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Hamm CA, Baumgärtner GL, Padhani AR, Froböse KP, Dräger F, Beetz NL, Savic LJ, Posch H, Lenk J, Schallenberg S, Maxeiner A, Cash H, Günzel K, Hamm B, Asbach P, Penzkofer T. Reduction of false positives using zone-specific prostate-specific antigen density for prostate MRI-based biopsy decision strategies. Eur Radiol 2024:10.1007/s00330-024-10700-z. [PMID: 38538841 DOI: 10.1007/s00330-024-10700-z] [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: 11/03/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES To develop and test zone-specific prostate-specific antigen density (sPSAD) combined with PI-RADS to guide prostate biopsy decision strategies (BDS). METHODS This retrospective study included consecutive patients, who underwent prostate MRI and biopsy (01/2012-10/2018). The whole gland and transition zone (TZ) were segmented at MRI using a retrained deep learning system (DLS; nnU-Net) to calculate PSAD and sPSAD, respectively. Additionally, sPSAD and PI-RADS were combined in a BDS, and diagnostic performances to detect Grade Group ≥ 2 (GG ≥ 2) prostate cancer were compared. Patient-based cancer detection using sPSAD was assessed by bootstrapping with 1000 repetitions and reported as area under the curve (AUC). Clinical utility of the BDS was tested in the hold-out test set using decision curve analysis. Statistics included nonparametric DeLong test for AUCs and Fisher-Yates test for remaining performance metrics. RESULTS A total of 1604 patients aged 67 (interquartile range, 61-73) with 48% GG ≥ 2 prevalence (774/1604) were evaluated. By employing DLS-based prostate and TZ volumes (DICE coefficients of 0.89 (95% confidence interval, 0.80-0.97) and 0.84 (0.70-0.99)), GG ≥ 2 detection using PSAD was inferior to sPSAD (AUC, 0.71 (0.68-0.74)/0.73 (0.70-0.76); p < 0.001). Combining PI-RADS with sPSAD, GG ≥ 2 detection specificity doubled from 18% (10-20%) to 43% (30-44%; p < 0.001) with similar sensitivity (93% (89-96%)/97% (94-99%); p = 0.052), when biopsies were taken in PI-RADS 4-5 and 3 only if sPSAD was ≥ 0.42 ng/mL/cc as compared to all PI-RADS 3-5 cases. Additionally, using the sPSAD-based BDS, false positives were reduced by 25% (123 (104-142)/165 (146-185); p < 0.001). CONCLUSION Using sPSAD to guide biopsy decisions in PI-RADS 3 lesions can reduce false positives at MRI while maintaining high sensitivity for GG ≥ 2 cancers. CLINICAL RELEVANCE STATEMENT Transition zone-specific prostate-specific antigen density can improve the accuracy of prostate cancer detection compared to MRI assessments alone, by lowering false-positive cases without significantly missing men with ISUP GG ≥ 2 cancers. KEY POINTS • Prostate biopsy decision strategies using PI-RADS at MRI are limited by a substantial proportion of false positives, not yielding grade group ≥ 2 prostate cancer. • PI-RADS combined with transition zone (TZ)-specific prostate-specific antigen density (PSAD) decreased the number of unproductive biopsies by 25% compared to PI-RADS only. • TZ-specific PSAD also improved the specificity of MRI-directed biopsies by 9% compared to the whole gland PSAD, while showing identical sensitivity.
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Affiliation(s)
- Charlie A Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
| | - Georg L Baumgärtner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Konrad P Froböse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Dräger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Lynn J Savic
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Helena Posch
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Schallenberg
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Germany and PROURO, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Jacewicz M, Günzel K, Rud E, Sandbæk G, Magheli A, Busch J, Hinz S, Baco E. Antibiotic prophylaxis versus no antibiotic prophylaxis in transperineal prostate biopsies (NORAPP): a randomised, open-label, non-inferiority trial. Lancet Infect Dis 2022; 22:1465-1471. [PMID: 35839791 DOI: 10.1016/s1473-3099(22)00373-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The benefit of antibiotic prophylaxis is uncertain when performing transperineal prostate biopsies. Judicious use of antibiotics is required as antimicrobial resistance increases worldwide. We aimed to assess whether antibiotic prophylaxis can be omitted when performing transperineal prostate biopsies under local anaesthesia as an outpatient procedure. METHODS In this randomised, open-label, non-inferiority trial, we aimed to enrol all patients with a suspicion of prostate cancer undergoing transperineal prostate biopsies at two hospitals in Norway and Germany. Patients with a high risk of infection or ongoing infection were excluded. Patients were randomised (1:1) to receive intramuscular (in Norway) or intravenous (in Germany) 1·5 g cefuroxime antibiotic prophylaxis or not. Follow-up assessments were done after 2 weeks and 2 months. The primary outcome was rate of sepsis or urinary tract infections requiring hospitalisation within 2 months. The secondary outcome was the rate of urinary tract infections not requiring hospitalisation. These outcomes were assessed in all eligible randomly allocated participants with a prespecified non-inferiority margin of 4%. Biopsies were performed using an MRI-transrectal ultrasound fusion transperineal technique under local anaesthesia. Patients with a positive MRI underwent 2-4 biopsies per target; in addition, 8-12 systematic biopsies were performed in biopsy naive and MRI-negative patients. This study is registered with ClinicalTrials.gov, NCT04146142. FINDINGS Between Nov 11, 2019, and Feb 23, 2021, 792 patients were referred for biopsy, of whom 555 (70%) were randomly allocated to treatment groups. 277 (50%) patients received antibiotic prophylaxis and 276 (50%) did not; two (<1%) patients were excluded after randomisation because of unknown allergy to study drug. Sepsis or urinary tract infections requiring hospitalisation occurred in no patients given antibiotic prophylaxis (0%, 95% CI 0 to 1·37) or not given antibiotic prophylaxis (0%, 0 to 1·37; difference 0% [95% CI -1·37 to 1·37]). Urinary tract infections not requiring hospitalisation occurred in one patient given antibiotic prophylaxis (0·36%, 95% CI 0·01 to 2·00) and three patients not given antibiotic prophylaxis (1·09%, 0·37 to 3·15; difference 0·73% [95% CI -1·08 to 2·81]). The number needed to treat with antibiotic prophylaxis to avoid one infection was 137. INTERPRETATION The non-inferiority margin of 4% was not exceeded, suggesting rates of infections were not higher in patients not receiving antibiotic prophylaxis before transperineal prostate biopsy than in those receiving it. Therefore, antibiotic prophylaxis might be omitted in this population. FUNDING Oslo University Hospital, Oslo, Norway and Vivantes Klinikum Am Urban, Berlin, Germany.
