History Of Biopsy Research Articles

Perineal prostate biopsy

The prostate biopsy is an essential tool for diagnosing prostate cancer (PCa). While transrectal biopsy (TR-Bx) continues to be considered the gold standard in Germany, the European Association of Urology (EAU) guidelines increasingly recommend transperineal biopsy (TP-Bx) due to lower infection rates and higher tumor detection rates. This article provides an overview of the history and development of the perineal biopsy, compares TR-Bx and TP-Bx and discusses the need for antibiotic prophylaxis before TP-Bx. Current studies have shown that TP-Bx can be performed without antibiotic prophylaxis and new techniques such as robotic-assisted and vector biopsy show very precise results. The establishment of TP-Bx is being promoted by extrabudgetary funding and technological advancements, with the choice of biopsy method remaining an individual decision jointly made in dialogue with the patient.

Pathological Assessment of Men with Grade Group 2 Prostate Cancer.

A variety of treatment options are now available for men with localized prostate cancer (PC); however, there is still debate in determining how and when to intervene for Grade Group (GG) 2 disease. Our study aims to formulate strategies to identify men at risk of upgrading and having adverse pathological outcomes. This retrospective study includes 243 patients with GG2 PC that were treated with radical prostatectomy between 2015 and 2021. Patients on active surveillance, previous history of prostate biopsy, hormonal and/or radiation therapy prior to surgery were excluded from this study. A retrospective analysis was conducted using clinicopathological data obtained from medical records. Prostate-specific antigen (PSA) and Prostate Imaging Reporting and Data System (PI-RADS) score were statistically significant variables for risk of upgrading. In men who had presence of composite poor outcomes, PSA, PI-RADS score, presence of extraprostatic extension and seminal vesical invasion on MRI, number of positive cores, percentage of high grade (pattern 4/5) on prostate biopsy and Gleason pattern 4 volume on biopsy were all statistically significant variables. Strategy 8 (PI-RADS 5 lesion or percentage high grade [Gleason pattern 4] on prostate biopsy grade >10% or >3 cores positive on prostate biopsy) had significant association to identifying the highest number of men with upgrading and composite poor outcomes. Our study supports the use of strategy 8 in treatment decision making of men with GG2 PC. Further validation of the use of this strategy is warranted.

Prior Negative Biopsy, PSA Density, and Anatomic Location Impact Cancer Detection Rate of MRI-Targeted PI-RADS Index Lesions.

MRI fusion prostate biopsy has improved the detection of clinically significant prostate cancer (CSC). Continued refinements in predicting the pre-biopsy probability of CSC are essential for optimal patient counseling. We investigated potential factors related to improved cancer detection rates (CDR) of CSC in patients with PI-RADS ≥ 3 lesions. The pathology of 980 index lesions in 980 patients sampled by transrectal mpMRI-targeted prostate biopsy across four medical centers between 2017-2020 was reviewed. PI-RADS lesion distribution included 291 PI-RADS-5, 374 PI-RADS-4, and 315 PI-RADS-3. We compared CDR of index PI-RADS ≥ 3 lesions based on location (TZ) vs. (PZ), PSA density (PSAD), and history of prior negative conventional transrectal ultrasound-guided biopsy (TRUS). Mean age, PSA, prostate volume, and level of prior negative TRUS biopsy were 66 years (43-90), 7.82 ng/dL (5.6-11.2), 54 cm3 (12-173), and 456/980 (46.5%), respectively. Higher PSAD, no prior history of negative TRUS biopsy, and PZ lesions were associated with higher CDR. Stratified CDR highlighted significant variance across subgroups. CDR for a PI-RADS-5 score, PZ lesion with PSAD ≥ 0.15, and prior negative biopsy was 77%. Conversely, the CDR rate for a PI-RADS-4 score, TZ lesion with PSAD < 0.15, and prior negative biopsy was significantly lower at 14%. For index PI-RADS ≥ 3 lesions, CDR varied significantly based on location, prior history of negative TRUS biopsy, and PSAD. Such considerations are critical when counseling on the merits and potential yield of prostate needle biopsy.

Does the type of the previous biopsy affect the fusion prostate biopsy results?

