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Şeref C, Acar Ö, Kılıç M, Vural M, Sağlıcan Y, Saraç H, Coşkun B, İnce Ü, Esen T, Lack NA. Histologically benign PI-RADS 4 and 5 lesions contain cancer-associated epigenetic alterations. Prostate 2022; 82:145-153. [PMID: 34672371 DOI: 10.1002/pros.24255] [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: 07/14/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The detection rate of clinically significant prostate cancer has improved with the use of multiparametric magnetic resonance imaging (mpMRI). Yet, even with MRI-guided biopsy 15%-35% of high-risk lesions (Prostate Imaging-Reporting and Data System [PI-RADS] 4 and 5) are histologically benign. It is unclear if these false positives are due to diagnostic/sampling errors or pathophysiological alterations. To better understand this, we tested histologically benign PI-RAD 4 and 5 lesions for common malignant epigenetic alterations. MATERIALS AND METHODS MRI-guided in-bore biopsy samples were collected from 45 patients with PI-RADS 4 (n = 31) or 5 (n = 14) lesions. Patients had a median clinical follow-up of 3.8 years. High-risk mpMRI patients were grouped based on their histology into biopsy positive for tumor (BPT; n = 28) or biopsy negative for tumor (BNT; n = 17). From these biopsy samples, DNA methylation of well-known tumor suppressor genes (APC, GSTP1, and RARβ2) was quantified. RESULTS Similar to previous work we observed high rates of promoter methylation at GSTP1 (92.7%), RARβ2 (57.3%), and APC (37.8%) in malignant BPT samples but no methylation in benign TURP chips. Interestingly, similar to the malignant samples the BNT biopsies also had increased methylation at the promoter of GSTP1 (78.8%) and RARβ2 (34.6%). However, despite these epigenetic alterations none of these BNT patients developed prostate cancer, and those who underwent repeat mpMRI (n = 8) demonstrated either radiological regression or stability. CONCLUSIONS Histologically benign PI-RADS 4 and 5 lesions harbor prostate cancer-associated epigenetic alterations.
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Affiliation(s)
- Ceren Şeref
- Department of Health Sciences, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Ömer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Mert Kılıç
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Yeşim Sağlıcan
- Department of Pathology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Hilal Saraç
- Department of Health Sciences, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Bilgen Coşkun
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Ümit İnce
- Department of Pathology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Tarık Esen
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Nathan A Lack
- Department of Health Sciences, Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
- Department of Medical Pharmacology, Koç University School of Medicine, Istanbul, Turkey
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
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Navarrete-Dechent C, Cordova M, Sahu A, Liopyris K, Rishpon A, Chen C, Rajadhyaksha M, Busam KJ, Marghoob AA, Chen CSJ. Optical imaging guided- 'precision' biopsy of skin tumors: a novel approach for targeted sampling and histopathologic correlation. Arch Dermatol Res 2021; 313:517-529. [PMID: 32844312 PMCID: PMC10185006 DOI: 10.1007/s00403-020-02126-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/29/2020] [Revised: 08/02/2020] [Accepted: 08/08/2020] [Indexed: 01/25/2023]
Abstract
Dermoscopy and reflectance confocal microscopy (RCM) are two noninvasive, optical imaging tools used to facilitate clinical diagnosis. A biopsy technique that produces exact correlation with optical imaging features is not previously reported. To evaluate the applications of a novel feature-focused 'precision biopsy' technique that correlates clinical-dermoscopy-RCM findings with histopathology. This was a prospective case-series performed during August 2017 and June 2019 at a tertiary care cancer. We included consecutive patients requiring a precise dermoscopy-RCM-histopathologic correlation. We performed prebiopsy dermoscopy and both wide probe and handheld RCM of suspicious lesions. Features of interest were isolated with the aid of paper rings and a 2 mm punch biopsy was performed in the dermoscopy- or RCM-highlighted area. Tissue was processed either en face or with vertical sections. One-to-one correlation with histopathology was obtained. Twenty-three patients with 24 lesions were included in the study. The mean age was 64.6 years (range 22-91 years); there were 16 (69.6%) males, 14 (58.3%) lesions biopsied were on head and neck region. We achieved tissue-conservation diagnosis in 100% (24/24), 13 (54.2%) were clinically equivocal lesions, six (25%) were selected for 'feature correlation' of structures on dermoscopy or RCM, and five (20.8%) for 'correlation of new/unknown' RCM features seen on follow-up. The precision biopsy technique described herein is a novel method that facilitates direct histopathological correlation of dermoscopy and RCM features. With the aids of optical imaging devices, accurate diagnosis may be achieved by minimally invasive tissue extraction.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
| | - Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
| | - Ayelet Rishpon
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Curtis Chen
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
| | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA
| | - Chih-Shan Jason Chen
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd floor Hauppauge, New York, NY, 11788, USA.
