Difference In Cancer Detection Research Articles

Effectiveness of hybrid digital breast tomosynthesis/digital mammography compared to digital mammography in women presenting for routine screening at Maroondah BreastScreen: Study protocol for a co-designed, non-randomised prospective trial

BackgroundDigital breast tomosynthesis (DBT) for breast cancer screening has been shown in international trials to increase cancer detection compared with mammography; however, results have varied across screening settings, and currently there is limited and conflicting evidence on interval cancer rates (a surrogate for screening effectiveness). Australian pilot data also indicated substantially longer screen-reading time for DBT posing a barrier for adoption. There is a critical need for evidence on DBT to inform its role in Australia, including evaluation of potentially more feasible models of implementation, and quantification of screening outcomes by breast density which has global relevance. MethodsThis study is a prospective trial embedded in population-based Australian screening services (Maroondah BreastScreen, Eastern Health, Victoria) comparing hybrid screening comprising DBT (mediolateral oblique view) and digital mammography (cranio-caudal view) with standard mammography screening in a concurrent group attending another screening site. All eligible women aged ≥40 years attending the Maroondah service for routine screening will be enrolled (unless they do not provide verbal consent and opt-out of hybrid screening; are unable to provide consent; or where a ‘pushback’ image on hybrid DBT cannot be obtained). Each arm will enrol 20,000 women. The primary outcomes are cancer detection rate (per 1000 screens) and recall rate (percentage). Secondary outcomes include ‘opt-out’ rate; cohort characteristics; cancer characteristics; assessment outcomes; screen-reading time; and interval cancer rate at 24-month follow-up. Automated volumetric breast density will be measured to allow stratification of outcomes by mammographic density. Stratification by age and screening round will also be undertaken. An interim analysis will be undertaken after the first 5000 screens in the intervention group. DiscussionThis is the first Australian prospective trial comparing hybrid DBT/mammography with standard mammography screening that is powered to show differences in cancer detection. Findings will inform future implementation of DBT in screening programs world-wide and provide evidence on whether DBT should be adopted in the broader BreastScreen program in Australia or in subgroups of screening participants.

Digital breast tomosynthesis in mammographic screening: false negative cancer cases in the To-Be 1 trial

ObjectivesThe randomized controlled trial comparing digital breast tomosynthesis and synthetic 2D mammograms (DBT + SM) versus digital mammography (DM) (the To-Be 1 trial), 2016–2017, did not result in higher cancer detection for DBT + SM. We aimed to determine if negative cases prior to interval and consecutive screen-detected cancers from DBT + SM were due to interpretive error.MethodsFive external breast radiologists performed the individual blinded review of 239 screening examinations (90 true negative, 39 false positive, 19 prior to interval cancer, and 91 prior to consecutive screen-detected cancer) and the informed consensus review of examinations prior to interval and screen-detected cancers (n = 110). The reviewers marked suspicious findings with a score of 1–5 (probability of malignancy). A case was false negative if ≥ 2 radiologists assigned the cancer site with a score of ≥ 2 in the blinded review and if the case was assigned as false negative by a consensus in the informed review.ResultsIn the informed review, 5.3% of examinations prior to interval cancer and 18.7% prior to consecutive round screen-detected cancer were considered false negative. In the blinded review, 10.6% of examinations prior to interval cancer and 42.9% prior to consecutive round screen-detected cancer were scored ≥ 2. A score of ≥ 2 was assigned to 47.8% of negative and 89.7% of false positive examinations.ConclusionsThe false negative rates were consistent with those of prior DM reviews, indicating that the lack of higher cancer detection for DBT + SM versus DM in the To-Be 1 trial is complex and not due to interpretive error alone.Critical relevance statementThe randomized controlled trial on digital breast tomosynthesis and synthetic 2D mammograms (DBT) and digital mammography (DM), 2016–2017, showed no difference in cancer detection for the two techniques. The rates of false negative screening examinations prior to interval and consecutive screen-detected cancer for DBT were consistent with the rates in prior DM reviews, indicating that the non-superior DBT performance in the trial might not be due to interpretive error alone.Key points• Screening with digital breast tomosynthesis (DBT) did not result in a higher breast cancer detection rate compared to screening with digital mammography (DM) in the To-Be 1 trial.• The false negative rates for examinations prior to interval and consecutive screen-detected cancer for DBT were determined in the trial to test if the lack of differences was due to interpretive error.• The false negative rates were consistent with those of prior DM reviews, indicating that the lack of higher cancer detection for DBT versus DM was complex and not due to interpretive error alone.Graphical

MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 Apr 2023MP38-09 TRACKING MRI-INVISIBLE LESIONS DURING ACTIVE SURVEILLANCE Daniel Nemirovsky, Zoe Blake, Jacob Enders, Alexander Kenigsberg, Neil Mendrihatta, Michael Rothberg, Michael Daneshvar, Lindsey Hazen, Charisse Garcia, Sheng Xu, Baris Turkbey, Bradford Wood, Peter Pinto, and Sandeep Gurram Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Jacob EndersJacob Enders More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Michael DaneshvarMichael Daneshvar More articles by this author , Lindsey HazenLindsey Hazen More articles by this author , Charisse GarciaCharisse Garcia More articles by this author , Sheng XuSheng Xu More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , Peter PintoPeter Pinto More articles by this author , and Sandeep GurramSandeep Gurram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monitoring MRI-invisible prostate cancer remains a challenge for patients on active surveillance (AS) due to an inability to reliably re-biopsy tumors without an associated lesion on MRI. In this study, we sought to describe our experience using a prostate image-fusion platform in tracking MRI-invisible lesions in patients on AS, as well as to determine differences in cancer detection and upgrading rates between systematic, MRI-targeted, and tracked biopsies. METHODS: A prospectively maintained AS database was queried for patients with ≥1 tracked prostate biopsy session. Needle trajectories of all biopsy cores were saved using the UroNav™ (Philips) platform. Patients underwent MRI/US guided biopsies of systematic and MRI-targeted lesions via transperineal or transrectal approaches. Tracked biopsy was defined as a repeat MRI/US fusion-guided biopsy which re-targeted regions corresponding to previously positive systematic cores not associated with MRI visible lesions. Gleason grade was compared between initial and subsequent biopsy sessions for all three biopsy modalities: systematic, MRI-targeted, and tracked. RESULTS: Between 2009-2022, 271 patients on AS with ≥1 tracked biopsy sessions were identified. 101/271 (37.3%) had two tracked biopsy sessions and 31/271 (11.4%) had three. The median time from initial to subsequent biopsy session was 19 months (IQR: 13-29). Among 271 patients, there were 83 upgrading events captured by the three modalities on first repeat biopsy (Table 1). On first repeat biopsy, 31/83 (37.3%) upgrading events were identified by tracking, with 11/83 (13.3%) identified only on tracking biopsy. Of the 110 total upgrading events between the three repeat tracked biopsy sessions, 41/110 (37.3%) were captured on tracking, with 16/110 (14.5%) discovered solely by tracking. The median number of biopsy cores for systematic, MRI-targeted, and tracked approaches were 12, 4 (IQR: 2-4), and 2 (IQR: 2-4), respectively. CONCLUSIONS: In this series, a significant portion of upgrading events for patients on AS were uniquely identified on tracked biopsy and would have otherwise been missed on repeat systematic and MRI-targeted biopsy. Notably, given the low number of additional biopsy cores required for tracking, this approach may be an appropriate and low-risk supplement to standard AS protocols. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e527 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Jacob Enders More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Michael Rothberg More articles by this author Michael Daneshvar More articles by this author Lindsey Hazen More articles by this author Charisse Garcia More articles by this author Sheng Xu More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Sandeep Gurram More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study.

