Positive Biopsy Rate Research Articles

Application value of magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer.

Magnetic resonance spectroscopy (MRSI) can distinguish between benign and malignant prostate diseases. This study investigated the potential of MRSI for diagnosing prostate cancer and guiding prostate biopsy. We retrospectively reviewed 234 patients with suspected prostate cancer who underwent MRSI with targeted prostate biopsy. Patients were divided into two groups according to their puncture pathology: prostate cancer (n = 103, 44.02%) and benign prostatic disease (n = 131, 55.98%). The t-test, Mann-Whitney U test, or chi-square test was used to compare the groups. The diagnostic abilities of MRSI, prostate-specific antigen level, digital rectal examination, and magnetic resonance imaging without contrast for prostate cancer were compared using the area under the receiver operating characteristic curve (AUC-ROC); the ARC-ROC values were 0.831, 0.768, 0.692, and 0.656, respectively. The AUC-ROC value for diagnosing prostate cancer using the CC/c ratio was 0.853. CC/c ratio > 0.97 was identified as the optimal threshold for diagnosing prostate cancer (sensitivity, 86.5%; specificity, 78.6%; Youden index, 0.651). Spearman correlation analysis revealed a correlation between the CC/c ratio and Gleason score (r = 0.737, p < 0.001). Using the CC/c ratio of MRSI as an adjunct to targeted prostate biopsy can improve the detection rate of positive biopsies and evaluate prostate cancer invasiveness.

Lesion size may affect diagnostic capabilities of MRI-guided ultrasound fusion biopsy and cognitive targeted biopsy for clinically significant prostate cancer

MRI-guided targeted biopsy (MRGB) was recommended as part of biopsy paradigm of prostate cancers by current guidelines. This study aimed to analyze the diagnostic efficacy of MRGB and systemic biopsy (SB), and to compare diagnostic capabilities within subgroups of MRGB: MRI-cognitive biopsy (MRCB) and MRI-fusion biopsy (MRFB). We retrospectively enrolled patients who underwent MRGB for suspicious malignant lesion(s) identified on MRI in a single tertiary center, sample size was 74 patients. An mpMRI was performed prior to biopsy and reviewed by an experienced radiologist specialized in prostate cancer. Per-person results of MRGB and each concomitant SB were analyzed as independent biopsies for its positive biopsy rate and positive core percentage. Per-lesion results of MRFB and MRCB were compared for the detection rate. Variables of interest were analyzed with t-test, chi-squared test, and logistic regression analysis. Statistical analyses were performed with IBM Statistical Product and Service Solutions (SPSS), Version 23 (IBM, Armonk, New York). Total of 74 patients fulfilled the inclusion criteria and were enrolled. MRFB had higher PCa detection rate comparing to both MRCB and SB (56.1%, 30.3%, and 33.9% respectively, p value = 0.036); clinically significant prostate cancer (csPCa) detection rate was also significantly higher in MRFB group (43.9%, 24.2%, and 16.9% in each group respectively, p value = 0.011). In per-lesion analysis, MRCB and MRFB had no significant difference in PCa and csPCa detection rate (41.0% vs. 26.2% and 29.5% vs. 16.7% respectively, p value = 0.090 and 0.103). In the lesion ≦ 1.3 cm group, MRFB could achieve higher PCa detection rate, comparing to MRCB (36.4% vs. 14.3%, p value = 0.047); there were also higher positive rates for PCa and csPCa per biopsied cores (22.1% vs. 6.8% and 15.6% vs. 2.7%, p value = 0.029 and 0.028, respectively). Further logistic regression of multi-variate analysis in subgroup of lesion ≦ 1.3 cm revealed that PIRADS score and biopsy method were significant predictors of positive biopsy result for PCa (p value = 0.045 and 0.026, respectively) and for csPCa (p value = 0.043 and 0.025, respectively). In patients receiving trans-perineal prostate biopsy, MRFB had higher cancer detection rate than MRCB and SB. In per lesion comparison, MRFB and MRCB had similar diagnostic accuracy. However, in lesions with diameter less than 1.3 cm, MRFB can provided better diagnose value for PCa and csPCa than MRCB.

Safety and efficacy of percutaneous biopsy and microwave ablation in patients with pulmonary nodules on antithrombotic therapy: A study with rivaroxaban bridging.