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Connor MJ, Eldred-Evans D, van Son M, Hosking-Jervis F, Bertoncelli Tanaka M, Reddy D, Bass EJ, Powell L, Ahmad S, Pegers E, Joshi S, Sri D, Wong K, Tam H, Hrouda D, Qazi H, Gordon S, Winkler M, Ahmed HU. A Multicenter Study of the Clinical Utility of Nontargeted Systematic Transperineal Prostate Biopsies in Patients Undergoing Pre-Biopsy Multiparametric Magnetic Resonance Imaging. J Urol 2020; 204:1195-1201. [PMID: 32516029 DOI: 10.1097/ju.0000000000001184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Accepted: 06/02/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The added value of nontargeted systematic prostate biopsies when performed alongside magnetic resonance imaging targeted biopsies in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal nontargeted systematic prostate biopsies, when performed alongside targeted systematic prostate biopsies, using pre-biopsy multiparametric magnetic resonance imaging. MATERIALS AND METHODS Consecutive patients referred with a suspicion of prostate cancer (April 2017 to October 2019) underwent pre-biopsy multiparametric magnetic resonance imaging. A transperineal biopsy was advised if multiparametric magnetic resonance imaging PI-RADS® (v.2.0) score was 4 or 5, and score 3 required a prostate specific antigen density 0.12 ng/ml or greater. Primary threshold for clinically significant prostate cancer was defined as any Gleason 3+4 or greater. Multivariable logistic regression analysis identified pre-biopsy predictors of clinically significant prostate cancer in nontargeted systematic prostate biopsies, regardless of targeted pathology (p <0.05, R, version 3.5.1). RESULTS A total of 1,719 men underwent a pre-biopsy multiparametric magnetic resonance imaging, with 679 (39.5%) proceeding to combined targeted systematic prostate biopsies and nontargeted systematic prostate biopsies. In these men clinically significant prostate cancer was detected in 333 (49%) and 139 (20.5%) with targeted systematic prostate biopsies and nontargeted systematic prostate biopsies, respectively. In those men with clinically significant prostate cancer in targeted systematic prostate biopsies, clinically significant prostate cancer was also present in nontargeted systematic prostate biopsies in 117 (17.2%); Gleason 3+3 was present in 50 (7.4%). In 287 men without any cancer in the targeted systematic prostate biopsies, 13 (1.9%) had clinically significant prostate cancer in nontargeted systematic prostate biopsies. In addition 18/679 (2.7%) had Gleason 3+3 disease and no Gleason greater than 4+3 was detected. Predictors associated with clinically significant prostate cancer in nontargeted systematic prostate biopsies were prostate specific antigen 5 ng/ml or greater (OR 2.05, 95% CI 1.13-3.73, p=0.02), PI-RADS score 5 (OR 2.26, 95% CI 1.51-3.38, p <0.001) and prostate volume less than 50 cc (OR 2.47, 95% CI 1.57-3.87, p <0.001). CONCLUSIONS Detection of clinically significant prostate cancer in exclusively nontargeted transperineal systematic biopsies in a pre-biopsy multiparametric magnetic resonance imaging pathway was low (1.9%).
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Affiliation(s)
- M J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - D Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - M van Son
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Hosking-Jervis
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - M Bertoncelli Tanaka
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - D Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - E J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - L Powell
- Department of Urology, St. George's Hospital NHS Foundation Trust, London, United Kingdom
| | - S Ahmad
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, United Kingdom
| | - E Pegers
- RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom
| | - S Joshi
- RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom
| | - D Sri
- Department of Urology, St. George's Hospital NHS Foundation Trust, London, United Kingdom
| | - K Wong
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, United Kingdom
| | - H Tam
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D Hrouda
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Qazi
- Department of Urology, St. George's Hospital NHS Foundation Trust, London, United Kingdom
| | - S Gordon
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, United Kingdom
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
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Zahalka AH, Fram E, Lin W, Mohn L, Frenette PS, Agalliu I, Watts KL. Use of beta-blocker types and risk of incident prostate cancer in a multiethnic population. Urol Oncol 2020; 38:794.e11-794.e16. [PMID: 32307329 DOI: 10.1016/j.urolonc.2020.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/02/2020] [Revised: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Increased adrenergic innervation is observed in prostate cancer (CaP) and is associated with aggressive disease. Emerging evidence suggests that beta-adrenergic blockade inhibits CaP progression. However, the association between type of beta-blocker use and risk of incident CaP on initial prostate biopsy has not been investigated in multiethnic populations. MATERIALS AND METHODS A retrospective study of racially/ethnically diverse men (64% African-American and Hispanic), who underwent initial prostate biopsy between 2006 and 2016 in a large healthcare system was performed. Oral use of beta-blocker type was assessed by reviewing active prescriptions within the 5-year period preceding initial biopsy. Patient demographics and clinical factors were collected. RESULTS Of 4,607 men who underwent initial prostate biopsy, 4,516 met criteria and 2,128 had a biopsy positive for CaP; 20% high-risk, 41% intermediate-risk, and 39% low or very-low risk (National Comprehensive Cancer Network classification). Overall, 15% of patients were taking a beta-blocker prior to initial biopsy, with Metoprolol, Atenolol, and Carvedilol accounting for the majority. Of beta-blocker types, Atenolol alone was associated with a 38% reduction in odds of incident CaP (P= 0.01), with a 40% and 54% reduction in risks of National Comprehensive Cancer Network intermediate and high-risk CaP (P = 0.03 and P = 0.03, respectively) compared to men not taking a beta-blocker. Furthermore, longer duration of Atenolol use (3-5 years) was associated with a 54% and 72% reduction in intermediate and high-risk disease, (P = 0.03 and P = 0.03, respectively). CONCLUSIONS Among beta blocker types, long-term Atenolol use is associated with a significant reduction in incident CaP risk on initial prostate biopsy for clinically-significant intermediate and high-risk disease compared to men not taking a beta-blocker.
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Affiliation(s)
- Ali H Zahalka
- Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Ethan Fram
- Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY
| | - Wilson Lin
- Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY
| | - Larkin Mohn
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Paul S Frenette
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY; Ruth L. Gottesman Institute for Stem Cell and Regenerative Medicine Research, Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Ilir Agalliu
- Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kara L Watts
- Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY
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Jiang G, Zhang G, Chen S, Chen M. Targeted and Systematic Prostate Biopsy in Biopsy-naive Men With Positive Multiparameter Magnetic Resonance Imaging Findings: A Meta-analysis. Clin Genitourin Cancer 2019; 18:105-110.e5. [PMID: 31902712 DOI: 10.1016/j.clgc.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/14/2019] [Revised: 09/20/2019] [Accepted: 10/06/2019] [Indexed: 12/09/2022]
Abstract
We assessed the difference in the detection rate of prostate cancer, specifically clinically significant prostate cancer, using targeted biopsy (TB), systematic biopsy (SB), and the combination of these 2 (CB) in biopsy-naive men with positive multiparameter magnetic resonance imaging results. We performed a literature review in September 2018 using PubMed and the Web of Science. Relevant studies acquired from specific articles' references were also reviewed. Only those studies that had provided the detection rate of TB, SB, and CB in biopsy-naive men with positive multiparameter magnetic resonance imaging findings were included for a total of 11 studies with 2099 patients. The combined strategy was better than TB or SB alone, with an odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.30-1.67; P < .001) and 1.45 (95% CI, 1.28-1.65; P < .001), respectively, in the overall detection rate. Also, TB was not better than SB, with an OR of 0.99 (95% CI, 0.87-1.12; P = .825). For the clinically significant prostate cancer detection rate, CB was still better than TB or SB alone, with an OR of 1.25 (95% CI, 1.11-1.42; P < .001) and an OR of 1.23 (95% CI, 1.08-1.40; P = .002), respectively. Again, TB was not better than SB, with an OR of 0.98 (95% CI, 0.86-1.12; P = .768). In conclusion, CB resulted in a better detection rate than TB or SB alone for both the overall prostate cancer detection rate and the clinically significant prostate cancer detection rate.