BackgroundIt has been more than a decade since fusion prostate biopsy (FPB) has been used in the diagnosis of prostate cancer (PCa). Therefore, patients with a previous history of negative FPB and ongoing suspicion of PCa are beginning to emerge. This study investigated whether the first biopsy type (standard or fusion) should be effective in deciding on a second biopsy. MethodsMale patients aged 40–75, with a serum prostate-specific antigen (PSA) value of less than 10 ng/mL and a negative biopsy history within the last 24 months, who underwent FPB in our clinic due to persistent PSA elevation and/or suspicious multiparametric prostate magnetic resonance imaging (MpMRI) findings were included to the study. Patients were divided into groups according to the type of first biopsy (Group 1; those whose first biopsy was FPB, Group 2; those whose first biopsy was standard prostate biopsy). Some demographic and clinical data of the groups, as well as PCa detection rates, were compared. A p value of less than 0.05 was considered statistically significant. ResultsA total of 275 patients (Group 1: 84, Group 2: 191) were included in this study. The groups were similar in terms of age, PSA values before the first biopsy, PSA values before the second biopsy, family history of PCa, and prostate volume. PCa was detected at a higher rate in Group 2 than Group 1 (23% vs 15.5%, p = 0.044). ConcluisonThe data obtained from this study indicate that the type of initial biopsy should be taken into account when deciding on FPB in secondary patients with a previous negative biopsy history.

A prospective evaluation of the prostate microbiome in malignant and benign tissue using transperineal biopsy.

The link between the prostate microbiome and prostate cancer remains unclear. Few studies have analyzed the microbiota of prostate tissue, and these have been limited by potential contamination by transrectal biopsy. Transperineal prostate biopsy offers an alternative and avoids fecal cross-contamination. We aim to characterize the prostate microbiome using transperineal biopsy. Patients with clinical suspicion for prostate cancer who were to undergo transperineal prostate biopsy with magnetic resonance imaging(MRI) fusion guidance were prospectively enrolled from 2022 to 2023. Patients were excluded if they had Prostate Imaging Reporting and Data System lesions with scores ≤ 3, a history of prostate biopsy within 1 year, a history of prostate cancer, or antibiotic use within 30 days of biopsy. Tissue was collected from the MRI target lesions and nonneoplastic transitional zone. Bacteria were identified using 16S ribosomal RNA gene sequencing. Across the 42 patients, 76% were found to have prostate cancer. Beta diversity indices differed significantly between the perineum, voided urine, and prostate tissue. There were no beta diversity differences between cancerous or benign tissue, or between pre- and postbiopsy urines. There appear to be unique genera more abundant in cancerous versus benign tissue. There were no differences in alpha diversity indices relative to clinical findings including cancer status, grade, and risk group. We demonstrate a rigorous method to better characterize the prostate microbiome using transperineal biopsy and to limit contamination. These findings provide a framework for future large-scale studies of the microbiome of prostate cancer.

MYH9-related disorder with sole presentation of end-stage kidney disease and long-term, recurrence-free living after living donor renal transplantation: a case report.

MYH9-related disorders are a group of autosomal dominant disorders caused by mutations in MYH9, and are characterized by thrombocytopenia, sensorineural hearing loss, cataracts, and renal failure. Here, we report a case of chronic renal failure due to MYH9-related disorder with renal symptoms in a patient who underwent living-donor renal transplantation. The patient was diagnosed with proteinuria during a health checkup at the age of 12years. Her renal function gradually deteriorated, and hemodialysis was initiated at 34years of age. No definitive diagnosis of renal disease was made through renal biopsy. At the age of 35, she underwent living-donor renal transplantation from her mother as the donor. Six years after transplantation, her renal function remained stable, and no evidence of recurrent nephritis was found during renal biopsies. The family history revealed that her father, uncle, and younger brother had end-stage kidney disease. Genetic testing revealed a mutation (p.E1653D) related to the MYH9 gene. As her father had a history of renal biopsy and was diagnosed with focal segmental glomerulosclerosis (FSGS), we diagnosed chronic renal failure due to FSGS associated with MYH9 disorder. There were no findings suggestive of hearing loss, cataracts, or thrombocytopenia in the recipient or their family members with renal failure, and no symptoms other than renal failure were noted.