To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain. We conducted a before-and-after, study to evaluate participation, recall, false positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012-2019). Using multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571women. During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR = 0.90 [95% CI = 0.84-0.96]) and in those who had previously participated regularly and irregularly (aOR = 0.63 [95% CI = 0.59-0.67] and aOR = 0.95 [95% CI = 0.86-1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR = 1.10 [95% CI = 1.01-1.20]). The recall rate decreased in both prevalent and incident screening (aOR = 0.74 [95% CI = 0.56-0.99] and aOR = 0.80 [95% CI = 0.68-0.95], respectively). False positives also decreased in both groups (prevalent aOR = 0.92 [95% CI = 0.66-1.28] and incident aOR = 0.72 [95% CI = 0.59-0.88]). No significant differences were observed in compliance with recall (OR = 1.26, 95% CI = 0.76-2.23), cancer detection rate (aOR = 0.91 [95% CI = 0.69-1.18]), or cancer stages. The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays. This study has received funding by grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).

Risk of Cancer in Regular and Low Meat-Eaters, Fish-Eaters, and Vegetarians: A Prospective Analysis of UK Biobank Participants

ObjectivesVegetarians may have a lower risk of cancer overall; however, for specific cancer sites, the evidence is limited. We aimed to assess the associations of vegetarian and non-vegetarian diets with risks of all cancer, colorectal cancer, postmenopausal breast cancer, and prostate cancer, and to explore the role of potential mediators. MethodsWe conducted a prospective analysis of 472,377 UK Biobank participants who were free from cancer at recruitment. Participants were categorised into regular meat-eaters (n = 247,571), low meat-eaters (n = 205,385), fish-eaters (n = 10,696), and vegetarians (n = 8,685) based on dietary questions completed at recruitment. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all cancer incidence and separate cancer sites across diet groups. ResultsAfter an average follow-up of 11.4 years, 54,961 incident cancers were identified from health records, including 5,882 colorectal, 7,537 postmenopausal breast, and 9,501 prostate cancers. Compared with regular meat-eaters, being a low meat-eater, fish-eater, or vegetarian were all associated with a lower risk of all cancer (HR:0.98, 95% CI:0.96–1.00; 0.90, 0.84–0.96; 0.86, 0.80–0.93, respectively). Being a low meat-eater was associated with a lower risk of colorectal cancer in comparison to regular meat-eaters (0.91, 0.86–0.96). Vegetarian postmenopausal women had a lower risk of breast cancer (0.82, 0.68–0.99), which was attenuated and non-significant after adjusting for BMI (0.87, 0.72–1.05); in mediation analyses, BMI was found to possibly mediate the observed association. In men, being a fish-eater or a vegetarian was associated with a lower risk of prostate cancer (0.80, 0.65–0.99 and 0.69, 0.54–0.89, respectively). ConclusionsThe lower risk of colorectal cancer in low meat-eaters is consistent with previous evidence suggesting an adverse impact of higher meat intake. The lower risk of postmenopausal breast cancer in vegetarian women may be explained by their lower BMI. It is unclear if the other differences observed for all cancers and for prostate cancer reflect causal relationships or are due to residual confounding or differences in cancer detection. Funding SourcesCRUK grant (C8221/A29017) and World Cancer Research Fund UK(2019/1953).