To evaluate the safety and efficacy of percutaneous biopsy and microwave ablation (B + MWA) in patients with pulmonary nodules (PNs) who are receiving antithrombotic therapy by rivaroxaban as bridging therapy. The study comprised 187 patients with PNs who underwent 187 B + MWA sessions from January 1, 2020, to December 31, 2021. The enrolled patients were divided into two groups: Group A, who received antithrombotic therapy five days before the procedure and received rivaroxaban as a bridging drug during hospitalization, and group B, who had no antithrombotic treatment. Information about the technical success rate, positive biopsy rate, complete ablative rate, and major complications were collected and analyzed. Group A comprised 53 patients and group B comprised 134 patients. The technical success rate was 100% in both groups. The positive biopsy rates were 88.68% and 91.04%, respectively (p = 0.6211, X2 = 0.2443). In groups A and B, the complete ablative rates at 6, 12, and 24 months were 100.0% versus 99.25%, 96.23% versus 96.27%, and 88.68% versus 89.55%, respectively. There were no significant differences in bleeding and thrombotic complications between the two groups. No grade 5 complications occurred. It is generally considered safe and effective that patients who are on antithrombotic therapy by rivaroxaban as bridging to undergo B + MWA for treating PNs.

Management considerations and treatment outcomes for newly diagnosed prostate cancer in advanced age patients (≥80 years): real-world data from a single urological center over a 10-year period.

There is ongoing debate regarding prostate cancer (PCa) screening in advanced age males, leading to treatment decisions often based on tumor staging and life expectancy. A critical gap in clinical evidence and tailored guidelines for the advanced age with PCa persists. This study aims to compare survival outcomes of various treatment approaches in this demographic. We analyzed data from a large urological center for advanced age patients suspected of having PCa between 2012 and 2022. We collected clinical and pathological characteristics and evaluated treatment modalities, including palliative therapy and definitive therapy. Propensity score matching (PSM) analysis was implemented to reduce bias between treatment modalities. Kaplan-Meier and multivariate Cox proportional hazard regression analyses were conducted to evaluate progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Out of 4,333 suspected patients, 376 individuals aged 80 years and older underwent prostate biopsy. The overall detection rate of PCa was 78.7%, with a high prevalence of high-grade tumors [International Society of Urological Pathology (ISUP) grade ≥2]. Most patients (86.5%) received palliative therapy, while 13.5% underwent definitive therapy. Patients in the definitive therapy group had lower prostate-specific antigen (PSA) values, lower tumor stage, and Charlson Comorbidity Index (CCI), longer life expectancy, and a higher Geriatric 8 (G8) score compared to the palliative therapy group. The median OS for the entire cohort was 72.0 months, with 70.0 months for palliative therapy and 96.0 months for definitive therapy. Multivariable analyses identified lymphatic and bone metastasis, as well as definitive therapy, as independent prognostic factors for PFS, CSS, and OS. Advanced age patients, although a small group, have distinct characteristics, including higher PSA levels, positive biopsy rates, and pathological grading and staging. In medically fit elderly patients, especially those with localized PCa and a life expectancy of ≥5 years, definitive therapy could improve survival outcomes.

A 2-year prospective evaluation of the Prostate Health Index in guiding biopsy decisions in a large cohort.

To prospectively evaluate how the Prostate Health Index (PHI) impacts on clinical decision in a real-life setting for men with a prostate-specific antigen (PSA) level between 4 and 10 ng/mL and normal digital rectal examination. Since 2016, the PHI has been available at no cost to eligible men in all Hong Kong public hospitals. All eligible patients who received PHI testing in all public Urology units (n = 16) in Hong Kong between May 2016 and August 2017 were prospectively included and followed up. All included men had a PHI test, with its result and implications explained; the subsequent follow-up plan was then decided via shared decision-making with urologists. Patients were followed up for 2 years, with outcomes including prostate biopsy rates and biopsy findings analysed in relation to the initial PHI measurements. A total of 2828 patients were followed up for 2 years. The majority (82%) had PHI results in the lower risk range (score <35). Knowing the PHI findings, 83% of the patients with elevated PSA decided not to undergo biopsy. In all, 11% and 45% opted for biopsy in the PHI score <35 and ≥35 groups, respectively. The initial detection rate of International Society of Urological Pathology (ISUP) Grade Group (GG) ≥2 cancer was higher in the PHI score ≥35 group (23%) than in the PHI score <35 group (7.9%). Amongst patients with no initial positive biopsy findings, the subsequent positive biopsy rate for ISUP GG ≥2 cancer was higher in the PHI score ≥35 group (34%) than the PHI score <35 group (13%) with a median follow-up of 2.4 years. In a real-life setting, with the PHI incorporated into the routine clinical pathway, 83% of the patients with elevated PSA level decided not to undergo prostate biopsy. The PHI pathway also improved the high-grade prostate cancer detection rate when compared to PSA-driven strategies. Higher baseline PHI predicted subsequent biopsy outcome at 2 years. The PHI can serve as a tool to individualise biopsy decisions and frequency of follow-up visits.