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Affiliation(s)
- Maciej Jacewicz
- Department of Urology, Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway.
| | - Karsten Günzel
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Gunnar Sandbæk
- Department of Radiology, Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Ahmed Magheli
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Jonas Busch
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Universitatsklinikum Magdeburg, Magdeburg, Germany
| | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
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Kornienko K, Reuter M, Maxeiner A, Günzel K, Kittner B, Reimann M, Hofbauer SL, Wiemer LE, Heckmann R, Asbach P, Wendler JJ, Schostak M, Schlomm T, Friedersdorff F, Cash H. Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy. Sci Rep 2022; 12:13603. [PMID: 35948575 PMCID: PMC9365776 DOI: 10.1038/s41598-022-17260-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Magnetic resonance imaging/Ultrasound (MRI/US) fusion targeted biopsy (TB) in combination with a systematic biopsy (SB) improves cancer detection but limited data is available how to manage patients with a Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 4 lesion and a negative biopsy. We evaluate the real-world management and the rate of clinically significant Prostate Cancer (csPCa) during follow-up. 1546 patients with a multi-parametric MRI (mpMRI) and a PI-RADS ≥ 3 who underwent SB and TB between January 2012 and May 2017 were retrospectively analyzed. 222 men with a PI-RADS ≥ 4 and a negative biopsy were included until 2019. For 177/222 (80%) complete follow-up data was obtained. 66/84 (78%) had an initial PI-RADS 4 and 18 (22%) a PI-RADS 5 lesion. 48% (84/177) received a repeat mpMRI; in the follow-up mpMRI, 39/84 (46%) lesions were downgraded to PI-RADS 2 and 11 (13%) to PI-RADS 3; three cases were upgraded and 28 lesions remained consistent. 18% (32/177) men underwent repeated TB and csPCa was detected in 44% (14/32). Our study presents real world data on the management of men with a negative TB biopsy. Men with a positive mpMRI and lesions with high suspicion (PI-RADS4/5) and a negative targeted biopsy should be critically reviewed and considered for repeat biopsy or strict surveillance. The optimal clinical risk assessment remains to be further evaluated.
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Affiliation(s)
- Kira Kornienko
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Miriam Reuter
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Vivantes Am Urban, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Sebastian L Hofbauer
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Laura E Wiemer
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Robin Heckmann
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Patrick Asbach
- Clinic for Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Schostak
- Department of Urology, University Magdeburg, Magdeburg, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité-Universitätsmedizin Berlin, Hardenbergstr.8, 10623, Berlin, Germany.
- Department of Urology, University Magdeburg, Magdeburg, Germany.
- PROURO, Berlin, Germany.
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Günzel K, Magheli A, Baco E, Cash H, Heinrich S, Neubert H, Schlegel J, Schostak M, Henkel T, Asbach P, Hinz S. Infection rate and complications after 621 transperineal MRI-TRUS fusion biopsies in local anesthesia without standard antibiotic prophylaxis. World J Urol 2021; 39:3861-3866. [PMID: 33866401 DOI: 10.1007/s00345-021-03699-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/25/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study was to assess the post biopsy infection rate, feasibility and prostate cancer (PCa) detection rate (CDR) by performing transperineal MRI-TRUS fusion biopsy of the prostate (TPBx) under local anesthesia (LA) without antibiotic prophylaxis (AP). METHODS We prospectively screened 766 men with suspicious lesions on mpMRI, an elevated PSA level or a suspect digital examination undergoing MRI-TRUS-TPBx in LA, from May 2019 to July 2020. Patients with the need for antibiotic prophylaxis or without a PI-RADS target lesion were excluded from final analyses. We reported CDR, perioperative pain (0-10) and postoperative complications. PCa with an ISUP grade ≥ 2 was classified as clinically significant PCa (csPCa). RESULTS We included 621 patients with a median age of 68 years (IQR 62-74), a PSA of 6.43 ng/mL (IQR 4.72-9.91) and a prostate volume of 45 cc (IQR 32-64). In median, 4 targeted (TB) (IQR 3-4) and 6 (IQR 5-7) systematic biopsies (SB) detected in combination overall 416 (67%) PCa and 324 (52%) csPCa. Overall CDR of TB for PI-RADS 3, 4 and 5 was 26%, 65% and 84%, respectively. Patients reported a median perioperative pain level of 2 (IQR 1-3). Four patients (0.6%) developed a post biopsy infection, one experienced urosepsis. CONCLUSION Our results demonstrate that transperineal MRI-TRUS fusion-guided prostate biopsy under LA without AP is feasible, safe and well tolerated.
