1016/j.ijporl.2005.10.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 10/05/2005] [Accepted: 10/06/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Congenital H-Type tracheoesophageal fistulae (H-Type TEF) and recurrent fistulae after primary repair of esophageal atresia represent a difficult problem in diagnosis and management. The treatment traditionally involved an open technique via a cervical or thoracic route, approaches with high morbidity and mortality rates of up to 50%. Endoscopic closure of fistulae has been reported with various techniques such as tissue adhesives, electrocautery, sclerosants and laser. However, the published case series contain a small number of patients with usually short-term follow-up. The aim of this paper is to present the experience of a decade at Toronto's Hospital for Sick Children, using diathermy and histoacryl tissue adhesive and discuss the indications and limitations of this technique. METHODS Since 1995, 192 patients have been managed in this institution with tracheoesophageal fistulae of which 10 patients have been treated endoscopically. The fistulae were both of H-Type and recurrent tracheoesophageal fistulae following surgery for esophageal atresia and fistula division. One fistula occurred following trauma. The procedure was undertaken under general anesthesia in the image guided therapy suite under fluoroscopic control. Flexible ball electrocautery and injection of histoacryl glue were used either on their own or in combination. RESULTS Fistula closure was achieved in 9 out of 10 fistulae. Four patients had a second endoscopic procedure. No major respiratory or other complications were encountered in association with the procedure. Follow-up has been between 3 months and 9 years. CONCLUSION We conclude, endoscopic treatment of tracheoesophageal fistulae with electrocautery and histoacryl glue has been a safe and successful technique of managing H-Type and recurrent tracheoesophageal fistulae. In this paper, we discuss the indications and the surgical steps of the procedure. We highlight that diathermy should be carefully controlled and applied preferably in the small non-patulous fistulae. A fistula that has not closed after two endoscopic attempts is not suitable for further endoscopic treatment and therefore an external approach should be recommended.
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Affiliation(s)
- K T Tzifa
- Department of Pediatric Otorhinolaryngology Head and Neck Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, Ont., Canada M5G 1X8.
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Triggiani M, Giannattasio G, Balestrieri B, Loffredo S, Forte V, Granata F. Phenotypical and functional heterogeneity of human lung macrophages. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1472-9725.2004.00045.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Re M, Forte V, Berardi C, Mallardi V. Role of endoscopic CO2 laser surgery in the treatment of congenital infantile subglottic hemangioma. Experience in the Department of Otolaryngology, "Sick Children Hospital", Toronto, Canada. Acta Otorhinolaryngol Ital 2003; 23:175-9. [PMID: 14677310] [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: 04/27/2023]
Abstract
Subglottic hemangioma is a rare, histologically benign congenital neoplasm. The natural history is characterized by progressive obstruction of the airways during the proliferative stage, followed by gradual regression of the obstructive symptomatology in the involutional phase. After an asymptomatic neonatal period, the infant presents a characteristic biphasic stridor as the lesion progressively obstructs the subglottic space. In 80-90% of cases, these symptoms appear in the first six months of life. The involutional process generally begins at 12 months of age and continues until the subglottic hemangioma regresses completely. Due to high incidence of mortality in untreated cases, therapy should be undertaken immediately. Aim of therapy is to restore normal respiration, attempting to preserve the child's voice and alter the quality of life both of the infant and the family as little as possible. A retrospective study was carried out on all cases of infantile subglottic hemangioma treated in the Department of Otolaryngology, "Sick Children Hospital", Toronto, between 1980 and 2000. The therapeutic strategy adopted until breathing returned to normal comprised repeated endoscopic CO2 laser treatment of the lesion and perioperative administration of oral cortisone (1 mg/kg/day dexamethazone, subdivided in 3 doses) for 24-48 hours. CO2 laser was used each time the patient presented progressive worsening of obstructive respiratory symptoms. The interval between two laser treatments was > or = 6 weeks. Repeated endoscopic laser treatment, combined with other therapeutic modalities, enabled tracheotomy to be avoided in all but 4 (7.2%) cases.