Impact of quantitative CT texture analysis on the outcome of CT-guided bone biopsy

Texture analysis can provide new imaging-based biomarkers. Texture analysis derived from computed tomography (CT) might be able to better characterize patients undergoing CT-guided percutaneous bone biopsy. The present study evaluated this and correlated texture features with bioptic outcome in patients undergoing CT-guided bone biopsy. Overall, 123 patients (89 female patients, 72.4 %) were included into the present study. All patients underwent CT-guided percutaneous bone biopsy with an 11 Gauge coaxial needle. Clinical parameters and quantitative imaging features were investigated. Random forest classifier was used to predict a positive biopsy result. Overall, 69 patients had osteolytic metastasis (56.1 %) and 54 had osteoblastic metastasis (43.9 %). The overall positive biopsy rate was 72 %. The developed radiomics model demonstrated a prediction accuracy of a positive biopsy result with an AUC of 0.75 [95 %CI 0.65 – 0.85]. In a subgroup of breast cancer patients, the model achieved an AUC of 0.85 [95 %CI 0.73 – 0.96]. In the subgroup of non-breast cancer patients, the signature achieved an AUC of 0.80 [95 %CI 0.60 – 0.99]. Quantitative CT imaging findings comprised of conventional and texture features can aid to predict the bioptic result of CT-guided bone biopsies. The developed radiomics signature aids in clinical decision-making, and could identify patients at risk for a negative biopsy.

Efficacy analysis of 7 cases of mixed neuroendocrine-nonneuroendocrine neoplasm of the duodenal papilla

The clinical data of 7 patients diagnosed with mixed neuroendocrine-nonneuroendocrine neoplasm were analyzed in the Department of Hepatobiliary Surgery of Hunan Provincial People's Hospital from January 2016 to December 2022. Among the 7 patients, 5 were male and 2 were female, with an average age of 59.3 years. Its clinical characteristics are similar to malignant ampulla tumors, and it is difficult to differentiate them. The preoperative puncture biopsy positivity rate is low, making it difficult to diagnose preoperatively, and the prognosis is worse.Comprehensive treatment including surgery, chemotherapy, and radiotherapy can be the preferred treatment option for this disease.

The learning curve and experience of a novel multi-modal image fusion targeted transperineal prostate biopsy technique using electromagnetic needle tracking under local anesthesia.

Prostate cancer is the most common malignant tumor of male genitourinary system, and the gold standard for its diagnosis is prostate biopsy. Focusing on the methods and skills of prostate biopsy, we explored the learning curve and experience of a novel magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) image fusion transperineal biopsy (TPB) technique using electromagnetic needle tracking under local anesthesia. The clinical and pathological data of 92 patients who underwent targeted TPB from January 2023 to July 2023 in our center were prospectively collected. The cumulative sum (CUSUM) analysis method and the best fitting curve were used to analyze the learning curve of this novel technique, and the clinical characteristics, perioperative data and tumor positive rate of prostate biopsy of patients at different stages of the learning curve were compared. With the increase of the number of surgical cases, the overall operative time showed a downward trend. The best fitting curve of CUSUM reached its peak at the twelfth case, which is the minimum cumulative number of surgical cases needed to cross the learning curve of the operation. Taking this as the boundary, the learning curve is divided into two stages: learning improvement stage (group A, 12 cases) and proficiency stage (group B, 80 cases). The surgical time and visual analog scale score during prostate biopsy in group A were significantly higher than those in group B. The visual numerical scale score during prostate biopsy in group A was significantly lower than that in group B. There was no statistically significant difference between group A and group B in the detection rate of csPCa and the incidence of perioperative complications. The novel targeted TPB technique is divided into learning improvement stage and proficiency stage, and 12 cases may be the least cumulative number.

Development and Validation of Interpretable Machine Learning Models for Clinically Significant Prostate Cancer Diagnosis in Patients With Lesions of PI-RADS v2.1 Score ≥3.

For patients with PI-RADS v2.1 ≥ 3, prostate biopsy is strongly recommended. Due to the unsatisfactory positive rate of biopsy, improvements in clinically significant prostate cancer (csPCa) risk assessments are required. To develop and validate machine learning (ML) models based on clinical and imaging parameters for csPCa detection in patients with PI-RADS v2.1 ≥ 3. Retrospective. One thousand eighty-three patients with PI-RADS v2.1 ≥ 3, randomly split into training (70%, N = 759) and validation (30%, N = 324) datasets, and 147 patients enrolled prospectively for testing. 3.0 T scanners/T2-weighted fast spin echo sequence and DWI with diffusion-weighted single-shot gradient echo planar imaging sequence. The factors evaluated for csPCa detection were age, prostate specific antigen, prostate volume, and the diameter and location of the index lesion, PI-RADSv2.1. Five ML models for csPCa detection were developed: logistic regression (LR), extreme gradient boosting, random forest (RF), decision tree, and support vector machines. The csPCa was defined as Gleason grade ≥2. Univariable and multivariable LR analyses to identify parameters associated with csPCa. Area under the receiver operating characteristic curve (AUC), Brier score, and DeLong test were used to assess and compare the csPCa diagnostic performance with the LR model. The significance level was defined as 0.05. The RF model exhibited the highest AUC (0.880-0.904) and lowest Brier score (0.125-0.133) among the ML models in the validation and testing cohorts, however, there was no difference when compared to the LR model (P = 0.453 and 0.548). The sensitivity and negative predictive values in the validation and testing cohorts were 93.8%-97.6% and 82.7%-95.1%, respectively, at a threshold of 0.450 (99% sensitivity of the RF model). The RF model might help for assessing the risk of csPCa and preventing overdiagnosis and unnecessary biopsy for men with PI-RADSv2.1 ≥ 3. 3 TECHNICAL EFFICACY: Stage 2.