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Affiliation(s)
- Guiya Jiang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China; Urological Institute, Southeast University, Nanjing, China
| | - Guangyuan Zhang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China; Urological Institute, Southeast University, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China; Urological Institute, Southeast University, Nanjing, China.
| | - Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China; Urological Institute, Southeast University, Nanjing, China.
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Abstract
BACKGROUND This study aims to systematically investigate the impact of ultrasound angiography (UA) combined with fine needle aspiration (FNA) for the diagnosis of thyroid nodules (TNs). METHODS The following electronic databases will be searched: MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search them from their inceptions to the present without language limitations. We will consider all case-controlled studies on investigating the impact of diagnosis UA combined FNA for TNs. We will apply Quality Assessment of Diagnostic Accuracy Studies tool to assess methodological quality for all eligible studies. RESULTS In this study, outcomes consist of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. All these outcomes will be analyzed to evaluate the diagnostic accuracy of UA combined with FNA for TNs. CONCLUSION This study will provide evidence of the diagnostic accuracy of UA combined with FNA for TNs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138884.
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Affiliation(s)
- Jing Wang
- Department of Endocrine and Metabolism
| | | | - Zhe Liu
- Department of Cardiology, Yan’an University Affiliated Hospital, Yan’an, China
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7
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Fayyaz MB, Niazi IK. Diagnostic Accuracy Of Us-Fnac Of Axillary Lymph Nodes In Patients With Primary Breast Cancer Using Sentinel Lymph Node Biopsy As Standard Reference. J Ayub Med Coll Abbottabad 2019; 31:242-247. [PMID: 31094125] [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: 06/09/2023]
Abstract
BACKGROUND The advent of US guided FNAC in the investigation of adenopathy has become a suitable and commonly practiced minimally invasive procedure which is safe, simple, quick, highly cost effective and innocuous. Nowadays, in modern days FNAC is done in almost all cases due to its high specificity, Positive predictive value (PPV) and no complications resulting in fewer SNLB and directly proceeding with neo-adjuvant chemotherapy or ALND.. METHODS A total of 160 females between ages 30-60 years who had clinical palpable breast lump, newly diagnosed cases of breast cancer with palpable axilla nodes were included. Patients who already received neoadjuvant therapy and whose biopsy does not yield enough specimens and needs repeat biopsy were excluded. All the patients were then undergoing ultrasound guided fine needle aspiration. Afterwards, all patients were gone through axillary surgery for the definite histopathology report. FNAC results were compared with pathology after SLNB. RESULTS Mean age was 46.61±8.75 years. In 67 FNAC positive patients, 61 were True Positive and 06 were False Positive. Among, 93 FNAC negative patients, 18 were False Negative whereas 75 were True Negative. Overall sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of US guided FNAC of suspicious axilla nodes in patent with primary breast carcinoma was 77.22%, 92.59%, 80.65%, 91.04% and 85.0% respectively. CONCLUSIONS This study concluded that US guided FNAC of suspicious axilla nodes in patient with primary breast carcinoma has quite acceptable diagnostic accuracy.
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Affiliation(s)
| | - Imran Khalid Niazi
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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Marco-Doménech SF, Fernández-García P, Navarro-Ballester A, Cifrián-Pérez M, Escobar-Valero Á, Ibáñez-Gual MV. Cost-effectiveness of hydrogel plugs in CT-guided lung biopsies. Radiologia (Engl Ed) 2019; 61:153-160. [PMID: 30772002 DOI: 10.1016/j.rx.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/25/2018] [Revised: 11/04/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. MATERIAL AND METHODS We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. RESULTS Total costs: Group 1 = 1,261.28 + 52.65 = € 1,313.93; Group 2 = 1,201.36 + 67.25 = € 1,268.61; Group 3 = 1,220.22 + 47.20 = € 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. CONCLUSIONS Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure.
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Affiliation(s)
- S F Marco-Doménech
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón de la Plana, España; Unidad Predepartamental de Medicina, Universidad Jaume I (UJI), Castellón de la Plana, España.