Lessons learned from a genetic counseling randomized clinical trial: Implications for recruiting individuals identifying as Asians in research.

1576 Background: Despite the clinical importance of genetic testing and counseling for cancer risk reduction and treatment, minority populations are less likely to receive genetic testing and counseling or participate in genetics research, contributing to health disparities. In a randomized study of three modes of genetic counseling (GC3) conducted in three safety net hospitals, we noted a lower accrual of participants identifying as Chinese despite the availability of language-concordant study documents and bilingual staff. To understand barriers to recruitment, we conducted a mixed methods study using responses to the San Francisco Mammography Registry (SFMR) Breast Health History questionnaire (used for recruitment for GC3) and qualitative interviews with seven participants of the genetic counseling study. Methods: We extracted data from the SFMR from 2014-2018 for patients self-identifying as Asian and a control group of patients self-identifying as White. The primary outcome was the proportion of patients who agreed to be contacted for future breast health research. Survey data included information for personal history of breast cancer, history of biopsy, first-degree relative with cancer, age, and level of education. Z-tests were conducted for comparisons between groups. For qualitative analysis, seven Chinese-identifying participants were interviewed to understand why they chose to participate in the genetic counseling study and identify potential barriers and facilitators. Results: We included 121,415 patients (n=38,483 Asian). Asian patients had significantly lower rates of accepting future contact for breast health research studies (25.4% for Asians vs. 48.3% for White, p&lt;0.0001). Lower rates were observed across Chinese (23.3%), Filipina (30.2%), Japanese (27.8%), and Vietnamese (23.3%) subgroups (p&lt;0.0001 for all). A history of breast cancer (personal or family) or biopsy was associated with higher rates of acceptance within both Asian and White groups (p&lt;0.001 for all comparisons). Education did not change participation rates as much in Asian patients as in White patients. The qualitative study found barriers across three domains: awareness, opportunity, and acceptance, with a referral from the participant’s medical team identified as a facilitator. Conclusions: Individuals identifying as Asian in the SFMR were less likely to agree to be contacted for future breast health research. We identified multilevel barriers through qualitative interviews. This has important implications for designing recruitment strategies for Asian populations.

A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI

To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx). We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC. Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75. Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI.

Bridging Gaps: Analyzing Breast Imaging-Reporting and Data System (BI-RADS) 0 Rates and Associated Risk Factors in Disproportionally Affected Communities.

Introduction Disparities in access to breast cancer screening led to the creation of the Linda Fenner 3D Mobile Mammography Center (LFMMC), successfully increasing screening for uninsured women in Miami-Dade. However, a higher-than-expected rate of inconclusive mammograms (Breast Imaging-Reporting and Data System(BI-RADS) 0) was found, which could lead to unnecessary procedures, stress, costs, and radiation. Methods In this retrospective cross-sectional study, we analyzed data from 3,044 uninsured women aged over 40 (younger if positive family history of breast cancer) from Miami-Dade without breast symptoms or breast cancer history. Women's demographic characteristics, primary language spoken, body mass index (BMI), use of hormone replacement therapy and birth control, history of benign biopsy, breast surgery,family breast cancer, and menopausal status were assessed as potential risk factors for an inconclusive (BI-RADS 0) screening mammogram result. Multivariable logistic regression analyses were used to evaluate associations. Results The average age of women was 51 years (SD = 9); 59% were White, and 30% were African American. The overall frequency of BI-RADS 0 was 35%. Higher odds of BI-RADS 0 were found for women who were younger, single, premenopausal, and with benign biopsy history. Conversely, obesity and breast implant history decreased the odds of BI-RADS 0. Conclusion We found a high frequency of BI-RADS 0 in the LFMMC sample. Potential reasons include a higher risk for breast cancer or a younger sample of women screened. Future research should explore radiologists' reasoning for assigning BI-RADS 0 results and testing alternative screening strategies for younger women.

