Standard Biopsy Research Articles

Compаrative study: Efficacy and safety of MRI / ultrasound transperineal vs systematic transrectal prostate biopsy in patients with previous negative TRUS biopsy

Objective The aim of the study was to compare the efficacy and safety of magnetic resonance imaging / ultrasound-targeted transperineal prostate biopsy versus standard transrectal systemic biopsy, in detection of prostate cancer, in patients with evidence of previous negative systematic transrectal ultrasound prostate biopsy. Material and Methods From February 2019 to February 2021 in the Clinic of Endourology and SWL of the Military Medical Academy – Sofia, in 59 patients repeated prostate biopsy was performed after a previous negative systematic transrectal ultrasound-guided biopsy. In 35/59 patients in the group, MRI / ultrasound transperineal prostate biopsy was performed (group A), and in the remaining 24/59 patients a repeat systemic TRUS biopsy was performed (group B). The main indications for repeat prostate biopsy were persistent elevated PSA values, a finding on rectal digital examination, and / or a suspected area of prostate MRI. Results. Preoperative data were comparable in the two groups of patients, with no statistically significant differences. The mean value of PSA in group A was 17.27 ± 14.6 ng / ml, compared to 25.93 ± 24.19 ng / ml in group B, p = 0.264. MRI / ultrasound transperineal prostate biopsy revealed the presence of prostate cancer in 28 patients (80%) of the study group, compared to 8 patients (33.3%) in the group who underwent systematic TRUS biopsy, p = 0.001. The histopathological results of group A revealed the presence of low-grade prostate cancer in 15 patients (42.9%), compared to 13 patients (37.1%) in whom high-grade cancer was detected. The results show a statistically significant difference compared to patients in group B, where 3 patients (12.5%) showed low-grade prostate cancer, and 5 patients (20.8%) had a high-grade malignant process, p = 0.005. There was no statistically significant difference in intra- and postoperative complications in the two groups. Conclusion. Performing MRI / ultrasound targeted biopsy showed significant higher efficacy and identical safety in diagnosing a prostate neoplastic process compared to standard 12-core transrectal systemic biopsy in patients with previous negative systemic TRUS biopsy.

Recent Advances in Systematic and Targeted Prostate Biopsies.

Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.

THE IMPORTANCE OF CIRCULATING TUMOR DNA IN THE ASSESSMENT OF METASTATIC COLORECTAL CANCER TREATMENT EFFECTIVNE

Challenges in cancer detection, prognosis and management are currently being solved by determining circulating tumor DNA (ctDNA). The assessment of this marker has acquired particular importance in metastatic colorectal cancer (mCRC), the systemic treatment of which depends on the RAS gene status, which has prognostic and predictive value. However, the possibilities of taking samples from the primary or metastatic lesion for pathomorphological and molecular analysis in CRC are often limited. The determination of ctDNA using liquid biopsy has an advantage over standard biopsy due to its low invasiveness and high availability of the method. Analysis of mutations using ctDNA as well as changes in the level of this marker is a criterion for the effectiveness of systemic treatment, as well as a factor that determines the risk of disease progression. Currently, the potential of using ctDNA to monitor effectiveness of first-and second-line chemotherapy, as well as to predict the development of secondary resistance to EGFR inhibitors (cetuximab and panitumumab) in the first-line treatment and assessment of RAS status for returning to therapy with EGFR inhibitors in the third-line treatment of mCRC is being studied. Several pilot studies have provided evidence of the efficacy of EGFR re-treatment. The modern literature data published in leading peer-reviewed journals in Russian and international scientific citation databases, such as Medline, Elibrary, and PubMed were analyzed. Of the 138 analyzed publications, 56 were used to write this review.

A Prospective Study and Single-Center Experience: Effectivity of Fusion Prostate Biopsy in Biopsy-Naïve Patients.