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Affiliation(s)
- M Re
- Clinic of Otorhinolaryngology, University of Ancona, Italy.
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Abstract
Agenesis of the parotid gland is extremely rare with only few cases reported in the medical literature. This entity can be important to diagnose as occasionally the normal parotid gland can be mistaken for a tumor due to the facial asymmetry. In this article, we present the case of an isolated unilateral parotid gland agenesis in a young child. The entity is discussed along with important associated conditions that should be ruled out. These include amongst others first and second branchial arch anomalies, as well as the Levy-Hollister or lacrimo-auriculo-dentodigital syndrome.
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Affiliation(s)
- S J Daniel
- Department of Otolaryngology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ont., Canada M5G-2G4
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Affiliation(s)
- G Marone
- Division of Clinical Immunology and Allergy, University of Naples Federico II, School of Medicine, Naples, Italy.
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Triggiani M, Granata F, Forte V, Quaglietta L, Marone G. Histamine H1-receptor-mediated release of preformed mediators and cytokines and airway remodelling. ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1472-9725.2002.00043.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: 11/20/2022]
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Abstract
BACKGROUND/PURPOSE Laryngotracheoplasty has become an accepted treatment alternative for subglottic stenosis. However, the best autogenous material for laryngotracheoplasty remains controversial. Autogenous superior thyroid alar cartilage (TAC) has been used successfully in single stage laryngotracheal reconstruction in children with subglottic stenosis. METHODS This is a retrospective study of 6 children (mean age, 16.6 months) undergoing TAC graft laryngotracheoplasty between September 1995, and June 1999. Two children had immediate tracheal intubation for congenital subglottic stenosis. Four others had previous tracheostomy: 3 for severe postintubation subglottic stenosis and 1 for congenital subglottic stenosis. After an anterior cricoid split, a piece of TAC was sutured between the cut ends of the cricoid, with the graft perichondrium facing intraluminally. Endotracheal intubation was maintained postoperatively. RESULTS Four children underwent successfully extubation 9 to 21 days (mean, 15.5 days) postoperatively. Two required tracheostomy, which was maintained because of severe laryngomalacia and laryngotracheobronchomalacia. One child was treated with CO2 laser because of symptomatic recurrence of the subglottic stenosis 3 weeks after the surgery; another required fundoplication for gastroesophageal reflux 12 months after laryngotracheoplasty. There were no donor site complications in any of the 6 cases. Repeat laryngoscopy and bronchoscopy showed a patent subglottic airway. All of them are without symptoms after a mean follow-up of 26 months. CONCLUSIONS (1) This preliminary experience indicates that the TAC graft technique is a viable option for laryngotracheal reconstruction; (2) the TAC graft has significant advantages, including a single operative incision and absence of donor-site morbidity.
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Affiliation(s)
- J C Fraga
- Department of Pediatric Surgery, School of Medicine, and Graduate Program in Medicine, Surgery, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
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Abstract
Cricoid split is the procedure of choice in neonatal subglottic stenosis in many paediatric institutions. However, the post-operative care of these patients is a concern given the potentially lethal complications which can occur, in particular, self-extubation. We have been using the thyroid ala cartilage (TAC) reconstruction, a proven technique, as an alternative treatment for this disorder to avoid these complications. The purpose of this study was to compare the results of the TAC reconstruction for this patient population with the results of the cricoid split procedure previously reviewed at our own institution. Between January 1995 and December 1999, 17 patients that underwent the TAC reconstruction for neonatal subglottic stenosis were retrospectively reviewed. Of the 17 patients, two patients required tracheotomy prior to discharge from hospital. Fifteen patients were discharged from hospital with a safe airway without tracheotomy. There were only two minor complications. Compared with the cricoid split study, the success rate with TAC reconstruction was higher (88 vs 83%) and the major complication rate was lower (0 vs 9%). Factors associated with failed procedures may include prematurity, low birth and surgical weight and presence of severe GER. Those that failed required much greater resources in terms of post-operative care and length of hospital stay. The TAC reconstruction has replaced cricoid split in treatment of neonates with subglottic stenosis at our institution.