Morphological manifestation of tuberculous pleurisy in children under medical thoracoscope and diagnostic value.

Our study analyzed the main manifestations of tuberculous pleurisy (TBP) in children under medical thoracoscopy (MT). This article aimed to explore the clinical application value of MT in the diagnosis and treatment of TBP in children. In our study, we selected 23 TBP patients diagnosed in our hospital. We analyzed the clinical data and thoracoscopic morphology of these patients. At the same time, we also observed the pathological manifestations, acid-fast staining, and treatment effects of the patient's diseased tissue under MT. The MT clinical findings of TBP patients include pleural hyperemia and edema, miliary nodules, scattered or more white nodules, simple pleural adhesion, wrapped pleural effusion, massive cellulose exudation, yellow-white caseous necrosis, pleural hyperplasia and hyperplasia, and mixed pleural necrosis. The positive rate of pleural biopsy was 73.91% and that of acid-fast staining was 34.78%. The main pathologic types of these patients were tuberculous granulomatous lesions (16 cases), caseous necrosis (5 cases), and fibrinous exudative, multinucleated giant cell and other inflammatory cell infiltration lesions (13 cases). The average time of diagnosis of the 23 patients was 8.32 days (5.0-16.0 days), and they were transferred to specialized hospitals for treatment after diagnosis. The mean time of chest drainage was 3.0-5.0 days after treatment. The average time for their body temperature to return to normal was 3.31 days (2.0-5.0 days). Thoracoscopic lesions of TBP in children are varied. The use of MT is not only helpful for the early diagnosis and treatment of TBP. It also protects and improves lung function. Therefore, the use of MT has high clinical value.

Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy.

To investigate the effect of three-dimensional (3D) reconstruction-assisted cognitive fusion in targeted prostate biopsy. There was no significant difference in the detection rate of prostate cancer (PCa) between targeted biopsy and systematic biopsy, and there was significant difference in the detection rate of clinically significant prostate cancer (csPCa) between targeted biopsy and systematic biopsy. In the low prostate total specific antigen (tPSA) group, there was no statistically significant difference in the detection rate of prostate cancer between the two biopsy modalities. However, compared with systematic puncture, targeted puncture had a higher detection rate for csPCa and a lower detection rate for clinically insignificant prostate cancer (ciPCa), and the difference was statistically significant. In the high tPSA group, there was no significant difference in the detection rate of PCa, csPCa, and ciPCa between the two biopsy types. Single needle positive rate of targeted puncture (29.77%) was significantly higher than that of systematic puncture (10.28%). The detection rate of csPCa in 3D reconstruction-assisted cognitive fusion targeted prostate biopsy is better than that of 12-needle systematic biopsy, which markedly improved the positive rate of prostate biopsy.

Prevalence of transthyretin amyloidosis in patients undergoing carpal tunnel surgery: a prospective cohort study and risk factor analysis.

Transthyretin amyloidosis is a frequent cause of heart failure, resulting from an accumulation of abnormal proteins in the myocardium. Recent research has highlighted the importance of early diagnosis to enhance the effectiveness of specific treatments. Extra-cardiac symptoms may precede several years before cardiac complications, with carpal tunnel syndrome often considered a red flag. The aim of this prospective, observational cohort study was to determine the incidence rate of positive synovial biopsies for transthyretin amyloidosis in patients aged 60-80 years undergoing carpal tunnel decompression, and to identify risk factors. The diagnosis of transthyretin amyloidosis was confirmed through the analysis of synovial tissue biopsies using Congo Red and immunohistochemical staining. The study included 254 patients, with an 18.5% prevalence of transthyretin amyloidosis. Risk factors for positive test results were identified as male sex, trigger finger, hearing disorders and valve disease. A predictive analysis using logistic regression yielded a probability model for individuals belonging to the positive group.Level of evidence III.