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Affiliation(s)
- K Günzel
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany.
| | - A Magheli
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - E Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - H Cash
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - S Heinrich
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - H Neubert
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - J Schlegel
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - M Schostak
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
| | - T Henkel
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - P Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Hinz
- Department of Urology, Vivantes Klinikum Am Urban Berlin, Dieffenbachstraße 1, 10967, Berlin, Germany
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Jacewicz M, Günzel K, Rud E, Lauritzen PM, Galtung KF, Hinz S, Magheli A, Baco E. Multicenter transperineal MRI-TRUS fusion guided outpatient clinic prostate biopsies under local anesthesia. Urol Oncol 2020; 39:432.e1-432.e7. [PMID: 33257219 DOI: 10.1016/j.urolonc.2020.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/30/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Transperineal Prostate biopsies (TPBx) are usually performed under general anesthesia without image fusion. This study aimed to evaluate prostate cancer (Pca) detection rates (CDR), pain, and adverse events using a novel, free-hand TPBx technique, based on elastic fusion of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) under local anesthesia. MATERIALS AND METHODS This multicenter retrospective study included all consecutive patients scheduled for a TPBx. All had clinical suspicion of Pca, active surveillance scheduled for a re-biopsy, or suspicion of local recurrence after previous treatment. Bi-parametric or multiparametric MRI was performed in all patients and classified as positive in the case of Prostate Imaging-Reporting and Data System (PIRADS) suspicion ≥3. At least 1 targeted TPBx was realized from each PIRADS ≥3 index lesion. Six to 12 systematic random TPBx were done in patients with negative MRI. All biopsies were performed under local anesthesia in an outpatient clinic with MRI-TRUS fusion and the 3D navigation system Trinity Perine (Koelis, France). Any- and clinically significant Pca (csPca) (ISUP gr. ≥2) was recorded. Biopsy-related pain and adverse events were reported according to a visual analogue score of 0-10. RESULTS In total, 377 patients were included for analyses. The mean age was 67 years (95% Confidence Interval: 66-68) and the median prostate-specific antigen was 7.2 ng/ml (interquartile range [IQR] 4.8-11.0). MRI was negative in 6% and positive in 94%. The median MRI prostate volume was 43 ml (IQR 31-60) and the median MRI index tumor volume was 0.9 ml (IQR 0.5-2.1). The median number of TPBx was 4 (IQR 3-4). The overall detection of any- and csPca was 64% and 52%, respectively. The overall CDR according to PIRADS 3, 4, and 5 was 30%, 70%, and 94%, respectively. In patients with negative MRI, any- and csPca was detected in 23% and 9%, respectively. The median visual analogue score score was 2 (IQR 1-3, range 0-7). Two patients (0.5%) developed postbiopsy infection, of which one developed urosepsis. Treatment requiring haematuria or urinary retention did not occur. CONCLUSION Free-hand MRI/TRUS fusion-guided and systematic random TPBx in LA is a feasible, safe, and well-tolerated technique for diagnosing Pca.
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Affiliation(s)
- Maciej Jacewicz
- Department of Urology, Oslo University Hospital(,) Oslo. Norway; University of Oslo(,) Oslo. Norway
| | - Karsten Günzel
- Department of Urology Vivantes Am Urban, Berlin, Germany
| | - Erik Rud
- University of Oslo(,) Oslo. Norway; Department of Radiology, Oslo University Hospital(,) Oslo. Norway
| | | | - Kristina Flor Galtung
- University of Oslo(,) Oslo. Norway; Department of Radiology, Oslo University Hospital(,) Oslo. Norway
| | - Stefan Hinz
- Department of Urology Vivantes Am Urban, Berlin, Germany
| | - Ahmed Magheli
- Department of Urology Vivantes Am Urban, Berlin, Germany
| | - Eduard Baco
- Department of Urology, Oslo University Hospital(,) Oslo. Norway; University of Oslo(,) Oslo. Norway.
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Günzel K, Cash H, Buckendahl J, Königbauer M, Asbach P, Haas M, Neymeyer J, Hinz S, Miller K, Kempkensteffen C. The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy. BMC Urol 2017; 17:7. [PMID: 28086856 PMCID: PMC5234255 DOI: 10.1186/s12894-016-0196-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform. METHODS During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI-RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion. RESULTS The median age in group A was 67 years (IQR 61-72) and in group B 68 years (IQR 60-71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05-14) and in group B 8.59 ng/ml (IQR 5.65-12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7). CONCLUSION Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform.