ObjectiveFusion prostate biopsy (FPB) has become a popular technique in biopsy-naïve patients, though not accepted as a standard approach (yet). In this study, we aimed to present the clinical outcomes of biopsy-naïve patients who underwent FPB.Material and methodsThe study included 400 biopsy-naïve patients aged 45-75 years who had a prostate-specific antigen (PSA) level of 2-10 ng/ml and were detected with a Prostate Imaging-Reporting and Data System (PIRADS) ≥3 lesion on multiparametric prostate magnetic resonance imaging (mpMRI)-guided FPB. A combined biopsy (CB) was performed in each patient, in which 2-4 cores were obtained for suspicious lesions by targeted biopsy (TB) and then 12-core standard prostate biopsy (SPB) was conducted in the same session. Cancer detection rates, clinically significant prostate cancer (csPCa) detection rates, histological upgrading rates, and false negative rates were determined.ResultsThe 400 patients had a mean age of 62.01±7.00 years and a mean PSA value of 6.84±1.87 ng/ml. Overall PCa detection rate was 50% (200/400). The csPCa detection rates for TB, SPB, and CB were 25.0%, 31.8%, and 44.0%, respectively (p<0.001). In PIRADS 3, 4, and 5 lesions, CB had a csPCa detection rate of 29.2%, 54%, and 64.8%, respectively (p<0.001). The ratio of false negativity was significantly higher for TB compared to SPB (43.2% vs. 27.8%, p=0.003), whereas no significant difference was found between these two techniques with regard to upgrading rates although TB had a higher rate (19.6% vs. 13.7%, p=0.144).ConclusionFPB, a combined approach involving TB and SPB, was revealed as the most successful technique in biopsy-naïve patients with PSA<10 ng/ml due to its high cancer detection rates and low false negative rates.

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

499 A Retrospective Audit on Detection Rate of Clinically Significant Cancer Among MP-MRI Targeted Biopsy – A Single Centre Experience

Abstract Men with high serum prostate specific antigen (PSA) typically undergo standard transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) during which 10 to 12 cores are obtained. TRUS-biopsy can cause side-effects including bleeding, pain, and infection. Multi-parametric MRI (MP-MRI) used as a triage test might allow men to avoid unnecessary TRUS-biopsy and improve diagnostic accuracy. According to the renowned PROMIS study, for clinically significant cancer, MP-MRI was more sensitive and less specific than TRUS-biopsy. In this study, we performed a single centre, retrospective audit on the detection rate of clinically significant cancer among MP-MRI targeted biopsy and compare it with the standard TRUS biopsy. Clinically significant cancer is defined as Gleason score ³ 4 +3 or a maximum cancer core length 6mm or longer. Besides, we also compare the rate of clinically significant cancer in MP-MRI targeted biopsy against the PROMIS study. Through this audit, we found that in 2019, there is a 54% (60 out of 112 patients) of clinically significant cancer in MP-MRI biopsy and 41% (26 out of 64 patients) of clinically significant cancer among standard TRUS biopsy. Comparing it with the PROMIS study in which clinically significant cancer was detected in 38% in the MP-MRI targeted biopsy group and 26% in the standard-biopsy group, the adjusted difference in our study (13%) is similar to PROMIS study which is 12%. In conclusion, our study reaffirms that MP-MRI targeted biopsy reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer.

SC220 - Is standard biopsy still always necessary in the era of MRI/TRUS fusion biopsy? Retrospective analysis from a referral italian center

SC220 - Is standard biopsy still always necessary in the era of MRI/TRUS fusion biopsy? Retrospective analysis from a referral italian center

16P Evaluation of the relationship between clinicopathological features at diagnosis and acquisition of T790M resistance mutation in patients with EGFR-mutant metastatic lung cancer