A retrospective study of Pipelle endometrial biopsy for ovarian, fallopian tube, and peritoneal cancers

Objectives Although the Pipelle endometrial biopsy is widely performed as a practical and minimally invasive test for endometrial disease(s), its effectiveness in ovarian cancer has not been explored. The aim of the present study was to evaluate the results of Pipelle endometrial biopsy for ovarian, fallopian tube, and peritoneal cancers. Methods A pre-treatment Pipelle-endometrial biopsy was performed in 90 patients with ovarian, fallopian tube, or peritoneal cancers between January 2014 and November 2021. We retrospectively analysed the association between the results of Pipelle endometrial biopsy and clinicopathological data. Moreover, we evaluated their impact on the following treatment in advanced cases initially treated with chemotherapy. Results The sensitivity and false-negative rates for Pipelle endometrial biopsy were 25/90 (27.8%) and 65/90 (72.2%) in all patients, respectively, and 23/56 (41.0%) and 33/56 (58.9%) in cases with advanced disease (stages III and IV), respectively. Pipelle-positive endometrial biopsy-positive (Pipelle-positive) was not observed in 29 patients with clinical stage I disease, and Pipelle-positive patients exhibited significantly more high-grade serous carcinomas, and positive peritoneal, endometrial, and cervical cytologies than Pipelle-endometrial biopsy-negative cases. Surgical pathology was confirmed in 23 Pipelle-positive patients, and 17/23 (74.0%) had the same diagnosis as that for Pipelle endometrial biopsy. Conversely, 6/23 (26.0%) patients exhibited a minor diagnostic discrepancy between Pipelle endometrial biopsy and surgical pathology. Nineteen of the 38 (50.0%) patients initially treated with chemotherapy were identified as Pipelle-positive, contributing to a prompt histological diagnosis and pre-treatment tumour sampling. Companion diagnostic tests were performed using Pipelle endometrial biopsy samples from 4 inoperable patients. Conclusion Although the positive rate of Pipelle endometrial biopsy in ovarian, fallopian tube, and peritoneal cancers is low, Pipelle endometrial biopsy may enable prompt histological diagnosis and initiation of chemotherapy while collecting tumour tissue for genetic testing in some cases with advanced disease.

Prognostic Impact of a Negative Central Pelvic Biopsy after Definitive Chemoradiotherapy (CRT) for Locally Advanced Cervical Cancer (LACC)

Central pelvic biopsies are occasionally performed during post-treatment surveillance of locally advanced cervical cancer (LACC) after a change in symptoms, abnormal pelvic exam, pap smear or imaging. Although it is established that a positive result is considered disease recurrence, it is unclear the prognostic impact of a negative biopsy. Here, we investigated the characteristics and the clinical course of patients with negative biopsy, focusing on central pelvic recurrence. Our institutional database of female patients with diagnosis of cervical cancer treated with definitive CRT was retrospectively reviewed (2013-2022). The central pelvic region was subdivided in: I) cervix, II) endocervix/endometrium, III) vagina, IV) vulva, V) bladder and VI) rectum. Each subsite sampled was considered a distinct biopsy event, but multiple samples from one subsite at the same procedure were considered one biopsy event. We calculated the rate of initial negative and positive biopsies. The central pelvic control (local recurrence rate [LCRR]) for patients with negative biopsy was estimated with Kaplan Meier method. Two hundred and twenty-five consecutive patients were included (initial FIGO 2018 staging: 30% I/II and 70% III-IVA). Of these, 66 (29.3%) underwent 112 central pelvic biopsies (average 1.7 per patient) during a median follow up time of 27.1 months [range: 0.2-94.0], with median time from treatment to first biopsy of 7.0 months [range: 1.0-41.7]. Biopsies were triggered by: symptoms/physical exam in 83 (73.4%), imaging abnormalities in 21 (18.6%), and abnormal pap smear in 9 (8%). The most common structures biopsied were: cervix (53.6%, n = 60), vagina (17.9%, n = 20), endocervix/endometrium (11.6%, n = 13), rectum/sigmoid (11.6%, n = 13), bladder (4.5%, n = 5) and vulva (0.9%, n = 1). Overall, 13.6% cases (9/66) had an initial positive biopsy, while 86.4% (57/66) had an initial negative biopsy. Of these patients with negative biopsies, 84.2% (48/57) remained without evidence of local recurrence and 15.8% (9/57) were subsequently diagnosed with local disease recurrence (1y post-biopsy LCRR 15.0% [95% CI 4.8-24.0]). Although most (>85%) post-treatment central pelvic biopsies are negative, these patients are still at considerable risk of early local recurrence thereafter (post-biopsy 1y-LCRR 15%). Strategies to intensify surveillance may be beneficial in the first year after a negative biopsy.

Prediction of extracapsular extension in prostate cancer using the Likert scale combined with clinical and pathological parameters.