| | - P Fernández-García
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón de la Plana, España; Unidad Predepartamental de Medicina, Universidad Jaume I (UJI), Castellón de la Plana, España
| | - A Navarro-Ballester
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón de la Plana, España
| | - M Cifrián-Pérez
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón de la Plana, España
| | - Á Escobar-Valero
- Unidad Predepartamental de Medicina, Universidad Jaume I (UJI), Castellón de la Plana, España
| | - M V Ibáñez-Gual
- IMAC. Departamento de Matemáticas. Universidad Jaume I (UJI), Castellón de la Plana, España
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Gupta R, Sinha N, Kumar P, Bhadani P, Rai DK, Kumar S. Intermittent CT fluoroscopic guided lung biopsy - Retrospective analysis of success rate, radiation exposure, complications and duration of procedure. J Xray Sci Technol 2019; 27:287-296. [PMID: 30856147 DOI: 10.3233/xst-180424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Intermittent CT fluoroscopic biopsy is a new technology, but has not been studied widely. This study aims to investigate correlation between the radiation dose and fluoroscopic CT exposure factors to establish the low dose parameters for performing percutaneous lung biopsies, as well as the relationship of the mean diameter and depth of lesions with radiation dose, procedure time, success and complication rates. MATERIALS AND METHODS This is a retrospective study to analyse lung biopsies performed using intermittent CT fluoroscopic technique with 18 G semi-automated coaxial gun on 256 slice scanner. A total of 50 patients were included in the study. Biopsy was done in three mAs and KVp settings (30 and 70, 10 and 120, 30 and 120, respectively). The statistical data analysis was performed using SPSS Statistics software. RESULTS Pneumothorax occurred in 22 % of cases. Sampling rate was 98% but histopathological diagnosis was made in 94% cases. Mean procedure time was 30.5±11.1 minutes. Low dose protocol (30 mAs and 70 KVp) had least radiation exposure during biopsy procedure (p < 0.001) with similar success rate, complications and procedure time (p > 0.05) in comparison with high dose protocol (10 and 120, 30 and 120 mAs and KVp, respectively). Mean diameter of lesions didn't correlate with radiation dose, success rate, complications and duration of procedure (p > 0.05) while significant association was found when depth was correlated with radiation exposure during fluoroscopic biopsy, duration of procedure and complication rates (p < 0.05) while no association was found with success rates. CONCLUSION On third generation dual energy source CT scanner, reducing mAs and KVp to 30 and 70 during fluoroscopy biopsy can produce images whose complications and success rates are comparable to high dose CT. In general, intermittent CT fluoroscopy guided lung biopsy has good success rates with acceptable complications, while utilising less radiation dose and procedure time.
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Affiliation(s)
- Ruchi Gupta
- Department of Radiodiagnosis, AIIMS Patna, Phulwarisharif, Bihar, India
| | - Neetu Sinha
- Department of Radiodiagnosis, AIIMS Patna, Phulwarisharif, Bihar, India
| | - Prem Kumar
- Department of Radiodiagnosis, AIIMS Patna, Phulwarisharif, Bihar, India
| | - Punam Bhadani
- Department of Pathology, AIIMS Patna, Phulwarisharif, Bihar, India
| | | | - Subhash Kumar
- Department of Radiodiagnosis, AIIMS Patna, Phulwarisharif, Bihar, India
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Zhou Y, Zhou Z, Li Q, Xu Y, Sun H, Xiao Y, Liang Z, Yan W, Ji Z, Li H. Diagnostic accuracy of magnetic resonance-guided prostate biopsy and template-guided transperineal saturation biopsy. Medicine (Baltimore) 2018; 97:e12495. [PMID: 30235754 PMCID: PMC6160219 DOI: 10.1097/md.0000000000012495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To compare the accuracy of magnetic resonance-guided prostate biopsy (MR-GPB) and template-guided transperineal prostate saturation biopsy (TTPSB).A total of 219 patients with elevated prostate-specific antigen, abnormal digital rectal examination or ultrasound findings were enrolled. All patients underwent multiparametric magnetic resonance image (mpMRI). Patients with a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 to 5 underwent MR-GPB using 2 to 5 biopsy cores and then immediately underwent an 11-region TTPSB. Patients with a PI-RADS score of 1 to 2 underwent TTPSB alone. We compared the detection rates for any cancer, clinically significant prostate cancer (csPCA), and the spatial distribution of missed csPCA lesions.Among the 219 cases, 66 (30.1%) had a PI-RADS score of 1 to 2 on mpMRI. The detection rate of TTPSB in these patients was 9.1% (6/66). In total, detection rates for any cancer and csPCA were 48.9% (107/219) and 42.9% (94/219), respectively. Detection rates for any cancer (TTPSB 87/219, 39.7%; MR-GPB76/219, 34.7%, P = .161) and csPCA (TTPSB 76/219, 34.7%; MR-GPB 72/219, 32.9%, P = .636) did not significantly differ between the 2 groups. The csPCA lesions missed by MR-GPB were most commonly located on the left (8.5%, 8/94) and right (9.6%, 9/94) sides of the urethra.MR-GPB can reduce the rate of unnecessary prostate biopsies by approximately 30% and exhibits an efficacy comparable to TTPSB for the detection of any cancer and csPCA. Nevertheless, approximately 1/4 of csPCAs were missed by MR-GPB and were most commonly located on both sides of the urethra.
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Affiliation(s)
- Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Qianyue Li
- Department of Urology, General Hospital of Xinjiang Production and Construction Corps, Urumqi
| | - Yinyan Xu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | | | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
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Waqas M, Shohab D, Khawaja MA, Masood A, Iqbal MW, Akhter S. Outcome Of Trans Rectal Ultrasound Guided Twelve Core Biopsy Of Prostate For The Detection Of Prostate Cancer- A Single Centre Experience. J Ayub Med Coll Abbottabad 2018; 30:49-53. [PMID: 29504329] [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: 06/08/2023]
Abstract
BACKGROUND This study was conducted to determine the outcome of trans-rectal ultrasound (TRUS) guided biopsy of prostate for the detection of prostatic carcinoma in a single tertiary care hospital in Pakistan. METHODS This is a retrospective study including three hundred and eightythree patients who underwent trans rectal ultrasound guided biopsy of prostate in a single tertiary care hospital. Indications for biopsy were raised prostate specific antigen (PSA), abnormal digital rectal examination (DRE) and/or both. Twelve core biopsy of prostate was done.. RESULTS The overall detection rate of prostate cancer was 59%. Prostate cancer detection in various PSA ranges of 0-3.99, 4-9.99, 10-19.99 and >20 ng/ml are 22.22%, 37.88%, 50.0% and 89.9%. PSA density >0.15ng/ml2 can diagnose 74.5% of patients with cancer. Prostate cancer detection rate based on abnormal DRE is 64.6% compared to 60.8% detected by PSA>4 ng/ml. CONCLUSIONS In conclusion raised PSA, smaller prostate volume, abnormal DRE and raised PSA density are associated with greater chances of detection of prostate carcinoma.