Data of the acquisition of T790M resistance mutation in patients with EGFR-mutant metastatic lung cancer is limited. This study aimed to assess the relationship between clinicopathological features at diagnosis, and acquisition of T790M mutation in patients with EGFR-mutant metastatic non-small cell lung cancer. We evaluated the EGFR-mutant metastatic lung cancer patients' data who progressed under first-line treatment with tyrosine kinase inhibitors and acquired T790M resistance mutation retrospectively. Survival analyses were assessed with Kaplan-Meier and Cox-regression methods. The relationship between the acquisition of T790M mutation and clinicopathological parameters was evaluated with logistic regression analysis. Fifty-two patients were included in the study. The median age was 58 (range, 33-78) years. The proportion of female patients was 53.2%. The proportions of exon 19, exon 21, and rare mutations were 68.7%, 23.5%, and 7.8%, respectively. Forty-five (86.5%) patients were de-novo metastatic. The proportion of patients who had one, two, and three or more metastatic sites at diagnosis were 25.5%, 41.3%, and 33.2%, respectively. The proportio of brain, liver and adrenal gland metastasis were 29.4%, 13.7%, and 7.8%, respectively. All patients received tyrosine kinase inhibitors. After the disease progressed, the acquisition of T790M mutation was detected with liquid (75.5%) or standard biopsies (24.5%). T790M mutations were detected in 33 (63.5%) patients. In logistic regression analysis, age, gender, de-novo metastatic disease, number of metastatic sites, primary tumor localization (left or right lung), and type of tyrosine kinase inhibitor was not statistically significant for the acquisition of T790M mutations. Due to rarity, the data on the acquisition of T790M mutations are limited. In this study, we showed that clinicopathological features were not related to the acquisition of T790M mutations.

SC216 - Target only vs target plus standard biopsy in naïve patients: analysis of detection rate and comparison with radical prostatectomy specimens

SC216 - Target only vs target plus standard biopsy in naïve patients: analysis of detection rate and comparison with radical prostatectomy specimens

S1354 Modification of the Tight Junctional Barrier in Human Duodenal Mucosal by Oral Zinc Administration in a Patient-Based Study: RNA-Seq and Western Immunoblot Analyses

Introduction: Mucosal barrier function is targeted in a wide variety of GI disease. Celiac disease, IBD, GI malignancies, sepsis and a wide variety of GI microbial infectious diseases all compromise the GI barrier. The tight junctional (TJ) complex is pivotal in this regard. The ability to safely modify the TJ complex and reduce its leakiness could be prophylactically and/or therapeutically useful. Methods: Patients 18-80 years of age presenting for endoscopic medical surveillance of gastroesophageal disorders but free of current small bowel disease were recruited for study. Patients were instructed to administer orally either a zinc-gluconate medication (12 patients) (26 mg elemental zinc) or a sodium gluconate placebo (11 patients), BID, for 14 days immediately prior to their EGD. During their EGD, standard duodenal bulb biopsies were taken for Western immunoblot analysis and for mRNA analysis. Biopsies were immediately flash frozen on dry ice in the procedures room and stored at -195oC for subsequent extraction. For protein studies, biopsies were homogenized in lysis buffer, sonicated and then analyzed by PAGE and Western immunoblot using a variety of antibodies to TJ proteins. Analysis of the biopsy transcriptome was performed by high-throughput RNA-seq. Results: Transcriptome analysis of over 20,000 genes revealed upregulation of many known zinc-regulated genes such as metallothioneins A, B, F, G, H, L, and M. The TJ barrier gene, occludin (OCLN), was also upregulated. Enrichment analysis using GSEA showed zinc upregulating several gene ontology (GO) biological processes as well as cellular components and pathways (Reactome). These included Zinc Ion Homeostasis (GO), Response to Zinc Ion (GO), Cell Junction Organization (Reactome), Cell-Cell Junction Assembly (GO), and Tight Junction (GO). Western immunoblot analyses showed statistically significant upregulation (two-tailed t-test) of the TJ proteins, claudin-2 and tricellulin, in mucosal biopsies of the zinc-treated group. Claudins -3 and -5 showed significant upregulations, and claudin-7, a significant down regulation, in a one-tailed t-test. Claudins -1, -4 and -18 showed no trend regarding a zinc-induced change. Conclusion: This is the first evidence of intended modification of TJ complexes in humans in situ. The results follow on a large body of published literature showing zinc-induced TJ changes and improved barrier function in a variety of human epithelial cell culture and animal models.