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Affiliation(s)
- Karsten Günzel
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - John Buckendahl
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Maximilian Königbauer
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Patrick Asbach
- Departement of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Matthias Haas
- Departement of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Jörg Neymeyer
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Carsten Kempkensteffen
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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Haas M, Günzel K, Miller K, Hamm B, Cash H, Asbach P. Is the Ellipsoid Formula the New Standard for 3-Tesla MRI Prostate Volume Calculation without Endorectal Coil? Urol Int 2016; 98:49-53. [DOI: 10.1159/000448593] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
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Günzel K, Haas M, Maxeiner A, Stephan C, Buckendahl J, Asbach P, Miller K, Kempkensteffen C, Cash H. Predictive Parameters Identifying Men Eligible for a Sole MRI/Ultrasound Fusion-Guided Targeted Biopsy without an Additional Systematic Biopsy. Urol Int 2016; 98:15-21. [DOI: 10.1159/000449258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/19/2016] [Indexed: 11/19/2022]
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Haas M, Günzel K, Penzkofer T, Maxeiner A, Fischer T, Miller K, Hamm B, Asbach P, Cash H. [Implications of PI-RADS Version 1 and Updated Version 2 on the Scoring of Prostatic Lesions in Multiparametric MRI]. Aktuelle Urol 2016; 47:383-7. [PMID: 27680189 DOI: 10.1055/s-0042-111128] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A revised version of the PI-RADS scoring system has been introduced and score-related variability between version 1 and 2 may be suspected. This study aimed to assess the PI-RADS scores derived from version 1 (v1) and the updated version 2 (v2). MATERIAL AND METHODS 61 patients with biopsy-proven prostate cancer (PCa) and 90 lesions detected on pre-biopsy 3-Tesla multiparametric MRI were included in this retrospective analysis. 2 experienced radiologists scored all lesions in consensus. Lesion scores differing between PI-RADS v1 and v2 were further analyzed. Histology data from radical prostatectomy (RP) were included when available. RESULTS The PI-RADS v1 and v2 score differed in 52% of patients (32/61) and in 39% of lesions (35/90). On a lesion basis, the reason for the differences were related to sum score in v1 vs. categorical system in v2 in 51% (18/35) of lesions, cutoff between PI-RADS 4 and 5 based on lesion size in v2 as opposed to the sum score in v1 in 31% (11/35) and were inconclusive in 17% (6/35). The RP subgroup indicates enhanced detection of PCas with GS 3+3 and GS 3+4 in v2. CONCLUSION PI-RADS scores of prostatic lesions frequently differed between v1 and v2, the major reasons for these differences being score-related. In men undergoing RP, PI-RADS v2 improved detection of low risk PCa, but did not increase accuracy for discrimination of GS 3+4 vs. GS≥4+3 compared to v1. Urologists should be aware of the system-related differences when interpreting PI-RADS scores.
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Affiliation(s)
- M. Haas
- Department of Radiology, Charité, Berlin
| | - K. Günzel
- Department of Urology, Charité, Berlin
| | | | | | - T. Fischer
- Department of Radiology, Charité, Berlin
| | - K. Miller
- Department of Urology, Charité, Berlin
| | - B. Hamm
- Department of Radiology, Charité, Berlin
| | - P. Asbach
- Department of Radiology, Charité, Berlin
| | - H. Cash
- Department of Urology, Charité, Berlin
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Abstract
Sertoli cell tumors are a rare malignancy which account for approximately 1.5 % of all testicular tumors. Although malignant Sertoli cell tumors are uncommon, they are associated with a poor prognosis. So far 36 cases of malignant courses of disease have been described. We present a patient with a lymphogenic metastasized Sertoli cell tumor, who 24 months after orchiectomy and extended retroperitoneal lymphadenectomy is relapse-free.
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Affiliation(s)
- K Günzel
- Klinik für Urologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland,
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Ebbing J, Seibert FS, Pagonas N, Bauer F, Miller K, Kempkensteffen C, Günzel K, Bachmann A, Seifert HH, Rentsch CA, Ardelt P, Wetterauer C, Amico P, Babel N, Westhoff TH. Dynamics of Urinary Calprotectin after Renal Ischaemia. PLoS One 2016; 11:e0146395. [PMID: 26745147 PMCID: PMC4706321 DOI: 10.1371/journal.pone.0146395] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/16/2015] [Indexed: 01/27/2023] Open
Abstract
Background: Urinary calprotectin has been identified as a promising biomarker for acute kidney injury. To date, however, the time-dependent changes of this parameter during acute kidney injury remain elusive. The aim of the present work was to define the time-course of urinary calprotectin secretion after ischaemia/reperfusion-induced kidney injury in comparison to neutrophil gelatinase—associated lipocalin, thereby monitoring the extent of tubular damage in nephron sparing surgery for kidney tumours. Methods: The study population consisted of 42 patients. Thirty-two patients underwent either open or endoscopic nephron sparing surgery for kidney tumours. During the surgery, the renal arterial pedicle was clamped with a median ischaemic time of 13 minutes (interquartile range, 4.5–20.3 minutes) in 26 patients. Ten retro-peritoneoscopic living donor nephrectomy patients and 6 nephron sparing surgery patients in whom the renal artery was not clamped served as controls. Urinary calprotectin and neutrophil gelatinase—associated lipocalin concentrations were repeatedly measured by enzyme-linked immunosorbent assay and assessed according to renal function parameters. Results: Urinary concentrations of calprotectin and neutrophil gelatinase—associated lipocalin increased significantly after ischaemia/reperfusion injury, whereas concentrations remained unchanged after nephron sparing surgery without ischaemia/reperfusion injury and after kidney donation. Calprotectin and neutrophil gelatinase—associated lipocalin levels were significantly increased 2 and 8 hours, respectively, post-ischaemia. Both proteins reached maximal concentrations after 48 hours, followed by a subsequent persistent decrease. Maximal neutrophil gelatinase—associated lipocalin and calprotectin concentrations were 9-fold and 69-fold higher than their respective baseline values. The glomerular filtration rate was only transiently impaired at the first post-operative day after ischaemia/reperfusion injury (p = 0.049). Conclusion: Calprotectin and neutrophil gelatinase—associated lipocalin can be used to monitor clinical and sub-clinical tubular damage after nephron sparing surgery for kidney tumours. Urinary calprotectin concentrations start rising within 2 hours after ischaemia/reperfusion-induced kidney injury.