This study aimed to investigate the independent clinical, pathological, and radiological factors associated with extracapsular extension in radical prostatectomy specimens and to improve the accuracy of predicting extracapsular extension of prostate cancer before surgery. From August 2018 to June 2023, the clinical and pathological data of 229 patients with confirmed prostate cancer underwent radical prostatectomy from The Second Hospital of Yinzhou. The patients' multiparametric magnetic resonance imaging data were graded using the Likert scale. The chi-square or independent-sample T-test was used to analyze the related factors for an extracapsular extension. Multivariate analysis was used to identify independent factors associated with extracapsular extension in prostate cancer. Additionally, receiver operating characteristic curve analysis was used to calculate the area under the curve and assess the diagnostic performance of our model. The clinical decision curve was used to analyze the clinical net income of Likert scale, biopsy positive rate, biopsy GG, and combined mode. Of the 229 patients, 52 had an extracapsular extension, and 177 did not. Multivariate analysis showed that the Likert scale score, biopsy grade group and biopsy positive rate were independent risk factors for extracapsular extension in prostate cancer. The area under the curves for the Likert scale score, biopsy grade group, and biopsy positive rate were 0.802, 0.762, and 0.796, respectively. Furthermore, there was no significant difference in the diagnostic efficiency for extracapsular extension (P>0.05). However, when these three factors were combined, the diagnostic efficiency was significantly improved, and the area under the curve increased to 0.905 (P<0.05). In the analysis of the decision curve, The clinical net income of the combined model is obviously higher than that of Likert scale, biopsy positive rate, and biopsy GG. The Likert scale, biopsy grade group and biopsy positive rate are independent risk factors for extracapsular extension in prostate cancer, and their combination can significantly improve the diagnostic efficiency for an extracapsular extension.

Cardiac amyloidosis: pathological classification and clinical analysis of 48 cases

Objective: To investigate the histological features and clinical manifestations in different types of cardiac amyloidosis to improve diagnostic accuracy. Methods: The histopathological features and clinical manifestations of 48 patients diagnosed with cardiac amyloidosis by Congo red stain and electron microscopy through endomyocardial biopsy were collected in West China Hospital of Sichuan University from January 2018 to December 2021. Immunohistochemical stains for immunoglobulin light chains (κ and λ) and transthyretin protein were carried out, and a review of literature was made. Results: The patients age ranged from 42 to 79 years (mean 56 years) and the male to female ratio was 1.1 to 1.0. The positive rate of endomyocardial biopsy was 97.9% (47/48), which was significantly higher than that of the abdominal wall fat (7/17). Congo red staining and electron microscopy were positive in 97.9% (47/48) and 93.5% (43/46), respectively. Immunohistochemical stains showed 32 cases (68.1%) were light chain type (AL-CA), including 31 cases of AL-λ type and 1 case of AL-κ type; 9 cases (19.1%) were transthyretin protein type (ATTR-CA); and 6 cases (12.8%) were not classified. There was no significant difference in the deposition pattern of amyloid between different types (P>0.05). Clinical data showed that ATTR-CA patients had less involvement of 2 or more organs and lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) than the other type patients (P<0.05). The left ventricular stroke volume and right ventricular ejection fraction of ATTR-CA patients were better than the other patients (P<0.05). Follow-up data of 45 patients was obtained, and the overall mean survival time was 15.6±2.0 months. Univariate survival analysis showed that ATTR-CA patients had a better prognosis, while cardiac amyloidosis patients with higher cardiac function grade, NT-proBNP >6 000 ng/L, and troponin T >70 ng/L had a worse prognosis (P<0.05). Multivariate survival analysis showed that NT-proBNP and cardiac function grade were independent prognostic factors for cardiac amyloidosis patients. Conclusions: AL-λ is the most common type of cardiac amyloidosis in this group. Congo red staining combined with electron microscopy can significantly improve the diagnosis of cardiac amyloidosis. The clinical manifestations and prognosis of each type are different and can be classified based on immunostaining profile. However, there are still a few cases that cannot be typed; hence mass spectrometry is recommended if feasible.

Single-use flexible bronchoscopes vs traditional reusable flexible bronchoscopes: a prospective controlled study

BackgroundSingle-use flexible bronchoscopes(SFB) eliminate the risk of bronchoscopy-related infection compared with traditional reusable flexible bronchoscopes(RFB). At present, there is no comparative study between SFB and RFB in the aspects of biopsy and interventional therapy. This study aims to explore whether SFB can perform complex bronchoscopic procedures such as transbronchial biopsies just like RFB.MethodsWe conducted a prospective controlled study. A total of 45 patients who required bronchoscopic biopsy in our hospital from June 2022 to December 2022 were enrolled. The patients were divided into the SFB group and the RFB group, and routine bronchoscopy, bronchoalveolar lavage, and biopsy were performed respectively. Data on the time of routine bronchoscopy, the recovery rate of bronchoalveolar lavage fluid(BALF), biopsy time, and bleeding volume were collected. Then we used the two-sample t-test and the χ2 test to assess the performance differences between SFB and RFB. We also designed a questionnaire to compare the performance between SFB and RFB by different bronchoscope operators.ResultsThe routine examination time of SFB and RFB was 3.40 ± 0.50 min and 3.55 ± 0.42 min, respectively. There was no significant difference between the two groups (P = 0.308). The recovery rate of BALF was (46.56 ± 8.22) % in the SFB group and (47.00 ± 8.07) in the RFB group, without a significant difference between the two groups(P = 0.863). The biopsy time was similar(4.67 ± 0.51 min VS 4.57 ± 0.45 min) in both groups, with no significant difference(P = 0.512). The positive biopsy rate was 100% in both groups, with no significant difference. Overall, the bronchoscope operators were generally satisfied with SFB.ConclusionSFBs are non-inferior to RFBs in routine bronchoscopy, bronchoalveolar lavage, and biopsy. It is suggested that SFBs have a wider clinical application.