IMPROVING PLEURAL BIOPSY YIELD THROUGH THE INTEGRATION OF ELECTROCAUTERY INTO SEMI-RIGID MEDICAL THORACOSCOPY

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Medical thoracoscopy is a minimally invasive method of obtaining pleural tissue for pathologic testing. While the use of a semi-rigid thoracoscope provides greater maneuverability over a rigid thoracoscope, the smaller working channel may limit the ability to obtain an adequate specimen using standard flexible forceps. CASE PRESENTATION: A 58-year-old male with a history of well-controlled HIV and sarcoidosis presented with a recurrent right pleural effusion. He underwent serial thoracenteses, which revealed a lymphocytic-predominant exudative effusion with triglycerides of 1,300 mg/dL consistent with chylothorax. However, cytology, pleural fluid and serologic testing, as well as lymphangiography failed to provide an underlying diagnosis. Given the uncertain etiology, the patient was consented for medical thoracoscopy. After being prepped and draped in the usual sterile fashion, the pleural space was entered with a semi-rigid thoracoscope. Visual inspection of the thoracic cavity did not reveal an obvious etiology of the pleural effusion or evidence of pleural metastases. Initially, large capacity flexible forceps (2.8mm - Boston Scientific) were used to obtain several specimens averaging 2mm x 4mm (Figure 1). Next, a section of parietal pleura was identified and using an electrocautery knife (HookKnife – Olympus), a 4mm by 10mm full-thickness section was dissected and removed en bloc. This piece was then retrieved with forceps and sent for pathologic testing. The site of the electrocautery biopsy was observed and did not show any evidence of active bleeding (Figure 2). A chest tube was left in place for ongoing management of the patient's pleural effusion. The patient tolerated the procedure well without complications and is awaiting final pathologic diagnosis. DISCUSSION: We describe the integration of a flexible electrocautery knife into semi-rigid medical thoracoscopy. This technique allows for larger specimens of intact pleural tissue to be obtained than would otherwise be possible with a standard flexible forceps biopsy. CONCLUSIONS: The use of electrocautery as a biopsy tool during semi-rigid thoracoscopy provides an effective means of acquiring full-thickness pleural samples and helps to mitigate the disadvantages of a smaller working channel when compared to rigid thoracoscopy. REFERENCE #1: Canto A, et al. Points to consider when choosing a biopsy method in cases of pleurisy of unknown origin. Chest. 1983 Aug;84(2):176-9. doi: 10.1378/chest.84.2.176. PMID: 6872597. DISCLOSURES: Consultant relationship with medtronic Please note: 2019-2021 Added 04/27/2021 by George Cheng, source=Web Response, value=Consulting fee Consultant relationship with boston scientific Please note: 2019-2021 Added 04/27/2021 by George Cheng, source=Web Response, value=Consulting fee Consultant relationship with pinnicle biologics Please note: 2019-2021 Added 04/28/2021 by George Cheng, source=Web Response, value=Consulting Owner/Founder relationship with restor3D Please note: 2016-present Added 04/28/2021 by George Cheng, source=Web Response, value=Ownership interest Consultant relationship with Intuitive Surgical Please note: 2019-2021 Added 04/28/2021 by George Cheng, source=Web Response, value=Consulting fee No relevant relationships by Russell Miller, source=Web Response No relevant relationships by Matthew Nobari, source=Web Response No relevant relationships by Alex Pearce, source=Web Response No relevant relationships by Grant Senyei, source=Web Response