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Affiliation(s)
- Muhammad Waqas
- Department of Urology, Shifa International Hospital, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Durre Shohab
- Department of Urology, Shifa International Hospital, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Mohammad Athar Khawaja
- Department of Urology, Shifa International Hospital, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Afifa Masood
- Department of Urology, Shifa International Hospital, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Muhammad Waqas Iqbal
- Department of Urology, Shifa International Hospital, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Saeed Akhter
- Department of Urology, Shifa International Hospital, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
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Xie Y, Tokas T, Grabski B, Loch T. Internal Fusion: exact correlation of transrectal ultrasound images of the prostate by detailed landmarks over time for targeted biopsies or follow-up. World J Urol 2017; 36:693-698. [PMID: 29282497 DOI: 10.1007/s00345-017-2161-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/20/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Innovative imaging modalities are applied for diagnosing and follow-up of prostate cancer (PCa). To perform authentic targeted biopsies and evaluate prostate changes, it is essential to reliably identify and hit targets in their true anatomical location over time. A newly described image correlation method (Internal Fusion) allows precise correlation of serial transrectal ultrasound (TRUS) images in vitro and vivo. Identifiable morphologic structures such as prostatic calcifications define internal anchor points (Internal Landmarks) to facilitate exact correlation. METHODS After verification of Internal Fusion in vitro, 83 patients were included from January to August 2017 with at least one prior series of 5-mm spaced TRUS images stored as computed tomographic (US-CT) online data set. Two experienced operators collected new images in correlation with each cross-section of the previous examinations based on Internal Landmarks. RESULTS Of the 83 patients, fifty (60%) had prior negative biopsies. Fourteen (17%) wished US-CT targeted biopsies and PCa were detected in 7/14 patients (50%). Overall, accurate imaging correlations were attained in 369/397 slices (93%). In initial and repeat biopsy, 31/31 and 35/35 images could be correlated detecting PCa in 5/8 (63%) and 2/6 patients (33%). The longest observation of prostate changes over time (Trend Monitoring) with accurate image correlation was 8 years and 6 months. CONCLUSIONS Internal Fusion by Internal Landmarks ensures exact correlation in long-term follow-up. It is possible to precisely monitor trends in prostate tissue changes. In case of PCa suspicion, biopsies could be targeted with high accuracy by Internal Fusion, even over time.
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Affiliation(s)
- Yanqi Xie
- Urologische Klinik des Ev. Luth. Diakonissenkrankenhauses, Akademisches Lehrkrankenhaus der Christian-Albrechts-Universität zu Kiel, Knuthstraße 1, 24939, Flensburg, Germany.
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria
| | - Björn Grabski
- Urologische Klinik des Ev. Luth. Diakonissenkrankenhauses, Akademisches Lehrkrankenhaus der Christian-Albrechts-Universität zu Kiel, Knuthstraße 1, 24939, Flensburg, Germany
| | - Tillmann Loch
- Urologische Klinik des Ev. Luth. Diakonissenkrankenhauses, Akademisches Lehrkrankenhaus der Christian-Albrechts-Universität zu Kiel, Knuthstraße 1, 24939, Flensburg, Germany
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13
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Hansen NL, Kesch C, Barrett T, Koo B, Radtke JP, Bonekamp D, Schlemmer HP, Warren AY, Wieczorek K, Hohenfellner M, Kastner C, Hadaschik B. Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. BJU Int 2017; 120:631-638. [PMID: 27862869 DOI: 10.1111/bju.13711] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres. PATIENTS AND METHODS A two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7-10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test. RESULTS The median (interquartile range) PSA level was 9.0 (6.7-13.4) ng/mL. PI-RADS 3-5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7-10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7-10 prostate cancer was 0.20 (±0.07) for PI-RADS 3, 0.32 (±0.09) for PI-RADS 4, and 0.70 (±0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1-2 was 0.92 (±0.04) for Gleason score 7-10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7-10 cancers. In patients with suspicious lesions (PI-RADS 4-5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7-10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846. CONCLUSION In patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7-10 cancer still required combined targeted and systematic MRI/US image-fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.
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Affiliation(s)
- Nienke L Hansen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tristan Barrett
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Brendan Koo
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Jan P Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, DKFZ, Heidelberg, Germany
| | | | | | - Anne Y Warren
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Pathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Kathrin Wieczorek
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | | | - Christof Kastner
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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Sugano D, Sidana A, Calio B, Cobb K, Turkbey B, Pinto PA. MRI-targeted biopsy: is systematic biopsy obsolete? Can J Urol 2017; 24:8876-8882. [PMID: 28832304] [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: 06/07/2023]
Abstract
INTRODUCTION Although prostate cancer is the most common non-cutaneous cancer in men, it is traditionally diagnosed with a non-targeted, systematic transrectal ultrasound prostate biopsy (TRUS-Bx). This technique has been demonstrated to both under-detect clinically significant (CS) cancer and over-detect clinically insignificant cancer, and performs poorly in patients with a prior negative biopsy. With recent advances in MRI technology, most prominently the advent of multiparametric MRI, MRI-targeted prostate biopsy (MRI-TB) has been gaining favor as a more accurate alternative to TRUS-Bx. In this review, we attempt to summarize the current literature on MRI-TB and to determine if there is evidence supporting the use of MRI-TB alone. MATERIALS AND METHODS The literature was reviewed for articles pertaining to MRI-TB and its performance compared to systematic biopsy. RESULTS Most studies support the increased sensitivity of MRI-TB (0.90, 95% CI 0.85-0.94) compared to TRUS-Bx (0.79, 95% CI 0.68-0.87) for the detection of CS prostate cancer, as MRI-TB can detect up to 30% more high risk and 17% fewer low risk cancers. MRI-TB also tends to perform better than TRUS-Bx in patients with prior negative biopsy, as TRUS-Bx may miss up to half of CS cancers detected by MRI-TB, and in those with lesions at atypical locations. However, as the technology for imaging and image-guided biopsies continues to develop, there is still a role for TRUS-Bx in the management of patients with prostate cancer. CONCLUSIONS Our analysis of the literature suggests that although MRI-TB is superior to TRUS-Bx, there is still a role for traditional systematic biopsy.