MP58-19 COMPARISON OF URONAV TRUS AND COGNITIVE FUSION TP BIOPSY IN DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP58-19 COMPARISON OF URONAV TRUS AND COGNITIVE FUSION TP BIOPSY IN DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER Amanda Sherman, Daneil Kuftinec, Lori Lyn Price, Alireza Moinzadeh, and William Faust Amanda ShermanAmanda Sherman More articles by this author , Daneil KuftinecDaneil Kuftinec More articles by this author , Lori Lyn PriceLori Lyn Price More articles by this author , Alireza MoinzadehAlireza Moinzadeh More articles by this author , and William FaustWilliam Faust More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal (TP) prostate biopsy is a safe and effective technique to sample the prostate gland with less risk of infection and bleeding. Targeting of abnormal lesions on MRI at time of biopsy can be performed with cognitive fusion or software-based platforms. The success of TP MRI-guided biopsy, particularly cognitive fusion, remains unclear. This study compares cancer detection rates between software-based transrectal US (TRUS)/MRI fusion biopsy and cognitive fusion TP prostate biopsy. METHODS: Biopsies (n=495) taken between 2019 and 2021 were performed using either TRUS with UroNav (TRUSUN) guidance, or via TP approach with cognitive fusion (TPCF) to target MRI lesion. Demographic characteristics, PSA, prostate volume, DRE status, highest PIRADS lesion on MRI and final biopsy pathology were collected. Cancer Detection Rate (CDR), clinically significant Cancer Detection Rate (csCDR), and clinically significant cancer detection rate in target only (csCDRt) were compared by technique type. Statistical analysis was performed using Chi-squared, Fisher's exact, and t-tests as appropriate. RESULTS: A total of 377 TRUSUN and 118 TPCF prostate biopsies were performed. TPCF detected more cancers of any grade (p=0.02), but there was no difference in csCDR or csCDRt. When stratified by lesion, there was no difference in cancer detection except in the PIRADS 5 group, where TPCF outperformed TRUSUN biopsy in detecting clinically significant prostate cancer (p=0.006). Further analysis of the PIRADS 5 group found no difference in baseline characteristics except for age (mean age 72.2y in TP group, 68.7y in TRUS p=0.008). CONCLUSIONS: TPCF prostate biopsy showed similar rates of csCDR and csCDRt as TRUSUN prostate biopsy. When analyzed by PI-RADS score, TPCF was found to have similar or, in the case of PI-RADS 5 lesion, superior csCDRt. Subgroup analysis did not find significant group differences, aside from age, to explain this finding. This data suggests that TPCF is as effective at detecting clinically significant prostate cancer as TRUSUN. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e999 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Sherman More articles by this author Daneil Kuftinec More articles by this author Lori Lyn Price More articles by this author Alireza Moinzadeh More articles by this author William Faust More articles by this author Expand All Advertisement PDF DownloadLoading ...

Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants

BackgroundFollowing a vegetarian diet has become increasingly popular and some evidence suggests that being vegetarian may be associated with a lower risk of cancer overall. However, for specific cancer sites, the evidence is limited. Our aim was to assess the associations of vegetarian and non-vegetarian diets with risks of all cancer, colorectal cancer, postmenopausal breast cancer, and prostate cancer and to explore the role of potential mediators between these associations.MethodsWe conducted a prospective analysis of 472,377 UK Biobank participants who were free from cancer at recruitment. Participants were categorised into regular meat-eaters (n = 247,571), low meat-eaters (n = 205,385), fish-eaters (n = 10,696), and vegetarians (n = 8685) based on dietary questions completed at recruitment. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all cancer incidence and separate cancer sites across diet groups.ResultsAfter an average follow-up of 11.4 years, 54,961 incident cancers were identified, including 5882 colorectal, 7537 postmenopausal breast, and 9501 prostate cancers. Compared with regular meat-eaters, being a low meat-eater, fish-eater, or vegetarian were all associated with a lower risk of all cancer (HR: 0.98, 95% CI: 0.96–1.00; 0.90, 0.84–0.96; 0.86, 0.80–0.93, respectively). Being a low meat-eater was associated with a lower risk of colorectal cancer in comparison to regular meat-eaters (0.91, 0.86–0.96); however, there was heterogeneity in this association by sex (p = 0.007), with an inverse association across diet groups in men, but not in women. Vegetarian postmenopausal women had a lower risk of breast cancer (0.82, 0.68–0.99), which was attenuated and non-significant after adjusting for body mass index (BMI; 0.87, 0.72–1.05); in mediation analyses, BMI was found to possibly mediate the observed association. In men, being a fish-eater or a vegetarian was associated with a lower risk of prostate cancer (0.80, 0.65–0.99 and 0.69, 0.54–0.89, respectively).ConclusionThe lower risk of colorectal cancer in low meat-eaters is consistent with previous evidence suggesting an adverse impact of meat intake. The lower risk of postmenopausal breast cancer in vegetarian women may be explained by their lower BMI. It is not clear whether the other differences observed for all cancers and for prostate cancer reflect any causal relationships or are due to other factors such as residual confounding or differences in cancer detection.