#2265 The challenge of renal biopsy in diabetic patients: evaluation of a single center large cohort from North-West Italy

Abstract Background and Aims Diabetic kidney disease is one of the most severe long-term complications of diabetes. Currently, the international guidelines suggest diagnosis of diabetic nephropathy to be achieved on a clinical ground only. However, in the heterogeneous cluster of different conditions putatively co-existing with diabetes, renal biopsy is a unique tool for an accurate diagnosis and a guide for patient management. The aim of the study was to retrospectively analyze monocentric case history of kidney biopsies performed in diabetic patients over a period of 10 years. Patient's data were collected both at the time of histological examination and during follow-up. Method Data of renal biopsies (RB) performed in patients with diabetes mellitus from 1st January 2014 to 31th July 2023, were collected. Patient identification was performed by reviewing clinical histories and histopathological charts. Data on the indication for RB were collected from the medical report of the hospitalisation when the procedure was performed or from the visit when the indication was given. Atypical features were categorized according to an adaptation of the 2007 KDOQI guidelines for diabetes and chronic kidney disease. The significance of baseline differences was determined by the chi-squared test, Fisher's exact test or the unpaired t-test, as appropriate. Significance of univariate analysis were confirmed through the use of multivariate analysis. Correlation analysis, linear regression and Cox regression were also performed. A two-sided P-value &amp;lt;0.05 was statistically significant. All statistical analyses were performed using SPSS version 26.0 (IBM, Armonk, NY, USA). Results Among 1990 patients (pts) who underwent kidney biopsy during the study period, 297 had type 1 or type 2 DM (14.9%) and were therefore included in the study, regardless of diagnostic suspicion and histological findings. Histological examination revealed diabetic nephropathy (DN) in 112 cases (group 1), DN associated with another kidney disease in 56 cases (group 2) and nondiabetic renal diseases alone in the remaining 129 cases (62%) (group 3). In group 2 the kidney disease most frequently associated with DN was focal and segmental glomerulosclerosis, FSGS (24/56 pts) followed by IgA nephropathy, IgAN (14/56 pts). In this population the histological examination led to specific therapeutic indications in 22 patients. In group 3 the most frequently observed kidney disease was FSGS (37/112 pts) followed by ANCA-vasculitis (14/112 pts), membranous nephropathy (14/112 pts) and IgAN (10/112). In this population, histological examination led to a specific therapeutic indication in 67 pts. To determine predictors for histopathological diagnosis of DKD, we ran a logistic regression model. The covariates used in this model were the duration of diabetes, presence of retinopathy, hypertension, serum creatinine values, eGFR values and 24-hours proteinuria. None of them was found to be statistically significant. It should also be noted that 47 out of 112 pts (42%) with diabetic nephropathy had no retinopathy. In contrast, 9 pts (7%) with histological evidence of NDRD had diabetic retinopathy. 215 out of 297 pts had a follow-up of at least 6 months. During a mean follow up of 41.6±31.8 months, 53 pts (24 in group 1, 15 in group 2 and 14 in group 3) reached end stage kidney disease (16.5 months). In our population the presence of DN associated with another biopsy-proven nephropathy was especially prevalent. Having double nephropathy conferred a relative risk-RR for dialysis of 1.8089 (95% CI 1.0094 to 3.2415, P = .0464). Conclusion To our knowledge this is the largest cohorts of diabetic patients receiving renal biopsy even reported in a Western country. Our data proved kidney biopsy not to be an academic exercise in diabetic pts. Clinical and laboratory features do not predict histologic findings. Renal biopsy allowed the identification of unsuspecting nondiabetic kidney injuries and double nephropathies, which could be susceptible to different outcomes, and paved the pathway for treatment of potentially manageable histological changes.

Extramammary Paget's Disease of the Vulva: A Rare Case Report

Background: Extramammary Paget’s Disease (EMPD) is a rare disease characterized by intraepithelial involvement of the skin by non-squamous carcinoma cells in areas containing apocrine glands such as the vulva, perineum, perianal area, scrotum, and penis. Case presentation: A 48 year old woman complained of a non-healing wound in the genital area for 1 year. The wound feels painful and does not bleed easily. No lumps were found anywhere else. The patient works as a private employee with minimal exposure to sunlight. No history of trauma. There is a history of surgical biopsy with the result of a malignant tumor with an impression Extramammary Paget Disease. Conclusion: We present a case of a rare malignant tumor with EMPD impression of the vulva, extending to the perineum and suprapubic.