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Affiliation(s)
- Dordaneh Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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15
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Hansen N, Patruno G, Wadhwa K, Gaziev G, Miano R, Barrett T, Gnanapragasam V, Doble A, Warren A, Bratt O, Kastner C. Magnetic Resonance and Ultrasound Image Fusion Supported Transperineal Prostate Biopsy Using the Ginsburg Protocol: Technique, Learning Points, and Biopsy Results. Eur Urol 2016; 70:332-40. [PMID: 26995327 DOI: 10.1016/j.eururo.2016.02.064] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [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: 12/16/2015] [Accepted: 02/26/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate biopsy supported by transperineal image fusion has recently been developed as a new method to the improve accuracy of prostate cancer detection. OBJECTIVE To describe the Ginsburg protocol for transperineal prostate biopsy supported by multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) image fusion, provide learning points for its application, and report biopsy results. The article is supplemented by a Surgery in Motion video. DESIGN, SETTING, AND PARTICIPANTS This single-centre retrospective outcome study included 534 patients from March 2012 to October 2015. A total of 107 had no previous prostate biopsy, 295 had benign TRUS-guided biopsies, and 159 were on active surveillance for low-risk cancer. SURGICAL PROCEDURE A Likert scale reported mpMRI for suspicion of cancer from 1 (no suspicion) to 5 (cancer highly likely). Transperineal biopsies were obtained under general anaesthesia using BiopSee fusion software (Medcom, Darmstadt, Germany). All patients had systematic biopsies, two cores from each of 12 anatomic sectors. Likert 3-5 lesions were targeted with a further two cores per lesion. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Any cancer and Gleason score 7-10 cancer on biopsy were noted. Descriptive statistics and positive predictive values (PPVs) and negative predictive values (NPVs) were calculated. RESULTS AND LIMITATIONS The detection rate of Gleason score 7-10 cancer was similar across clinical groups. Likert scale 3-5 MRI lesions were reported in 378 (71%) of the patients. Cancer was detected in 249 (66%) and Gleason score 7-10 cancer was noted in 157 (42%) of these patients. PPV for detecting 7-10 cancer was 0.15 for Likert score 3, 0.43 for score 4, and 0.63 for score 5. NPV of Likert 1-2 findings was 0.87 for Gleason score 7-10 and 0.97 for Gleason score ≥4+3=7 cancer. Limitations include lack of data on complications. CONCLUSIONS Transperineal prostate biopsy supported by MRI/TRUS image fusion using the Ginsburg protocol yielded high detection rates of Gleason score 7-10 cancer. Because the NPV for excluding Gleason score 7-10 cancer was very high, prostate biopsies may not be needed for all men with elevated prostate-specific antigen values and nonsuspicious mpMRI. PATIENT SUMMARY We present our technique to sample (biopsy) the prostate by the transperineal route (the area between the scrotum and the anus) to detect prostate cancer using a fusion of magnetic resonance and ultrasound images to guide the sampling.
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Affiliation(s)
- Nienke Hansen
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Giulio Patruno
- Department of Urology, University of Rome "Tor Vergata", Rome, Italy
| | - Karan Wadhwa
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Gabriele Gaziev
- Department of Urology, University of Rome "Tor Vergata", Rome, Italy
| | - Roberto Miano
- Department of Urology, University of Rome "Tor Vergata", Rome, Italy
| | - Tristan Barrett
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Vincent Gnanapragasam
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Doble
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Anne Warren
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - Ola Bratt
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Christof Kastner
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
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Cui Z, Wright JD, Accordino MK, Buono D, Neugut AI, Hu JC, Hershman DL. Safety, Utilization, and Cost of Image-Guided Percutaneous Liver Biopsy Among Cancer Patients. Cancer Invest 2016; 34:189-96. [PMID: 27065211 PMCID: PMC5002313 DOI: 10.3109/07357907.2016.1166232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Indexed: 12/12/2022]
Abstract
Image-guided percutaneous liver biopsy (PLB) is a diagnostic tool for lesions in the liver. Hemorrhage is the most common complication. We selected patients with a diagnostic claim for cancer who had undergone PLB. There were a total of 26,941 patients who underwent PLB. Hemorrhage risk was 1.43% among patients undergoing PLB. When stratified by setting, odds of hemorrhage were 4.5 times higher when biopsy was performed in an inpatient setting (p < .001). Risk factors associated with hemorrhage included marital status, liver cancer and comorbidity score. The use of PLB has increased over time. Reassuringly, the hemorrhage risk associated with PLB is low.
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Affiliation(s)
- Zhu Cui
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA
| | - Jason D Wright
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University , New York , New York , USA
- c Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , New York , USA
| | - Melissa K Accordino
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University , New York , New York , USA
- d Department of Medicine , College of Physicians and Surgeons, Columbia University , New York , New York , USA
| | - Donna Buono
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA
| | - Alfred I Neugut
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University , New York , New York , USA
- d Department of Medicine , College of Physicians and Surgeons, Columbia University , New York , New York , USA
| | - Jim C Hu
- e Department of Urology , Weill Cornell Medical College , New York , New York , USA
| | - Dawn L Hershman
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University , New York , New York , USA
- d Department of Medicine , College of Physicians and Surgeons, Columbia University , New York , New York , USA
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Klooker TK, Huibers A, In 't Hof K, Nieveen van Dijkum EJM, Phoa SS, van Eeden S, Bisschop PH. Screw needle cytology of thyroid nodules is associated with a lower non-diagnostic rate compared to fine needle aspiration. Eur J Endocrinol 2015; 173:677-81. [PMID: 26311089 DOI: 10.1530/eje-15-0337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/26/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fine needle aspiration (FNA) cytology is the method of choice to exclude malignancy in thyroid nodules. A major limitation of thyroid FNA is the relatively high rate (13-17%) of non-diagnostic samples. The aim of this study is to determine the diagnostic yield of a screw needle compared to the conventional FNA. METHODS We retrospectively analysed thyroid nodule cytology of all patients that underwent thyroid nodule fine needle or screw needle aspiration between July 2007 and July 2012 in a single academic medical centre. Cytology results were categorized according to the Bethesda classification system. RESULTS In total, 644 punctures of thyroid nodules from 459 patients were available for analysis. The screw needle was used 531 times, and the conventional fine needle 113 times. The percentage of non-diagnostic cytology was significantly lower in the screw needle samples than in the fine needle samples (3% vs 17%, P<0.001). CONCLUSION This study shows a significantly better diagnostic performance of the screw needle compared to the conventional fine needle in cytology of thyroid nodules.