The Role of Ultrasound in Screening Dense Breasts-A Review of the Literature and Practical Solutions for Implementation.

Breast cancer is the second leading cause of cancer death in women. Estimates indicate a nearly 40% breast cancer mortality reduction when screening women annually starting at age 40. Although mammography is well known to be a powerful screening tool in the detection of early breast cancer, it is imperfect, particularly for women with dense breasts. In women with dense breast tissue, the sensitivity of mammography is reduced. Additionally, women with dense breasts have an increased risk of developing breast cancer while mammography has a lower sensitivity. Screening ultrasound, both handheld and automated, is effective in detecting mammographically occult cancer in women with dense tissue. Studies have shown that ultrasound significantly increases detection of clinically important, small, largely invasive, node-negative cancers. The purpose of this review article is to summarize the literature to date regarding screening breast ultrasound, emphasizing differences in cancer detection in high risk and intermediate risk women, and to discuss practical ways to implement screening ultrasound in clinical practice, including automated whole breast ultrasound, as a viable solution to the increasing need for additional screening.

Nurse-led service development for suspected bowel cancer

Bowel cancer is the fourth most common cancer in the UK. Early diagnosis has a significant effect on survival rates.Referral guidelines for suspected bowel cancer state that symptomatic patients should be referred by a GP for an appointment with a specialist within two weeks. Once referred, the primary aim of secondary care clinics is early diagnosis.This article describes a nurse-led service development to respond to the increasing numbers of people with suspected bowel cancer referred under the two-week guideline. The reconfigured service has streamlined care, reduced waiting times and has been received positively by patients.The innovation resulted in the award of an international travel scholarship for the team. As a result, the first transanal total mesorectal excision has been performed in the trust and the team’s knowledge of malignant and benign conditions in the bowel has improved.The service has further responded to increased demand by providing telephone assessments. Audits are being conducted to assess and compare patient satisfaction with face-to-face versus telephone assessments, and any differences in cancer detection, number or type of investigation.

Overview of Tomosynthesis (3D Mammography) for Breast Cancer Screening

This review of the evidence on digital breast tomosynthesis, a 3D-mammography technology, for breast cancer (BC) screening describes two types of studies. Prospective trials comparing tomosynthesis (combined with 2D mammography) with 2D mammography alone in the same participants were based on double-reading practice in mostly biennial screening. These showed incremental BC detection attributed to use of tomosynthesis ranging from 2.2 to 2.7 per 1000 screens. Retrospective studies reported the difference in BC detection between women screened with tomosynthesis (2D plus 3D mammography) or with 2D mammography alone, using single-reading and mostly annual screening. Differences in cancer detection ranged between 0.2 and 2.1 per 1000 screens favoring tomosynthesis. The impact of using tomosynthesis on recall was heterogeneous; however, significant reduction in recall rates was observed among the retrospective studies.

Higher Prostate Cancer Grade Groups Are Detected in Patients Undergoing Multiparametric MRI-targeted Biopsy Compared With Standard Biopsy.

Recent studies have suggested that multiparametric magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided prostate biopsy can detect more clinically significant prostate cancers, which could impact patient management. As many of the studies evaluating MRI/US fusion-guided prostate biopsy were conducted in specialized quaternary care centers, the question remains whether this technology is transferable to general practice. Our study assesses the diagnostic ability of MRI/US fusion-guided prostate biopsy compared with standard biopsy in the new era of prostate cancer Grade Grouping. We reviewed our prostate biopsy database evaluating men who underwent MRI/US fusion-guided prostate biopsy with concurrent standard 12-core extended-sextant biopsy. Patient demographics and pathologic findings were reviewed. All patient biopsies were performed by 1 of 2 urologic oncologists. Tumors were given a Grade Group for each biopsy based on the core with the highest grade in each case. A total of 191 patients underwent MRI/US fusion-guided biopsy with concurrent 12-core extended sextant biopsy, with a cancer detection rate of 56%. The average number of biopsy cores obtained via the targeted approach was significantly less than those obtained by standard biopsy, 4.8 cores versus 12 cores, respectively, P<0.001. There was no difference in cancer detection between targeted and standard biopsy, 41.4% and 49.2%, respectively, P=0.15. However, when comparing the 2 techniques, the degree of detection of ≥Grade Group 3 tumors significantly favored targeted biopsy over standard biopsy (P=0.009). MRI/US fusion-guided prostate biopsy is equivalent to the standard-of-care 12-core biopsy in terms of cancer detection and superior in detecting higher grade disease.