Effect of ultrasound use on the pathological outcomes in temporal artery biopsy

Aim:This study aimed to determine whether there is a significant difference between the results of a standard biopsy and Doppler ultrasonography-guided biopsy of the temporal artery, which showed low preoperative pulse pressure.&#x0D; Material and Methods: Data from 21 patients, who received preliminary diagnosis of temporal arteritis at the neurology clinic were retrospectively investigated. Patients were divided into two groups depending on the method with Doppler ultrasonography and without ultrasonography.&#x0D; Results: Results from a total of 21 patients were evaluated. The first group consisted of 11 patients who underwent standard temporal artery biopsy, while the second group consisted of 10 patients who underwent ultrasonography-guided biopsy. Six patients in the group without the ultrasonography guidance showed insignificant results. Furthermore, the samples were insufficient in four of these six patients. In contrast, four patients from the Doppler ultrasonography-guided group were diagnosed with arteritis, in addition to the fact that an insufficient biopsy sample was not encountered in these patients.&#x0D; Statistical analysis showed that there was no significant difference between the pathology results of the two groups.&#x0D; Conclusion: Although we failed to find a significant difference between the groups, we believe that the Doppler ultrasonography-guided biopsy should be used as a supportive tool rather than diagnostic tool per se, as the Doppler ultrasonography-guided group did not provide insufficient biopsy samples in the pathology results as opposed to the standard group.

Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study.

Simple SummaryThe introduction of imaging techniques has improved the diagnostic pathway for prostate cancer. In this study we compared the diagnostic accuracy of multiparametric MRI with fusion ultrasound-guided prostate biopsy and standard biopsy, both performed through the transperineal route. Our results support the combined targeted and standard biopsy pathway to reduce the risk of missing clinically significant prostate cancer.The management of prostate biopsy in men with clinical suspicion of prostate cancer has changed in the last few years, especially with the introduction of imaging techniques, to overcome the low efficacy of risk stratification based on PSA levels. Here, we aimed to compare the diagnostic accuracy of multiparametric MRI with fusion ultrasound-guided prostate biopsy and standard biopsy, both performed through the transperineal route. To this end, we retrospectively analyzed 272 patients who underwent combined transperineal targeted and standard biopsy during the same session. The primary outcome was to compare the cancer detection rate between targeted and standard biopsy. The secondary outcome was to evaluate the added value of combined targeted and standard biopsy approach as compared to only targeted or standard biopsy. Results showed that a rate of 16.7% clinically significant tumors (International Society of Urological Pathology (ISUP) grade ≥ 2) would have been lost if only the standard biopsy had been used. The combined targeted and standard biopsy showed an added value of 10.3% and 9.9% in reducing the risk of prostate cancer missing after targeted or standard biopsy alone, respectively. The combined targeted and standard biopsy pathway is recommended to reduce the risk of missing clinically significant prostate cancer.

МРТ- ТРУЗИ фьюжн-биопсия в диагностике рака предстательной железы

Introduction. Significant improvement in the quality of visualization of the prostate using magnetic resonance imaging (MRI), as well as the development of technologies for virtual combination of MRI and ultrasound images opens new horizons in the diagnosis of prostate cancer. The introduction of the PI-RADS system has allowed the standardization of MRI findings, and the development of fusion biopsy systems seeks to make diagnostics more accurate and less operator-dependent. Materials and methods. In this literature review, we evaluate the effectiveness of various biopsy approaches and discuss the prospects for targeted biopsies. The search for publications was carried out in the databases PubMed, e-library, Web of Scince et al. For citation, 55 literature sources were selected that met the search criteria for the keywords, «prostate cancer», «biopsy», «MRI», «TRUS», «fusion». Results. Diagnosis of prostate cancer using MRI. Modern technologies for radiological diagnosis of prostate cancer using magnetic resonance imaging (MRI) are based on the standardized PI-RADS protocol, using different modes (T2, diffusion-weighted images and contrast enhancement), which provides the best visualization of tumor-suspicious nodes in the prostate gland, allowing determination of lesion localization and size for subsequent targeted biopsy. Options for performing a prostate biopsy to diagnose prostate cancer. A description of the methods and effectiveness of transrectal and transperineal biopsy under ultrasound guidance is carried out - due to the fact that ultrasound diagnostics of prostate cancer has a rather low sensitivity due to small differences in the ultrasound structure of normal and tumor tissue of the prostate, an extended template biopsy technique was proposed, which involves puncture of the prostate through a special lattice. It also describes the technology of fusion biopsy and also provides literature data comparing the diagnostic accuracy of standard TRUS and fusion prostate biopsy, as well as the importance of transrectal / transperineal access. Questions for further study. Given the desire to reduce the number of biopsies while maintaining or even increasing the accuracy of diagnosing prostate cancer, data from studies investigating the feasibility of combining polyfocal (non-targeted) and targeted (targeted) biopsies are presented. Conclusion. The existing methods of non-targeted biopsy (polyfocal, saturation, template) and targeted (fusion biopsy) have their advantages and disadvantages, which currently do not allow making certain recommendations for their use, but a significant number of authors prefer MRI-as sisted, fusion -biopsy.