Clinically Significant Prostate Cancer Detection Following Transrectal and Transperineal Biopsy: Results of the Prostate Biopsy Efficacy and Complications Randomized Clinical Trial.

The comparative effectiveness of transrectal and transperineal prostate biopsy in detecting clinically significant prostate cancer is not well understood. We conducted a randomized clinical trial to determine whether transperineal biopsy improves the detection of clinically significant prostate cancer. Of the 840 men randomized, 93% were White, 44% had a previous biopsy, with a median age of 66 years and median PSA density of 0.14. Of these, 384 underwent transrectal and 398 underwent transperineal prostate biopsy. Prebiopsy prostate MRI was performed in 96% of men. Grade Group ≥ 2 prostate cancer was classified as clinically significant. Odds ratios were calculated using logistic regression to evaluate the effect of biopsy procedures on cancer detection rates. The detection rates of clinically significant prostate cancer were 47.1% and 43.2% (odds ratio 1.17; 95% CI, 0.88-1.55) for transrectal and transperineal biopsy, respectively. Age, PSA density, clinical stage and Prostate Imaging Reporting and Data System score were associated with the diagnosis of clinically significant cancer, whereas history of previous biopsy, anterior tumors, and biopsy procedure (transrectal or transperineal) were not. Clinically significant cancer detection rates in biopsy-naïve men undergoing MRI-targeted transrectal or transperineal biopsy were 59% and 62%, respectively. The overall cancer detection rates following transrectal and transperineal biopsy were 72.1% and 70.4%, respectively. There was no significant difference noted in the detection of clinically significant prostate cancer following transrectal or transperineal prostate biopsy. Urologists may utilize either biopsy procedure that best suits their patients' needs and practice setting.

Predicting clinically significant prostate cancer following suspicious mpMRI: analyses from a high-volume center

PurposempMRI is routinely used to stratify the risk of clinically significant prostate cancer (csPCa) in men with elevated PSA values before biopsy. This study aimed to calculate a multivariable risk model incorporating standard risk factors and mpMRI findings for predicting csPCa on subsequent prostate biopsy.MethodsData from 677 patients undergoing mpMRI ultrasound fusion biopsy of the prostate at the TUM University Hospital tertiary urological center between 2019 and 2023 were analyzed. Patient age at biopsy (67 (median); 33–88 (range) (years)), PSA (7.2; 0.3–439 (ng/ml)), prostate volume (45; 10–300 (ml)), PSA density (0.15; 0.01–8.4), PI-RADS (V.2.0 protocol) score of index lesion (92.2% ≥3), prior negative biopsy (12.9%), suspicious digital rectal examination (31.2%), biopsy cores taken (12; 2–22), and pathological biopsy outcome were analyzed with multivariable logistic regression for independent associations with the detection of csPCa defined as ISUP ≥ 3 (n = 212 (35.2%)) and ISUP ≥ 2 (n = 459 (67.8%) performed on 603 patients with complete information.ResultsOlder age (OR: 1.64 for a 10-year increase; p < 0.001), higher PSA density (OR: 1.60 for a doubling; p < 0.001), higher PI-RADS score of the index lesion (OR: 2.35 for an increase of 1; p < 0.001), and a prior negative biopsy (OR: 0.43; p = 0.01) were associated with csPCa.ConclusionmpMRI findings are the dominant predictor for csPCa on follow-up prostate biopsy. However, PSA density, age, and prior negative biopsy history are independent predictors. They must be considered when discussing the individual risk for csPCa following suspicious mpMRI and may help facilitate the further diagnostical approach.

Abstract PO2-06-01: Validity of patient-reported data from long-term survivors of metastatic breast cancer