An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources

PurposeTo review the ability of an abbreviated, high-risk, screening, breast MRI protocol to detect cancer and save resources. MethodsHigh-risk screening breast MR images were reviewed, from both an abbreviated protocol and a full diagnostic protocol. Differences in cancer detection, scanner utilization, interpretation times, and need for additional imaging were recorded in an integrated data form, and reviewed and compared. ResultsA total of 568 MRI cases were reviewed, with the abbreviated and full protocols. No difference was found in the number of cancers detected. Scan times were decreased by 18.8 minutes per case, for a total of 10,678 minutes (178 hours). Interpretation time, on average, was 1.55 minutes for the abbreviated protocol, compared with 6.43 minutes for the full protocol. Review of the full protocol led to a significant change in the final BI-RADS® assessment in 12 of 568 (2.1%) cases. ConclusionsAbbreviated MRI is as effective as full-protocol MRI for demonstration of cancers in the high-risk screening setting, with only 12 (2.1 %) cases recommended for additional MRI evaluation. The efficiency and resource savings of an abbreviated protocol would be significant, and would allow for opportunities to provide MRI for additional patients, as well as improved radiologist time management and workflow, with the potential to add real-time MRI interpretation or double reading.

An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources

PurposeTo review the ability of an abbreviated, high-risk, screening, breast MRI protocol to detect cancer and save resources. MethodsHigh-risk screening breast MR images were reviewed, from both an abbreviated protocol and a full diagnostic protocol. Differences in cancer detection, scanner utilization, interpretation times, and need for additional imaging were recorded in an integrated data form, and reviewed and compared. ResultsA total of 568 MRI cases were reviewed, with the abbreviated and full protocols. No difference was found in the number of cancers detected. Scan times were decreased by 18.8 minutes per case, for a total of 10,678 minutes (178 hours). Interpretation time, on average, was 1.55 minutes for the abbreviated protocol, compared with 6.43 minutes for the full protocol. Review of the full protocol led to a significant change in the final BI-RADS® assessment in 12 of 568 (2.1%) cases. ConclusionsAbbreviated MRI is as effective as full-protocol MRI for demonstration of cancers in the high-risk screening setting, with only 12 (2.1 %) cases recommended for additional MRI evaluation. The efficiency and resource savings of an abbreviated protocol would be significant, and would allow for opportunities to provide MRI for additional patients, as well as improved radiologist time management and workflow, with the potential to add real-time MRI interpretation or double reading.

Utilité de l’IRM pré-biopsique dans la détection du cancer de prostate : étude mono-opérateur

The diagnostic for prostate cancer is changing. To improve the detection of this cancer, urologists expect a lot from the contribution of magnetic resonance imaging (MRI). What is the role of this imaging in prostate cancer detection? This is a retrospective study, from 2011 to 2013, mono-centric and single-operator. Of the 464 needle biopsy of the prostate (BP), we excluded those with PSA>20 ng/mL or digital rectal examination (DRE)>T3. The remaining 430 BP were submitted or not to a 1.5 tesla MRI with pelvic antenna. The primary aim is the overall detection of prostate cancer. Secondary aim was the detection rate during the first series of BP and repeat BP, between the two groups in the MRI group. MRI and MRI without populations are comparable for age (63.3 vs 64.6), PSA (6.10 vs 6.13), DRE>T1c, prostate volume (55.4 cm(3) vs 51.7 cm(3)). There is no significant difference in overall detection between the two groups (P=0.12). There is no significant difference in cancer detection between the first BP (P=0.13) and the repeat BP (P=0.07). There is a significant difference in the early detection of BP MRI group (P=0.03) but not for the BP repeat MRI group (P=0.07). For 108 BP iterative MRI group, there were 67 BP targeted "mentally" with MRI: 18 cancers were detected, making a 25% detection rate. This study helps to highlight the value of MRI in the early rounds of BP but we can ask the value of this imaging during repeat biopsies. Targeted biopsies "mentally" do not have the expected detection sensitivity and seems to require a three-dimensional reconstruction to be more effective. 5.