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Affiliation(s)
- Jan Ebbing
- University Hospital Basel, Department of Urology, Basel, Switzerland
- Charité - University Hospital, Campus Benjamin Franklin, Department of Urology, Berlin, Germany
- * E-mail: (THW); (JE)
| | - Felix S. Seibert
- University Hospital Marien Hospital Herne, Medical Department I, Ruhr University of Bochum, Bochum, Germany
| | - Nikolaos Pagonas
- University Hospital Marien Hospital Herne, Medical Department I, Ruhr University of Bochum, Bochum, Germany
| | - Frederic Bauer
- University Hospital Marien Hospital Herne, Medical Department I, Ruhr University of Bochum, Bochum, Germany
| | - Kurt Miller
- Charité - University Hospital, Campus Benjamin Franklin, Department of Urology, Berlin, Germany
| | - Carsten Kempkensteffen
- Charité - University Hospital, Campus Benjamin Franklin, Department of Urology, Berlin, Germany
| | - Karsten Günzel
- Charité - University Hospital, Campus Benjamin Franklin, Department of Urology, Berlin, Germany
| | | | - Hans H. Seifert
- University Hospital Basel, Department of Urology, Basel, Switzerland
| | - Cyrill A. Rentsch
- University Hospital Basel, Department of Urology, Basel, Switzerland
| | - Peter Ardelt
- University Hospital Basel, Department of Urology, Basel, Switzerland
| | | | - Patrizia Amico
- University Hospital Basel, Department of Nephrology, Basel, Switzerland
| | - Nina Babel
- University Hospital Marien Hospital Herne, Medical Department I, Ruhr University of Bochum, Bochum, Germany
| | - Timm H. Westhoff
- University Hospital Marien Hospital Herne, Medical Department I, Ruhr University of Bochum, Bochum, Germany
- * E-mail: (THW); (JE)
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Cash H, Günzel K, Maxeiner A, Stephan C, Fischer T, Durmus T, Miller K, Asbach P, Haas M, Kempkensteffen C. Prostate cancer detection on transrectal ultrasonography-guided random biopsy despite negative real-time magnetic resonance imaging/ultrasonography fusion-guided targeted biopsy: reasons for targeted biopsy failure. BJU Int 2015; 118:35-43. [PMID: 26384851 DOI: 10.1111/bju.13327] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the value of additional transrectal ultrasonography (TRUS)-guided random biopsy (RB) in patients with negative magnetic resonance imaging (MRI)/ultrasonography (US) fusion-guided targeted biopsy (TB) and to identify possible reasons for TB failure. PATIENTS AND METHODS We conducted a subgroup analysis of 61 men with prostate cancer (PCa) detected by 10-core RB but with a negative TB, from a cohort of 408 men with suspicious multiparametric magnetic resonance imaging (mpMRI) between January 2012 and January 2015. A consensus re-reading of mpMRI results (using Prostate Imaging Reporting and Data System [PI-RADS] versions 1 and 2) for each suspicious lesion was performed, with the image reader blinded to the biopsy results, followed by an unblinded anatomical correlation of the lesion on mpMRI to the biopsy result. The potential reasons for TB failure were estimated for each lesion. We defined clinically significant PCa according to the Epstein criteria and stratified patients into risk groups according to the European Association of Urology guidelines. RESULTS Our analysis showed that RB detected significant PCa in 64% of patients (39/61) and intermediate-/high-risk PCa in 57% of patients (35/61). The initial mpMRI reading identified 90 suspicious lesions in the cohort. Blinded consensus re-reading of the mpMRI led to PI-RADS score downgrading of 45 lesions (50%) and upgrading of 13 lesions (14%); thus, negative TB could be explained by falsely high initial PI-RADS scores for 32 lesions (34%) and sampling of the target lesion by RB in the corresponding anatomical site for 36 out of 90 lesions (40%) in 35 of 61 patients (57%). Sampling of the target lesion by RB was most likely for lesions with PI-RADS scores of 4/5 and Gleason scores (GS) of ≥7. A total of 70 PCa lesions (67% with GS 6) in 44 patients (72%) were sampled from prostatic sites with no abnormalities on mpMRI. CONCLUSION In cases of TB failure, RB still detected a high rate of significant PCa. The main reason for a negative TB was a TB error, compensated for by positive sampling of the target lesion by the additional RB, and the second reason for TB failure was a falsely high initial PI-RADS score. The challenges that arise for both MRI diagnostics and prostate lesion sampling are evident in our data and support the integration of RB into the TB workflow.