Abstract Background: Metastatic Breast Cancer is incurable, with 5-year survival of ~30%. The Outliers Study recruited participants with metastatic breast cancer to fill out an extensive survey to better elucidate how clinical, social, and genetic factors affect metastatic breast cancer survivorship. Patient-reported surveys can be a valuable source of data for research studies and cancer registries to further our understanding of disease, but concerns regarding the validity of patient reporting remain. Beatty et al. (2022) suggest that patients with early stage breast cancer are reliable reporters of disease recurrence (79% accuracy rate), but no study to our knowledge has evaluated the validity of reporting regarding metastases, or those who are long-term survivors. In this study, over 1000 women with metastatic breast cancer filled out an extensive survey. We compared the medical records with self-reported data on clinical history to assess concordance. Objective: To determine the validity of patient-reported data pertaining to a wide variety of oncologic information, including but not limited to primary diagnosis date, stage, hormone status, metastatic date, site, and post-metastatic chemotherapy regimens, in long term survivors of metastatic breast cancer. Methods: Patients with metastatic breast cancer were recruited for the nation-wide Outliers Study to fill out an extensive survey on their oncologic history. Of &amp;gt;1000 participants enrolled in the Outliers Study, we identified a subpopulation of those who had lived the longest with metastatic disease and named this cohort “Long Term Survivors” (LTS). We acquired either partial or complete oncologic medical records from 31 LTS in order to determine the validity of patient-reported survey responses. Table 1 describes the details of this LTS cohort (n=31). We then compared each LTS survey to the medical record to verify responses and identify any inaccuracies. We also assessed accuracy to compare those who did and did not consult their medical records while responding to the survey. Results: Of the verifiable survey responses, we identified 592 accurate responses and 5 inaccuracies, yielding a 99.2% accuracy rate of patient-reported oncologic data. The identified errors included 2 minor discrepancies in clinical detail, 2 false-negative reports and 1 false-positive report. Specifically, there were minor discrepancies regarding biopsy type (i.e. core biopsy reported instead of fine needle) and site of radiation (e.g. “chest wall” instead of T12 vertebrae). The false-negative reporters failed to report 1) a positive history for surgery distant from breast for metastatic disease and 2) a positive history of biopsy for disease distant to the breast. The false positive error was a report of “surgery on distant metastasis” for a history of bone marrow biopsy. Each error identified was made by a separate participant and we found no association between patients who were reporting from memory and patients who reported an inaccurate response. Of note, there were no inaccurate responses identified pertaining to the topics of initial diagnosis date, stage, and histologic type, breast surgical history, hormone and HER2 receptor status of initial and metastatic disease, date and site of metastatic disease, BRCA mutation status, date and regimens of chemotherapy, and date of radiation history. Conclusion: Long term survivors of metastatic breast cancer report clinical data spanning a wide range of oncologic topics with high accuracy. The majority of errors identified in patient reported survey responses were minor and suggested misunderstandings of medical nomenclature (surgery vs biopsy; core vs FNA) and anatomic specificity. The topic of biopsy was most prone to error. Notably, we found no association between errored responses and patients who reported from memory without referencing their medical records. Table 1 Citation Format: Meredith Gallagher, Mark Burkard. Validity of patient-reported data from long-term survivors of metastatic breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-06-01.

Abstract 4867: Longitudinal latent class analysis to further understand trajectory of density over time and risk of breast cancer

Abstract Background: It is clinically important to refine strategies to manage women with dense breasts as they represent approximately 50% of all women screened. Change in breast density is related to risk of breast cancer.1 We also must understand this change in density over time in women with dense and non-dense breasts. While population level data have been reported to estimate decrease in density with age, this has largely used digitized film images.2 Expanding use of digital mammography and repeated screening generates a large library of images for each woman, offering the potential to use more of the image data. Methods: We use longitudinal latent class analysis to cluster women and estimate their change in density over time. To evaluate the groups of women with different patterns of change in density we fit latent class models to our previously published data.1 This includes 289 pathology confirmed cases of breast cancer and 658 controls among women followed from November 3, 2008 to October 31, 2020. Results: Among women with dense breasts, there are 107 who developed breast cancer during follow-up and 267 control women who remained free from breast cancer. In the women without dense breasts, 173 cases and 383 controls were evaluated and showed similar age and BMI within the controls as seen in women with dense breasts. Prevalence of family history and history of benign breast biopsy did not differ between the two groups. We observe this latent class and trajectory of density phenomenal separately for dense and non-dense groups in our data. We show that the data define 2 classes, those who have decrease in density over time and those who have increase over time. The odds ratio (OR) for cancer comparing decline vs. incline is 4.9 in women with dense breasts (BI-RADS C, D) and 6.17 on women with non-dense breasts (BI-RADS A, B). Discussion: To refine our understanding of patterns of change in breast density over time in relation to breast cancer risk we fit latent class models. Longitudinal change matters as reflected in the 2-class model. This is independent of starting density and confirms that a one-time measure of density is not enough to define level of risk for subsequent breast cancer. Further work is needed to better define the drivers and inhibitors of decline in breast density over time given this change over time as women age is a universal phenomenon.2 1. Jiang S, Bennett DL, Rosner BA, Colditz GA. Longitudinal Analysis of Change in Mammographic Density in Each Breast and Its Association With Breast Cancer Risk. JAMA Oncol 2023;9(6):808-814. (In English). DOI: 10.1001/jamaoncol.2023.0434. 2. Burton A, Maskarinec G, Perez-Gomez B, et al. Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide. PLoS Med 2017;14(6):e1002335. DOI: 10.1371/journal.pmed.1002335. Citation Format: Graham A. Colditz, Debbie L. Bennett, Shu Jiang. Longitudinal latent class analysis to further understand trajectory of density over time and risk of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4867.