Repeat Prostate Biopsy Strategies after Initial Negative Biopsy: Meta-Regression Comparing Cancer Detection of Transperineal, Transrectal Saturation and MRI Guided Biopsy

IntroductionThere is no consensus on how to investigate men with negative transrectal ultrasound guided prostate biopsy (TRUS-B) but ongoing suspicion of cancer. Three strategies used are transperineal (TP-B), transrectal saturation (TS-B) and MRI-guided biopsy (MRI-B). We compared cancer yields of these strategies.MethodsPapers were identified by search of Pubmed, Embase and Ovid Medline. Included studies investigated biopsy diagnostic yield in men with at least one negative TRUS-B and ongoing suspicion of prostate cancer. Data including age, PSA, number of previous biopsy episodes, number of cores at re-biopsy, cancer yield, and Gleason score of detected cancers were extracted. Meta-regression analyses were used to analyse the data.ResultsForty-six studies were included; 12 of TS-B, 14 of TP-B, and 20 of MRI-B, representing 4,657 patients. Mean patient age, PSA and number of previous biopsy episodes were similar between the strategies. The mean number of biopsy cores obtained by TP-B and TS-B were greater than MRI-B. Cancer detection rates were 30·0%, 36·8%, and 37·6% for TS-B, TP-B, and MRI-B respectively. Meta-regression analysis showed that MRI-B had significantly higher cancer detection than TS-B. There were no significant differences however between MRI-B and TP-B, or TP-B and TS-B. In a sensitivity analysis incorporating number of previous biopsy episodes (36 studies) the difference between MRI-B and TP-B was not maintained resulting in no significant difference in cancer detection between the groups. There were no significant differences in median Gleason scores detected comparing the three strategies.ConclusionsIn the re-biopsy setting, it is unclear which strategy offers the highest cancer detection rate. MRI-B may potentially detect more prostate cancers than other modalities and can achieve this with fewer biopsy cores. However, well–designed prospective studies with standardised outcome measures are needed to accurately compare modalities and define an optimum re-biopsy approach.

Prostate cancer detection and complication rates with transrectal ultrasound-guided prostate biopsies among different operators

ObjectiveTo evaluate interoperator differences in cancer detection and complication rates using transrectal ultrasound (TRUS)-guided prostate biopsies. We also analyzed whether there was a correlation between the experience of the operator and the cancer detection rate. Materials and methodsMedical records of 1879 patients who underwent a TRUS-guided prostate biopsy between 2005 and 2009 were retrospectively reviewed. Among them, 1496 patients who underwent a first biopsy without previous prostate surgery were selected for the analysis. Five urology residents performed 327, 351, 218, 332, and 268 biopsies, respectively. Cancer detection rates were analyzed by comparing the initial 20 and 100 patients with the final 20 and 100 patients. Patients were subdivided into two groups: prostate-specific antigen (PSA) of approximately 4–10 and >10 ng/mL. Prostate cancer (CaP) detection and complication rates were compared among operators. ResultsCancer was detected in 541 patients (36%). The operators performed a median of 403 (range: approximately 277–436) transrectal sono-guided prostate biopsies with CaP detection rates of approximately 33.9–42.2% (p = 0.243). Among different operators, we found no differences in cancer detection rates for the initial 100 or final 100 patients, even when separating patients into PSA > 10 ng/mL and 4 < PSA < 10 ng/mL groups. But significant individual variations in CaP-positive rates (p = 0.046) were observed in the first 20 biopsies for patients with PSA > 10 ng/mL receiving a TRUS biopsy; however, variable PSA levels in different groups of patients may have been responsible for this finding. There were no differences in complication rates among the different operators for the initial 20 and final 20 biopsies or for the initial 50 and final 50 biopsies. ConclusionNo clinically significant differences in CaP detection existed among operators performing TRUS-guided prostate biopsies. Complication rates did not differ among the operators. A TRUS-guided prostate biopsy is a rapidly learned technique and is a good diagnostic tool for CaP detection.