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Affiliation(s)
- Hannes Cash
- Department of Urology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Tahir Durmus
- Department of Radiology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité-University of Medicine Berlin, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité-University of Medicine Berlin, Berlin, Germany
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Cash H, Maxeiner A, Stephan C, Fischer T, Durmus T, Holzmann J, Asbach P, Haas M, Hinz S, Neymeyer J, Miller K, Günzel K, Kempkensteffen C. The detection of significant prostate cancer is correlated with the Prostate Imaging Reporting and Data System (PI-RADS) in MRI/transrectal ultrasound fusion biopsy. World J Urol 2015; 34:525-32. [PMID: 26293117 DOI: 10.1007/s00345-015-1671-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [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: 03/30/2015] [Accepted: 08/10/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the performance of real-time MRI/ultrasound (MRI/US) fusion-guided targeted biopsy (TB) in men with primary and repeat biopsies and correlate the prostate cancer detection rate (CDR) with the PI-RADS score. METHODS Analysis included 408 consecutive men with primary and prior negative biopsies who underwent TB and 10-core random biopsy (RB) between January 2012 and January 2015. TB was performed with a real-time MRI/US fusion platform with sensor-based registration. Clinically significant PCa was defined as Gleason score (GS) ≥ 7 or GS 6 with maximal cancer core length ≥ 4 mm for TB and according to Epstein criteria for RB. RESULTS The overall CDR was 56 % (227/408). The CDR for primary biopsy was 74 % (60/81) and 57 % (67/117), 49 % (62/126), 45 % (38/84) for patients with 1, 2 and ≥ 3 prior negative biopsies. CDRs correlated with PI-RADS 2/3/4/5 were 16 % (5/32), 26 % (29/113), 62 % (94/152) and 89 % (99/111), respectively. The rates of significant tumors in relation to PI-RADS 2/3/4/5 were 60 % (3/5), 66 % (19/29), 74 % (70/94), 95 % (94/99). In 139 (61 %) cases with radical prostatectomy (RP), the rates of ≥ pT3 tumors in correlation with PI-RADS 4 and 5 were 20 % (11/56) and 49 % (32/65). PI-RADS constituted the strongest predictor of significant PCa detection (p < 0.007). CONCLUSIONS Real-time MRI/US fusion-guided TB combined with RB improved PCa detection in patients with primary and repeat biopsies. The CDR was strongly correlated with a rising PI-RADS score, values of 4 and 5 increasing the detection of clinically significant tumors and leading to a higher histological stage after RP.
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Affiliation(s)
- Hannes Cash
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Andreas Maxeiner
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Tahir Durmus
- Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Josephine Holzmann
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Jörg Neymeyer
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Carsten Kempkensteffen
- Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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15
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Ebbing J, Wiebach T, Kempkensteffen C, Miller K, Bachmann A, Günzel K, Rieken M, Friedersdorff F, Baumunk D, Weikert S. Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification. Eur J Surg Oncol 2015; 41:941-52. [DOI: 10.1016/j.ejso.2015.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/17/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022] Open
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16
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Tafelski S, Nachtigall I, Troeger U, Deja M, Krannich A, Günzel K, Spies C. Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: Continuous versus intermittent application. J Infect Public Health 2015; 8:355-63. [PMID: 25794497 DOI: 10.1016/j.jiph.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 10/18/2014] [Revised: 01/13/2015] [Accepted: 01/23/2015] [Indexed: 12/29/2022] Open
Abstract
Different dosing regimens for vancomycin are in clinical use: intermittent infusion and continuous administration. The intention of using these different dosing regimens is to reduce toxicity, to achieve target levels faster and to avoid treatment failure. The aim of this phase IV study was to compare safety and effectiveness in both administration regimens. The study was conducted in 2010 and 2011 in three postoperative intensive care units (ICUs) in a tertiary care university hospital in Berlin, Germany. Adult patients with vancomycin therapy and therapeutic drug monitoring were included. Out of 675 patients screened, 125 received vancomycin therapy, 39% with intermittent and 61% with continuous administration. Patients with continuous administration achieved target serum levels significantly earlier (median day 3 versus 4, p=0.022) and showed fewer sub-therapeutic serum levels (41% versus 11%, p<0.001). ICU mortality rate, duration of ICU stay and duration of ventilation did not differ between groups. Acute renal failure during the ICU stay occurred in 35% of patients with intermittent infusion versus 26% of patients with continuous application (p=0.324). In conclusion, continuous administration of vancomycin allowed more rapid achievement of targeted drug levels with fewer sub-therapeutic vancomycin levels observed. This might indicate that patients with more severe infections or higher variability in renal function could benefit from this form of administration.