A Comparative Evaluation of Multiparametric Magnetic Resonance Imaging and Micro-Ultrasound for the Detection of Clinically Significant Prostate Cancer in Patients with Prior Negative Biopsies.

The diagnostic process for prostate cancer after a negative biopsy is challenging. This study compares the diagnostic accuracy of micro-ultrasound (mUS) with multiparametric magnetic resonance imaging (mpMRI) for such cases. A retrospective cohort study was performed, targeting men with previous negative biopsies and using mUS and mpMRI to detect prostate cancer and clinically significant prostate cancer (csPCa). In our cohort of 1397 men, 304 had a history of negative biopsies. mUS was more sensitive than mpMRI, with better predictive value for negative results. Importantly, mUS was significantly associated with csPCa detection (adjusted odds ratio [aOR]: 6.58; 95% confidence interval [CI]: 1.15-37.8; p = 0.035). mUS may be preferable for diagnosing prostate cancer in previously biopsy-negative patients. However, the retrospective design of this study at a single institution suggests that further research across multiple centers is warranted.

MpMRI-targeted biopsy of the prostate in men ≥ 75 years. 7-year report from a high-volume referral center.

Multiparametric magnetic resonance imaging (mpMRI) -Ultrasound- fusion guided biopsy of the prostate (FBx) is the new gold standard for the detection of prostate cancer. Hallmark studies showing superior detection rates of FBx over randomized biopsies routinely excluded patients≥75 years and information on outcome of FBx on this patient cohort is sparse. As a large referral center, we have performed FBx on a substantial number of patients this age. By evaluating outcome of FBx of patients over the age of 75 years we wanted to close the gap of knowledge on this patient cohort. Between 2015 -2022, 1577 patients underwent FBx at our department and were considered for analysis. Clinical and histopathological parameters were recorded. Clinical data comprised age at FBx, serum level of Prostate-specific antigen (PSA), prostate volume, PSA-density, history of previous biopsies of the prostate, result of the digital rectal examination (DRE) and assessment of the indexlesion of mpMRI according to the Prostate Imaging and Reporting Data System (PI-RADS). Univariate analysis and multivariable logistic regression was used to identify age barrier of 75 years as a potential risk factor of detection of clinically significant prostate cancer by FBx. 379/1577 patients (24%) were≥75 years and 1198/1577 (76%) patients were < 75 years, respectively. Preoperative PSA was significantly higher in patients≥75 years compared to patients < 75 years (9.54 vs. 7.8, p < 0.001). Patients≥75 years presented significantly more often with mpMRI target lesions classified as PI-RADS 5 compared to patients < 75 years (45% vs. 29%, p < 0.001). Detection rate of clinically significant prostate cancer was significantly higher in patients≥75 years compared to patients < 75 years (63% vs. 43%, p < 0.001). Aggressive prostate cancer grade ISUP 5 was significantly more often detected in patients≥75 years compared to patients < 75 years (13% vs. 8%, p = 0.03). On multivariable logistic regression model adjusted for PSA and PI-RADS score, age barrier of 75 years was identified as a significant risk factor for the detection of clinically significant prostate cancer by FBx (OR: 1.77, 95% CI: 1.36 -2.31, p < 0.001). After evaluation of a large patient cohort, we show that age≥75 years represents a significant risk factor for the detection of clinically significant prostate cancer. Further studies on mid- and long term outcome are necessary to draw conclusions for clinical decision making in this patient cohort.