PWE-100 Repeat two week wait referrals for suspected colorectal cancer

IntroductionThe two week-wait pathway for suspected colorectal cancer (CRC2ww) ensures prompt review and investigation of patients with symptoms concerning for malignancy. Previous investigation of such patients does not preclude future...

Is extended biopsy protocol justified in all patients with suspected prostate cancer?

To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson's Chi square test with level of significance set at <0.05. The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04) Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE.

The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis

This systematic review was performed to compare the efficacy and complications of transperineal (TP) vs. transrectal (TR) prostate biopsy. A systematic research of PUBMED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer (PCa) detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen (PSA) levels and digital rectal examination (DRE) findings. The Cochrane Collaboration's RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials (RCTs) and four case-control studies (CCS), met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups (risk difference (RD), -0.02; 95% confidence interval (CI), -0.08-0.03; P=0.34). Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group (RD, -0.01; 95% CI, -0.05-0.04; P=0.81). There was no significant difference in PCa detection rate between the saturation TR and TP approaches (31.4% vs. 25.7%, respectively; P=0.3). There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.

EFFECT OF PHOSPHODIESTERASE TYPE 5 INHIBITOR (PDE5I) USE ON LOWER URINARY TRACT SYMPTOMS (LUTS) OVER TIME AMONG MEN ON WATCHFUL WAITING VERSUS BPH MEDICAL THERAPY: RESULTS FROM THE BPH REGISTRY

To determine if cancer detection rates vary with prostate size using a sextant core biopsy pattern.We reviewed 1021 transrectal ultrasound (TRUS)-guided sextant pattern prostate biopsies to determine if cancer detection varied based on prostate size. Prostate size was determined using a computer generated elliptical estimation method. Sextant core biopsies were taken, and the patients divided into groups based on estimated size of the prostate and biopsy outcome. Large prostates were those that were estimated by TRUS as 50 cc or more. Prostates were considered small if they were less than 50 cc. Groups were compared based on size and biopsy outcome.Adenocarcinoma was detected in 33% (334 of 1021) of the patients. Large prostates were noted in 34% (346 of 1021), of which 23% (80 of 346) had cancer detected by sextant biopsy. Small prostates were noted in 66% (675 of 1021), of which 38% (254 of 675) had cancer detected. The difference in cancer detection in large and small glands using a sextant pattern was statistically significant (P < 0.01). Patients with positive biopsies had significantly smaller prostate sizes (40 cc ± 26) when compared with those with negative biopsies (51 cc ± 33) (P < 0.01). Only 14% (8 of 58) of patients with gland sizes 100 cc or greater had positive sextant biopsies while 49% (118 of 239) with prostates 25 cc or less had cancer detected. Multivariate statistical analysis was used to control for differences in age, prostate-specific antigen (PSA), PSA density, TRUS findings, and digital rectal examiniation between the large and small prostate groups. The difference in cancer detection persisted (P < 0.05)Currently no evidence exists to support differing cancer rates based on gland size alone. Our cancer detection rate using a sextant pattern was higher in men with prostates less than 50 cc, and patients diagnosed with cancer had significantly smaller prostates than those with a negative sextant biopsy. Our data suggest that significant sampling error may occur in men with large glands, and more biopsies may be needed under these circumstances. The effects of tumor volume, focality, and specimen size in relation to overall gland size may contribute to these findings.