5-alpha reductase inhibitors and MRI prostates: actively reducing prostate sizes and ambiguity

BackgroundMagnetic resonance imaging (MRI) scans are increasingly first-line investigations for suspected prostate cancer, and essential in the decision for biopsy. 5-alpha reductase inhibitor (5-ARI) use has been shown to reduce prostate size and prostate cancer risk. However, insufficient data exists on how 5-ARI use affects MRI findings and yield of biopsy. This study explores the differences in imaging and prostate cancer diagnoses between patients receiving and not receiving 5-ARI therapy.MethodsFrom 2015 to 2020, we collected retrospective data of consecutive patients undergoing prostate biopsy at one centre. We included patients who were biopsy-naïve, had prior negative biopsies, or on active surveillance for low-grade prostate cancer. Clinical and pathological data was collected, including 5-ARI use, Prostate Imaging Reporting and Data System (PIRADS) classification and biopsy results.Results351 men underwent saturation biopsy with or without targeted biopsies. 54 (15.3%) had a history of 5-ARI use. On mpMRI, there was no significant difference between the 5ARI and non-5-ARI groups in PIRADS distribution, number of lesions, and lesion location. Significantly fewer cancers were detected in the 5-ARI group (46.3% vs. 68.0%; p < 0.01). There were no significant differences in PIRADS distribution in 5-ARI patients with positive and negative biopsy.ConclusionOur study found significant differences in biochemical, imaging and biopsy characteristics between 5-ARI and non-5-ARI groups. While both groups had similar PIRADS distribution, 5-ARI patients had a lower rate of positive biopsies across all PIRADS categories, which may suggest that the use of 5ARI may confound MRI findings. Further studies on how 5-ARI therapy affects the imaging characteristics of prostate cancer should be performed.

PD15-03 RADIATION DOSE REQUIRED TO CONTROL PROSTATE CANCER AS DETERMINED BY POST-TREATMENT BIOPSY: LONG TERM RESULTS

You have accessJournal of UrologyCME1 Apr 2023PD15-03 RADIATION DOSE REQUIRED TO CONTROL PROSTATE CANCER AS DETERMINED BY POST-TREATMENT BIOPSY: LONG TERM RESULTS Nelson Stone, Rendi Shue, Barry Rosenstein, and Richard Stock Nelson StoneNelson Stone More articles by this author , Rendi ShueRendi Shue More articles by this author , Barry RosensteinBarry Rosenstein More articles by this author , and Richard StockRichard Stock More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003262.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation therapy for prostate cancer is typically prescribed at a standard dose, 79-81 Gy for external beam irradiation (EBRT) and 145 Gy for iodine-125 brachytherapy (BT). Unlike prostatectomy where the gland is removed at the time of treatment successful radiation treatment relies on the death of all cancer cells in situ. However, the dose requirement for different Gleason grade groups or NCCN risk groups may also differ. We investigated the relationship between the biological effective dose (BED) and local control as determined by post-treatment biopsy (PB) in a large cohort of men who had BT +EBRT. METHODS: 545 men who had BT were followed a median of 11 years (range 2-26) and had PB a mean of 3.2 years (2-17) post-treatment. All PB were performed by one investigator (NNS) and routinely performed at 2 years or later for a rising PSA. Median age, PSA and BED were 66 years (41-85), 7.0 ng/ml (1-189) and 185.5 Gy (15-282). 295 (54.1%) received hormone therapy (HT) for a median of 6 months. Radiation doses were converted post-implant to the BED using an ꭤ/β of 2. Associations with grade, stage, PSA, NCCN status, HT use, BED were compared to the PB results and prostate cancer survival (PCS) using ANOVA, chi-square, linear regression, Kaplan Meier estimates with comparisons by log rank and Cox proportion hazards. RESULTS: 34 (6.2%) of the 545 men had a positive PB which occurred a mean of 5.9 years (range 2-17) after all treatment. BED (p<0.001), stage (p=0.004), PSA (p=0.038) and HT use (p=0.019) were associated with a positive PB but only BED (p<0.001) remained significant on regression analysis. Dichotomizing BED to <140, 160, 180, 200, 220 or greater yielded optimal local control (positive biopsy rate 2% or less) at 180 Gy for all 3 NCCN risk groups (Table). Men with a positive PB had a mean BED of 136.8 vs. 181.3 Gy for negative PB (p<0.001). At <180 Gy 24/229 (10.5%) had local failure compared to 5/392 (1.7%) for higher doses (p<0.001, OR 6.7, 95% CI 2.5-17.9). PCS at 15 and 20 years for negative PB was 94.5 and 94.5% vs. 74.4 and 46.5% for a positive one (p<0.001). PCS was associated with BED (p<0.001), PSA (p=0.028) and stage (p=0.018). CONCLUSIONS: This long-term investigation defined the radiation dose necessary to eradicate prostate cancer and should be considered as the minimal requirement when prescribing and delivering this treatment option. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e419 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nelson Stone More articles by this author Rendi Shue More articles by this author Barry Rosenstein More articles by this author Richard Stock More articles by this author Expand All Advertisement PDF downloadLoading ...