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Affiliation(s)
- V Forte
- The Department of Otolaryngology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Ontario, M5G 18X, Toronto, Canada.
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Abstract
PURPOSE To determine whether pediatric nasal endoscopy improves treatment success in recurrent nasolacrimal duct obstruction. METHODS A retrospective analysis was carried out on 2 nonrandomized cohorts of consecutively treated patients who had one failed nasolacrimal duct probing at the Hospital for Sick Children, University of Toronto. The first cohort of 24 consecutive patients (32 eyes), group A, was treated with Crawford silicone tube intubation by one ophthalmologist (R.C.P.). The second cohort of 23 consecutive patients (33 eyes), group B, was treated with repeat probing by a second ophthalmologist (A.V.L.) in conjunction with nasal endoscopy by one otolaryngologist (V.F.). Abnormalities found on endoscopy were treated accordingly, and no tubes were inserted. Follow-up, through phone interviews or office visits, was conducted to assess the patients' symptoms. RESULTS Group A patients were older at both the first probing (P = .048) and the second procedure (P = .012). No significant difference in the failure rates was found, with treatment failing in 3 eyes (2 patients) in group A and in 5 eyes (4 patients) in group B (P = .479). Interestingly, 17 of the 32 tubes in group A were extruded in 1 month or less. Also, 28 of 33 eyes in group B had abnormalities on endoscopy-some, multiple. Twenty-two eyes underwent inferior turbinate infracture: 5 had redundant mucosa, which was removed, and 6 had abnormal openings of the inferior meatus. CONCLUSIONS We were unable to show any benefit of nasal endoscopy over intubation of the nasolacrimal system with silicone tubes in the treatment of failed probings despite the identification and treatment of abnormalities. The study was limited by its low power to detect differences because of the small number of patients and the high success rate of the traditional treatments for congenital nasolacrimal duct obstruction.
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Affiliation(s)
- J A Gardiner
- Department of Ophthalmology, British Columbia Children's Hospital, University of British Columbia, Ontario, Canada
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Abstract
Caustic ingestion with resultant corrosive esophagitis in the pediatric population comprises a heterogeneous group in terms of offending agent, location of burn and the degree of damage. Consequently, the treatment of these injuries has also varied over the years and the optimal management remains controversial. Another area of concern that is seldom reported in the otolaryngology literature is the socioeconomic impact of such injuries both on the child and on the family. We report a 30-year retrospective review of aerodigestive tract caustic injuries at The Hospital for Sick Children. Eighty patients were identified with an age range from 1 month to 16 years. Early and late complications are reviewed including 23 patients (29%) that developed medical complications and 16 patients (20%) that developed severe esophageal strictures. Five of these children required repeat prograde dilatation, while 11 children required gastrostomy and stringing with subsequent retrograde dilatation. All the 11 children required esophageal replacement surgery. The economic and social consequences to the child and family were also noted with particular attention to hospital costs, parental absenteeism from work, and the need for job relocation. A partial cost analysis using a child with a severe injury is presented as an example. Psychological aspects such as attempted murder, jail terms and attempted suicides are also documented. We also present an analysis of those children requiring esophageal replacement surgery, and examine the possible role of esophageal stents in recalcitrant strictures.
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Affiliation(s)
- A L de Jong
- The Department of Otolaryngology, The Hospital for Sick Children, 555 University Avenue, Ont., M5G 18X, Toronto, Canada
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Gooden EA, Forte V, Papsin B. Use of a commercially available metal detector for the localization of metallic foreign body ingestion in children. J Otolaryngol 2000; 29:218-20. [PMID: 11003072] [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: 04/15/2023]
Abstract
UNLABELLED Metallic foreign body (FB) ingestion is a common occurrence in the general paediatric population. We have shown that the use of a commercially available metal detector is sensitive in localizing and confirming metallic FB objects in the digestive tract. METHOD In a double-blinded randomized control trial, we used a commercially available metal detector to localize metal coins in the digestive tract in an animal model. Localization of the coins was confirmed using fluoroscopy. In 10 consecutive patients with metallic FB ingestion, detection and localization of the FB using the metal detector was compared with standard confirmatory radiographic imaging. RESULTS Using a commercially available, hand-held metal detector, we were able to localize a metallic FB in the gastrointestinal tract with 100% sensitivity in both the animal model and in 10 paediatric patients.