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Affiliation(s)
- Tamira K Klooker
- Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands
| | - Anne Huibers
- Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands
| | - Klaas In 't Hof
- Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands
| | - Els J M Nieveen van Dijkum
- Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands
| | - Saffire S Phoa
- Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands
| | - Susanne van Eeden
- Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands
| | - Peter H Bisschop
- Departments of Endocrinology and MetabolismSurgeryAcademic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The NetherlandsDepartment of SurgeryFlevo Hospital, Almere, The NetherlandsDepartments of RadiologyPathologyAcademic Medical Centre, Amsterdam, The Netherlands
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Lee CI, Bogart A, Hubbard RA, Obadina ET, Hill DA, Haas JS, Tosteson ANA, Alford-Teaster JA, Sprague BL, DeMartini WB, Lehman CD, Onega TL. Advanced Breast Imaging Availability by Screening Facility Characteristics. Acad Radiol 2015; 22:846-52. [PMID: 25851643 PMCID: PMC4465038 DOI: 10.1016/j.acra.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/06/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the relationship between screening mammography facility characteristics and on-site availability of advanced breast imaging services required for supplemental screening and the diagnostic evaluation of abnormal screening findings. MATERIALS AND METHODS We analyzed data from all active imaging facilities across six regional registries of the National Cancer Institute-funded Breast Cancer Surveillance Consortium offering screening mammography in calendar years 2011-2012 (n = 105). We used generalized estimating equations regression models to identify associations between facility characteristics (eg, academic affiliation, practice type) and availability of on-site advanced breast imaging (eg, ultrasound [US], magnetic resonance imaging [MRI]) and image-guided biopsy services. RESULTS Breast MRI was not available at any nonradiology or breast imaging-only facilities. A combination of breast US, breast MRI, and imaging-guided breast biopsy services was available at 76.0% of multispecialty breast centers compared to 22.2% of full diagnostic radiology practices (P = .0047) and 75.0% of facilities with academic affiliations compared to 29.0% of those without academic affiliations (P = .04). Both supplemental screening breast US and screening breast MRI were available at 28.0% of multispecialty breast centers compared to 4.7% of full diagnostic radiology practices (P < .01) and 25.0% of academic facilities compared to 8.5% of nonacademic facilities (P = .02). CONCLUSIONS Screening facility characteristics are strongly associated with the availability of on-site advanced breast imaging and image-guided biopsy service. Therefore, the type of imaging facility a woman attends for screening may have important implications on her timely access to supplemental screening and diagnostic breast imaging services.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Andy Bogart
- Group Health Research Institute, Seattle, Washington
| | | | - Eniola T Obadina
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Deirdre A Hill
- Department of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Dana Farber Harvard Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Jennifer A Alford-Teaster
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, Vermont
| | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Constance D Lehman
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Tracy L Onega
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
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Yang W, Sun W, Li Q, Yao Y, Lv T, Zeng J, Liang W, Zhou X, Song Y. Diagnostic Accuracy of CT-Guided Transthoracic Needle Biopsy for Solitary Pulmonary Nodules. PLoS One 2015; 10:e0131373. [PMID: 26110775 PMCID: PMC4482532 DOI: 10.1371/journal.pone.0131373] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/31/2015] [Indexed: 11/18/2022] Open
Abstract
To evaluate the diagnostic accuracy of computed tomography (CT)-guided percutaneous lung biopsy for solitary pulmonary nodules. Three hundred and eleven patients (211 males and 100 females), with a mean age of 59.6 years (range, 19-87 years), who were diagnosed with solitary pulmonary nodules and underwent CT-guided percutaneous transthoracic needle biopsy between January 2008 and January 2014 were reviewed. All patients were confirmed by surgery or the clinical course. The overall diagnostic accuracy and incidence of complications were calculated, and the factors influencing these were statistically evaluated and compared. Specimens were successfully obtained from all 311 patients. A total of 217 and 94 cases were found to be malignant and benign lesions, respectively, by biopsy. Two hundred and twenty-five (72.3%) carcinomas, 78 (25.1%) benign lesions, and 8 (2.6%) inconclusive lesions were confirmed by surgery and the clinical course. The diagnostic accuracy, sensitivity, and specificity of CT-guided percutaneous transthoracic needle biopsy were 92.9%, 95.3%, and 95.7%, respectively. The incidences of pneumothorax and self-limiting bleeding were 17.7% and 11.6%, respectively. Taking account of all evidence, CT-guided percutaneous lung biopsy for solitary pulmonary nodules is an efficient, and safe diagnostic method associated with few complications.