PD15-06 SYSTEMATIC PROSTATE BIOPSY WITH INSUFFICIENT BIOPSY CORE NUMBER AT DIAGNOSIS LEADS PSA FAILURE AFTER BRACHYTHERAPY AS MONOTHERAPY FOR CLINICAL STAGE T1C PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023PD15-06 SYSTEMATIC PROSTATE BIOPSY WITH INSUFFICIENT BIOPSY CORE NUMBER AT DIAGNOSIS LEADS PSA FAILURE AFTER BRACHYTHERAPY AS MONOTHERAPY FOR CLINICAL STAGE T1C PROSTATE CANCER Yu Ozawa, Sunao Nohara, Ken Nakamura, Seiya Hattori, Yasuto Yagi, Toru Nishiyama, Atsunori Yorozu, Tetsuo Monma, and Shiro Saito Yu OzawaYu Ozawa More articles by this author , Sunao NoharaSunao Nohara More articles by this author , Ken NakamuraKen Nakamura More articles by this author , Seiya HattoriSeiya Hattori More articles by this author , Yasuto YagiYasuto Yagi More articles by this author , Toru NishiyamaToru Nishiyama More articles by this author , Atsunori YorozuAtsunori Yorozu More articles by this author , Tetsuo MonmaTetsuo Monma More articles by this author , and Shiro SaitoShiro Saito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003262.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to the American Urological Association (AUA) guideline, systematic 10–12-core biopsy is optimal for detecting clinical stage T1c (cT1c) prostate cancer (PCA) and also for obtaining higher pathological concordance. Smaller number of prostate biopsy (PB) cores can underestimate pathological characteristics of PCA. This study reviews association between number of biopsy cores at diagnosis and clinical outcomes after low dose rate permanent seed implantation brachytherapy with iodine-125 (LDR) monotherapy. METHODS: This single-institution retrospective study included 542 cT1c PCA with Gleason score 3+3=6 or 3+4=7 treated between September 2003 and September 2014 with LDR monotherapy without hormonal therapy. Local extent of disease was evaluated by digital rectal examination and pelvic MRI. All specimens of ultrasound guided trans-rectal or trans-perineal systematic PB were reviewed by urological pathologists in our institute. We statistically analyzed with Kaplan-Meier and compared rate of biochemical-recurrence (BCR)-free survival, using the Phoenix definition, between adequate (≥10 biopsy cores, N=397) and inadequate (≤9 biopsy cores, N=144) biopsy groups. Possible risk factors for BCR, such as PSA, Gleason score, biopsy core number and positive biopsy core rate, were analyzed. RESULTS: The median age was 66 (38–87) years old and median follow up period was 10.6 (1.0–18.5) years. The median number of biopsy cores was 12 (4–46). In the adequate biopsy group, more patients had Gleason score 3+4=7 (31% vs. 15%, p<0.01). The 5- and 10-year rates of BCR-free survival rates in the adequate biopsy group were 98.7% and 96.9%, respectively, while those in the inadequate biopsy group were 98.6% and 95.6%, respectively. BCR-free survival rate was significantly higher than in the inadequate biopsy group (p <0.05). In multivariate analysis, biopsy core number ≥10 (Hazard ratio; HR 2.58, p<0.02) and Gleason score 3+4=7 (HR 3.26, p<0.01) were the significant factors for BCR. CONCLUSIONS: Systematic PB with sufficient core number greater than 9 leads to lower BCR in LDR monotherapy. Number of biopsy cores on PB might be an important factor for treatment outcomes. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e420 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yu Ozawa More articles by this author Sunao Nohara More articles by this author Ken Nakamura More articles by this author Seiya Hattori More articles by this author Yasuto Yagi More articles by this author Toru Nishiyama More articles by this author Atsunori Yorozu More articles by this author Tetsuo Monma More articles by this author Shiro Saito More articles by this author Expand All Advertisement PDF downloadLoading ...