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Affiliation(s)
- E A Gooden
- Department of Otolaryngology, University of Toronto, Ontario
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Abstract
Branchio-oculo-facial (BOF) syndrome is a rare autosomal dominant disorder that has a distinct phenotype with characteristic craniofacial abnormalities. These consist of branchial anomalies, including supra-auricular sinuses, and aplastic cervical skin lesions, with possible ectopic dermal thymus, malformed auricles, stenotic external auditory canals, conductive hearing loss, ocular abnormalities (microphthalmia and lacrimal duct obstruction), and pseudocleft of the upper lip. Extracraniofacial malformations are uncommon. We describe two new cases of BOF and discuss the classical clinical presentation and differential diagnosis. Our two patients presented with facial nerve paralysis and were also were found to have inner ear dysplasias with associated sensorineural hearing loss which, to our knowledge, have not been described in the literature in association with this syndrome.
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Affiliation(s)
- E Raveh
- Department of Pediatric Otolaryngology, Hospital for Sick Children, Ontario, Toronto, Canada
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Robichaud J, Papsin BC, Forte V. Third branchial cleft anomaly detected in utero. J Otolaryngol 2000; 29:185-7. [PMID: 10883836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- J Robichaud
- The Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario
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Daya H, Chan HS, Sirkin W, Forte V. Pediatric rhabdomyosarcoma of the head and neck: is there a place for surgical management? Arch Otolaryngol Head Neck Surg 2000; 126:468-72. [PMID: 10772299 DOI: 10.1001/archotol.126.4.468] [Citation(s) in RCA: 51] [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: 11/14/2022]
Abstract
OBJECTIVE To review and evaluate the place of surgical treatment in the management of rhabdomyosarcoma of the head and neck in children. DESIGN Retrospective analysis of patient charts from January 1, 1972, to December 31, 1998. SETTING Tertiary pediatric referral center. PATIENTS Twenty-nine consecutive children with nonorbital head and neck rhabdomyosarcoma. INTERVENTIONS Surgery, chemotherapy, and radiotherapy. MAIN OUTCOME MEASURES Disease-free survival and long-term morbidity from treatment. RESULTS Twenty patients had parameningeal and 9 had nonparameningeal head and neck tumors. All were treated with chemotherapy. For 18 patients, diagnostic biopsies were performed and they received radiotherapy. Eleven patients underwent surgery as definitive therapy. Using the Intergroup Rhabdomyosarcoma Study (IRS) staging system, 5 of these 11 patients had complete resection of tumor (IRS group I) and avoided radiotherapy. The other 6 patients required radiation because of compromised, regional, or incomplete resection of tumor. One had undergone regional resection with nodal involvement, and 2 had compromised resections with microscopic residual disease (IRS group II). Three had incomplete resections with gross residual tumor (IRS group III). Only 1 patient who underwent surgery ultimately died from recurrence at 2.7 years after an incomplete resection. The other 10 patients were relapse free at a median follow-up of 3.7 years (range 0.8-21.0 years). Long-term surgical morbidity was seen in 36% (4/11) of the patients and included facial nerve paralysis, trismus, and cosmetic deformity. CONCLUSIONS Children with localized disease of the head and neck are able to undergo complete surgical resection, with low long-term surgical morbidity. By undergoing complete surgical resection, these children are able to avoid radiotherapy and its long-term complications, with no compromise in survival.
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Affiliation(s)
- H Daya
- Department of Pediatric Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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