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Affiliation(s)
- Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Wenkui Sun
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Yanwen Yao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Junli Zeng
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Wenjun Liang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Xiaojun Zhou
- Department of pathology, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
- * E-mail:
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Yuan J, Zhang H, Jiang Z, Zhou J, Yang Q, Zhang Z. [Accuracy of different preoperative biopsy techniques in diagnosis of osteosarcomas and their value in prognostic evaluation]. Zhonghua Bing Li Xue Za Zhi 2015; 44:315-319. [PMID: 26178212] [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: 06/04/2023]
Abstract
OBJECTIVE To study the difference in pathologic diagnostic accuracy among different histologic subtypes of osteosarcoma and different methods of preoperative biopsy, and the influence of diagnostic accuracy on prognosis of osteosarcoma. METHODS The preoperative biopsies, complete clinical, radiological and pathological data of 347 pathologically confirmed osteosarcomas were evaluated. According to the Pathological Diagnostic and Technical Specifications, the accuracy of preoperative biopsies was divided into 6 grades. 1: definite diagnosis, 2: basically definite diagnosis, 3: significant diagnosis, 4: descriptive diagnosis, 5:inadequate sampling, 6:misdiagnosis. 1 to 3 were defined as successful diagnosis,while 4 to 6 were defined as unsuccessful diagnosis. RESULTS Of the 347 biopsies, 252 were CT-guided needle biopsies by the radiologists, and 95 were core-needle biopsies by orthopedic surgeons without CT-guidance. The latter showed a higher overall biopsy success rate (97.9%) in all osteosarcomas. Biopsies by surgeons showed a higher biopsy success rate (95.4%) in conventional osteosarcoma, but lower success rate in telangiectatic (55.6%) and low-grade central osteosarcomas (63.7%). The accuracy of pathologic diagnosis of preoperative biopsy was related to patients' age, serum AKP level, imaging diagnosis, method of biopsy and the subtype of osteosarcoma. Comparing the groups with successful and unsuccessful diagnosis, there were significant differences in recurrence rate and mortality after operation (P<0.01). CONCLUSIONS The accuracy of pathologic diagnosis of preoperative biopsy are related to recurrence rate and mortality after operation. Biopsy by orthopedic surgeons without CT-guidance is reliable and safe, followed by primary diagnosis at frozen section and final diagnosis by routine pathologic sections for osteosarcomas located in the long bones of the extremities. Close integration of the preoperative pathologic diagnosis with clinical and radiological data will improve the accuracy of diagnosis.
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Affiliation(s)
- Junqing Yuan
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Howlett DC, Skelton E, Moody AB. Establishing an accurate diagnosis of a parotid lump: evaluation of the current biopsy methods - fine needle aspiration cytology, ultrasound-guided core biopsy, and intraoperative frozen section. Br J Oral Maxillofac Surg 2015; 53:580-3. [PMID: 25886878 DOI: 10.1016/j.bjoms.2015.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 07/16/2014] [Accepted: 03/25/2015] [Indexed: 11/18/2022]
Abstract
The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic.
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Affiliation(s)
- D C Howlett
- Eastbourne District General Hospital, United Kingdom
| | - E Skelton
- Eastbourne District General Hospital, United Kingdom.
| | - A B Moody
- Eastbourne District General Hospital, United Kingdom
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Sconfienza LM, Mauri G, Sardanelli F, Murolo C. Response. Radiology 2014; 270:309. [PMID: 24501752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
PURPOSE Patient radiation dose during Computed Tomography (CT) guided biopsy procedures is determined by both acquisition technical parameters and physician practice. The potential effect of the physician practice is of concern. This study is to investigate the effects of those intangibles on patient radiation dose. METHODS Patient radiation dose from 252 patients who underwent CT guided biopsy from 2009 to 2010 were retrospectively studied. Ten physicians who used conventional intermittent shots, low mA dose saving feature, or both were included in the study. The patient dose reports were retrieved and the total dose length products (DLPs) were analyzed. Linear regression analysis performed between various variables and reported dose. Patient detriment index (PDI) was developed, which sets threshold (standard of practice) for comparing physician practice with their peers. Odds ratio was calculated to determine odds of a group of patients receiving dose above threshold when compared to another group. RESULTS Median DLP among ten physicians was 1194 mGy-cm. There was a significant difference (p< 0.01) between reported DLPs doses when physicians used dose saving feature vs. when feature not used (539.8 ± 169.4 mGy-cm vs. 1269.7 ± 659.0 mGy-cm). In general, physicians who used dose saving feature had lower relative PDIs (< 1) compared to the PDIs (> 1) without the dose feature. Odds ratio estimate of 7.7 at 95% confidence level indicates that the odds of a group receiving a high dose depends on practitioner. CONCLUSION Adjustments of practice habits, use of dose saving features or both may be needed to improve patient care for CT biopsy.
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Affiliation(s)
| | - Jie Zhang
- Department of Radiology, University of Kentucky, Lexington, KY, USA
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Seifabadi R, Cho NBJ, Song SE, Tokuda J, Hata N, Tempany CM, Fichtinger G, Iordachita I. Accuracy study of a robotic system for MRI-guided prostate needle placement. Int J Med Robot 2013; 9:305-16. [PMID: 22678990 PMCID: PMC3772968 DOI: 10.1002/rcs.1440] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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] [Accepted: 04/05/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Accurate needle placement is the first concern in percutaneous MRI-guided prostate interventions. In this phantom study, different sources contributing to the overall needle placement error of a MRI-guided robot for prostate biopsy have been identified, quantified and minimized to the possible extent. METHODS The overall needle placement error of the system was evaluated in a prostate phantom. This error was broken into two parts: the error associated with the robotic system (called 'before-insertion error') and the error associated with needle-tissue interaction (called 'due-to-insertion error'). Before-insertion error was measured directly in a soft phantom and different sources contributing into this part were identified and quantified. A calibration methodology was developed to minimize the 4-DOF manipulator's error. The due-to-insertion error was indirectly approximated by comparing the overall error and the before-insertion error. The effect of sterilization on the manipulator's accuracy and repeatability was also studied. RESULTS The average overall system error in the phantom study was 2.5 mm (STD = 1.1 mm). The average robotic system error in the Super Soft plastic phantom was 1.3 mm (STD = 0.7 mm). Assuming orthogonal error components, the needle-tissue interaction error was found to be approximately 2.13 mm, thus making a larger contribution to the overall error. The average susceptibility artifact shift was 0.2 mm. The manipulator's targeting accuracy was 0.71 mm (STD = 0.21 mm) after robot calibration. The robot's repeatability was 0.13 mm. Sterilization had no noticeable influence on the robot's accuracy and repeatability. CONCLUSIONS The experimental methodology presented in this paper may help researchers to identify, quantify and minimize different sources contributing into the overall needle placement error of an MRI-guided robotic system for prostate needle placement. In the robotic system analysed here, the overall error of the studied system remained within the acceptable range.
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Affiliation(s)
- Reza Seifabadi
- Laboratory for Percutaneous Surgery (Perk Lab), Queen's University, Kingston, ON, Canada
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