The Relationship Between Breast Cancer Risk Factors and Mammographic Density

Background: Mammography is the most important evaluation technique for breast cancer screening. The importance of understanding mammographic density becomes evident when considering its relationship with breast cancer risk. There exists a positive correlation between high mammographic density and an increased susceptibility to breast cancer. Therefore, knowing the prevalence of breast density and its associated factors helps consider possible interventions and medical management to alter the density and properly follow up with the patients. Methods: A total of 350 women in Azerbaijan enrolled in this cross-sectional study. Patient’s questionnaires included demographic data such as age, weight, height, education, menarche age, menopause status and age, oophorectomy history, marital status, number of successful deliveries, age of first delivery, number of breast-feeding times, duration of breastfeeding, oral contraceptives/ hormone replacement therapy (HRT) usage, menstrual status, familial history of cancer, history of benign breast lesion biopsy, and alcohol/smoking status. The evaluation of breast density was done according to the American College of Radiology grading A to D. Results: The average age of the studied patients was 45.68±6.96 years with a median of 44.5 years. The population of women with breast density above 50% was higher compared to those with low breast density (51.4% versus 48.6%). In women without a history of breastfeeding, the frequency of breast density above 50% was observed in 76.4% of women. Significantly, lower densities were observed during menopause, and higher densities were observed during nonmenopause (P=0.001). Furthermore, no relationship was observed between breast composition and nulliparity, history of oophorectomy, duration of breastfeeding, marital status, menstrual status, and oral contraceptive pill (OCP) consumption. Conclusion: The main risk factors of high breast density include young age, menstrual status (non-menopausal patients), lack of breastfeeding after childbirth, older age of first delivery, and lower body mass index

Clinical and economic impact of the introduction of pre-biopsy MRI-based assessment on a large prostate cancer centre diagnostic population and activity: 10years on.

Prostate mpMRI was introduced in 2011 as a secondary test and subsequently integrated into a prostate cancer (PCa) diagnostics unit representing a population of approximately 550,000 people. The following represents an audit of its step-wise introduction between 2 index years, 2009 and 2018, focusing on the activity, patient outcomes and economic benefits. PATIENTSAND METHODS: The 2 distinct years were selected for relying on a transrectal ultrasound biopsy pathway in 2009 to an mpMRI-based pathway in 2018. All referrals were retrospectively screened and compared for age, PSA levels, DRE findings, biopsy history, biopsy and mpMRI allocation data. Cost analysis was determined using local unit procedure costs. Patients referred included 648 in 2009 and 714 in 2018. mpMRI seldomly informed decision to biopsy in 2009 (9.8%), while in 2018 it was performed in the pre-biopsy setting in 87.9% cases and enabled biopsy avoidance in 137 patients. In 2018, there was a 31.8% decrease in the number of biopsies in patients without previous PCa diagnosis, coupled with an increase in diagnostic rates of csPCa, from 28.6 to 49.0% (p < 0.0001) and a reduction in negative biopsy rates from 52.3 to 33.8%. mpMRI had a positive impact on the system with reduced patient morbidity and post-procedural complications. The estimated overall cost savings amount to approximately £75,000/year for PCa diagnosis and £11,000/year due to reduced complications. Our evaluation shows the mpMRI-based pathway has improved early detection of csPCa and reduction of repeat biopsies, resulting in significant financial benefits for the local healthcare system.

Analysis of Breast Cancer Screening Results and Influencing Factors of Breast Cancer in Guangdong Province from 2017 to 2021.

Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong. This cross-sectional study was conducted among 2,024,960 women aged 35-64 in Guangdong Province during 2017-2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate. The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45-55 [OR (95% CI) 2.174 (1.872, 2.526)], 55-65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P < 0.05). The detection rate of breast cancer in screening showed an increasing trend year by year in Guangdong Province. Older age, education for high school and older age at first birth were risk factors for breast cancer detection rate, while no surgery or biopsy history, no family history of breast cancer and no history of breast cancer check were protective factors.