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Affiliation(s)
- S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - I Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Uwe Troeger
- Institute for Clinical Pharmacology, Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Alexander Krannich
- Department of Biostatistics, Coordination Center for Clinical Trials, Charité - Universitätsmedizin Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Charité - Universitaetsmedizin Berlin, Campus Benjamin-Franklin, Berlin, Germany
| | - C Spies
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
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17
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Maxeiner A, Stephan C, Fischer T, Durmus T, Kilic E, Asbach P, Haas M, Günzel K, Neymeyer J, Miller K, Cash H. [Real-time MRI/US fusion-guided biopsy in biopsy-naïve and pre-biopsied patients with suspicion for prostate cancer]. Aktuelle Urol 2015; 46:34-8. [PMID: 25519051 DOI: 10.1055/s-0034-1395563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy detects more prostate cancer (PCa) than transrectal US (TRUS)-guided biopsy in patients with an indication for prostate re-biopsy. The aim of this study was a) to compare the detection rates of MRI/US fusion-guided biopsy with conventional TRUS in a double centre cohort and b) to investigate the influence of the number of pre-biopsies on the PCa detection rate. MATERIAL AND METHODS In the period from January 2012 to July 2014, 310 consecutive patients gave written informed consent and underwent 3 Tesla MRI scans of the prostate. All patients had at least one PCa suspicious lesion in the MRI and were biopsied by MRI/US fusion followed by a conventional 10-core biopsy of the prostate. Detection rates based on technique, Gleason score and number of pre-biopsies were calculated. RESULTS The overall detection rate of the study was 51% (158 patients). Among these 158 patients a histopathological Gleason score of 6 was detected in 60 patients (38%), a Gleason score of 7 in 54 patients (34%) and a Gleason score≥8 in 44 patients (28%). MRI/US fusion-guided biopsy detected 110 (69.7%) of the overall detected 158 PCa. TRUS-guided biopsy detected a higher rate of Gleason score 6 (54%) and a lower rate of Gleason score≥8 (15%) lesions in comparison to 38% Gleason 6 and 28% Gleason≥8 in the MRI/US fusion-guided biopsy, respectively. Furthermore, a lower Gleason score was observed in patients with more than one pre-biopsy. The detection rate in biopsy-naïve patients undergoing MRI/US fusion was 75% (40 patients) among 75% detected Gleason score≥7. CONCLUSION MRI/US fusion-guided biopsy detected more PCa and also more clinically significant cancer than conventional TRUS. In our cohort patients with more than one pre-biopsy showed lower Gleason scores. The included patients with an initial MRI/US fusion-guided biopsy should be further investigated.
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Affiliation(s)
- A. Maxeiner
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - C. Stephan
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - T. Fischer
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - T. Durmus
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - E. Kilic
- Klinik für Pathologie, Charité – Universitätsmedizin Berlin, CCM, Berlin
| | - P. Asbach
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - M. Haas
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - K. Günzel
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - J. Neymeyer
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - K. Miller
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - H. Cash
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
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18
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Nachtigall I, Tafelski S, Günzel K, Uhrig A, Powollik R, Tamarkin A, Wernecke KD, Spies C. Standard operating procedures for antibiotic therapy and the occurrence of acute kidney injury: a prospective, clinical, non-interventional, observational study. Crit Care 2014; 18:R120. [PMID: 24923469 PMCID: PMC4095670 DOI: 10.1186/cc13918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/28/2014] [Indexed: 12/29/2022]
Abstract
Introduction Acute kidney injury (AKI) occurs in 7% of hospitalized and 66% of Intensive Care Unit (ICU) patients. It increases mortality, hospital length of stay, and costs. The aim of this study was to investigate, whether there is an association between adherence to guidelines (standard operating procedures (SOP)) for potentially nephrotoxic antibiotics and the occurrence of AKI. Methods This study was carried out as a prospective, clinical, non-interventional, observational study. Data collection was performed over a total of 170 days in three ICUs at Charité – Universitaetsmedizin Berlin. A total of 675 patients were included; 163 of these had therapy with vancomycin, gentamicin, or tobramycin; were >18 years; and treated in the ICU for >24 hours. Patients with an adherence to SOP >70% were classified into the high adherence group (HAG) and patients with an adherence of <70% into the low adherence group (LAG). AKI was defined according to RIFLE criteria. Adherence to SOPs was evaluated by retrospective expert audit. Development of AKI was compared between groups with exact Chi2-test and multivariate logistic regression analysis (two-sided P <0.05). Results LAG consisted of 75 patients (46%) versus 88 HAG patients (54%). AKI occurred significantly more often in LAG with 36% versus 21% in HAG (P = 0.035). Basic characteristics were comparable, except an increased rate of soft tissue infections in LAG. Multivariate analysis revealed an odds ratio of 2.5-fold for LAG to develop AKI compared with HAG (95% confidence interval 1.195 to 5.124, P = 0.039). Conclusion Low adherence to SOPs for potentially nephrotoxic antibiotics was associated with a higher occurrence of AKI. Trial registration Current Controlled Trials ISRCTN54598675. Registered 17 August 2007.
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Ebbing J, Mathia S, Seibert F, Erber B, Günzel K, Pagonas N, Kilic E, Kempkensteffen C, Miller K, Bachmann A, Rosenberger C, Zidek W, Westhoff T. MP22-05 URINARY CALPROTECTIN IN BLADDER CANCER. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Wandl UB, Günzel K, Kath R, Scheulen ME, Hayungs J, Höffken K, Seeber S, Niederle N. Treatment of high-risk, nonseminomatous testicular cancer with cisplatin, ifosfamide and bleomycin: long-term results. Ann Oncol 1992; 3:123-6. [PMID: 1376618 DOI: 10.1093/oxfordjournals.annonc.a058126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Thirty-four patients with stage IIC (unresectable, retroperitoneal tumor mass (RTM) greater than 5 cm), stage IVC (minimal lung metastases less than 10 cm3 and RTM greater than 5 cm) and IVD (lung metastases greater than 10 cm3 and RTM greater than 5 cm), who had not received previous chemotherapy, were treated with cisplatin (40 mg/m2, on days 2-4), ifosfamide (5 g/m2, on days 1 and 5) and bleomycin (30 mg, on days 1, 8, 15) (PIB), every 21 days. Twenty of the 34 patients (59%) achieved a complete remission (CR). Furthermore, five patients (15%) showed no evidence of disease (NED) after surgical removal of residual tumor masses (NED rate of 74%). A tumor marker-negative partial remission (PR) occurred in 3/34 patients (9%), and a tumor marker-positive PR in another 3/34 patients (9%). Three patients did not respond to this regimen. At a median follow-up period of 38 months (range, 15-47 months), 26/34 patients (76%) were alive, 21 (62%) of them without evidence of disease and three with a stable tumor marker-negative remission. Major toxicity consisted of myelosuppression, neurotoxicity and nephrotoxicity. Chemotherapy-related mortality occurred in two patients (one septicemia and one bleomycin-induced lung fibrosis). In conclusion, PIB is an effective induction regimen in patients with high-risk NSTC. However, controlled clinical trials are necessary to prove the superiority of dose intensification schedules.
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Affiliation(s)
- U B Wandl
- Department of Internal Medicine, West German Tumor Center, University of Essen
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21
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Kath R, Günzel K, Höffken K, Schmidt CG, Donhuijsen K. [Burkitt's lymphoma in HIV-infected patients]. Dtsch Med Wochenschr 1990; 115:1293-4. [PMID: 2390943] [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: 12/31/2022]
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22
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Kath R, Höffken K, Günzel K, Nowrousian MR, Donhuijsen K, Anders CU, Sack H, Schmidt CG. [Chemotherapy of nonendemic Burkitt's lymphoma]. Dtsch Med Wochenschr 1990; 115:1219-26. [PMID: 2387214 DOI: 10.1055/s-2008-1065144] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
14 patients (12 men, 2 women, mean age 26.3 [15-47] years) with histologically confirmed Burkitt's lymphoma were subjected between 1984 and 1989 to chemotherapy originally developed for treating lymphomas in children. Treatment consisted of medium doses of methotrexate, cyclophosphamide, teniposide, cytarabine, adriamycin and prednisone, intrathecal administration of methotrexate and if necessary prophylactic or therapeutic irradiation of the cranium. Most of the patients (64%) were in advanced stages of the disease. The rate of complete remissions was 100%. Four patients (29%) had a recurrence. Side effects were leukopenia (WHO grade III and IV) in 71%, grade III anaemia in 43% and grade III-IV thrombopenia in 29% of the patients. Considerable mucositides in 5 of the 14 patients (36%), and in one case a tumour lysis syndrome with transient renal insufficiency were other therapy-induced side effects. These results suggest that this treatment course can be successful also in non-endemic Burkitt's lymphoma in adolescents and adults.
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Affiliation(s)
- R Kath
- Innere Klinik und Poliklinik, Universität Essen
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23
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Völkner E, Stoll W, Günzel K, Kühnert H, Lauterbach H. [Radiocardiographic assessment of the effect of digoxin on heart conduction insufficiency]. Z Gesamte Inn Med 1978; 33:184-7. [PMID: 645154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
On 29 patients with heart insufficiency radiocardiographical investigations in rest and under stress were carried out before and after treatment with digoxin. Here it was shown that in existing functional insufficiency the determination of the stroke volume and of the minute volume in rest after digitalisation did not result in a remarkable change, but in obstructive insufficiency an improvement of the pump function of the heart began already under conditions of rest. Only in stress also in patients with functional insufficiency a significant increase of the heart-time volume and the stroke volume after application of glycoside was proved. An exacter information about the effect of glycoside was given by the temporary volume function particularly under stress.
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Günzel K, Bittrich HJ. Mischungsenthalpien binärer Systeme mit Olefinen und Diolefinen. Z PHYS CHEM 1977. [DOI: 10.1515/zpch-1977-01144] [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: 11/15/2022]
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Völkner E, Stoll W, Günzel K, Kühnert H, Mohorn M. [72. Evaluation of the cardiac performance by means of radiocardiographic studies]. Z Gesamte Inn Med 1975; 30:220-2. [PMID: 766432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In 2 series of investigations could be established that there exist relations between the radiocardiographically determined stroke volume and minute volume in rest and the maximum receptivity of oxygen and that the effect of a digitalisation is to be judged according to the increase of stroke and minute volume in rest and under load. The values obtained by the use of 113m indium allow an evidence concerning the functional capacity of the heart. A clear reduction of the stroke volume correlates with a diminution of the maximum oxygen pulse established during an ergometric examination and the maximum receptivity of oxygen.
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