High-intensity focused ultrasound (HIFU) hemiablation of the prostate: Late follow-up MRI findings in non-recurrent patients

ObjectivesFocal therapy with high-intensity focused ultrasound (HIFU) is an emerging option for the treatment of prostate cancer and often followed up by MRI. Image assessment of treatment failure, however, requires proper knowledge about typical procedure-related changes in prostate MRI, which is sparse, in particular for unilateral HIFU treatment and late follow up (beyond 6 months). The goal of this study was therefore to compile the type and frequency of such MRI findings in selected patients without recurrent cancer 12 months after prostate hemiablation. MethodsData from a prospective multicenter trial on HIFU hemiablation were reviewed retrospectively. Trial patients have had a late follow-up by MRI (at around 12 months) and either MRI/transrectal ultrasound (TRUS) fusion or standard TRUS-guided biopsy. This work deliberately included patients with non-recurrent cancer in the treated prostate lobe in per-protocol biopsy leaving 30 men with initial International Society of Urological Pathology (ISUP) Grade Group of 1 or 2. Six categories of potential HIFU-related MRI features were assessed by an expert committee and then evaluated by two readers in consensus: 1. shrinkage of the treated lobe, 2. residual prostate tissue, 3. fluid-filled cavity, 4. fibrosis, 5. hematoma residuals (in the prostate or seminal vesicles) and 6. contrast enhancement of the ablated area. ResultsShrinkage of the ablated lobe was seen in 93% of the cases with an average percent volume change of −37% (range: −70% to +108%). In the contralateral lobe, the volume remained practically the same (–2% on average, p = 0.804). In the ablated lobe, the frequency of fibrosis was 97%. Residual prostate tissue was seen in 93% of the cases. The frequency for fluid-filled cavities was 97%, with the wide majority (90%) contiguous with the urethra. Hematoma residuals in the prostate and in seminal vesicles were found in 47% and 10% of the patients, respectively. Contrast enhancement was both rim-like (50%) as well as diffuse (33%) within the ablated area. ConclusionIn our case series of HIFU hemiablation in the prostate, shrinkage, residual prostate tissue, fluid-filled cavities contiguous with the urethra and fibrosis were very common late MRI findings of the ablated lobe in non-recurrent patients. Rim-like contrast enhancement or diffuse one within the ablated area were less frequent.

Lymphocyte-to-monocyte ratio is a predictor of clinically significant prostate cancer at prostate biopsy.

Inflammation plays critical roles at different stages of carcinogenesis and cancer progression. Several previous studies showed conflicting results for the predictive role of systemic inflammation markers in the detection of clinically significant prostate cancers (CSPCs). We aimed to determine the predictive roles of lymphocyte-to-monocyte (LMR) and eosinophil-to-lymphocyte ratios (ELR) in the detection of CSPC at standard 12-core transrectal ultrasound-guided prostate biopsy (12-core-TRUS-Bx) using our large-cohort database. Clinical and pathological data of a total of 1740 men, who underwent initial standard 12-core TRUS-Bx, were analyzed. LMR and ELR were calculated from the prebiopsy complete blood count. Definitions of CSPC, LMR, and ELR were "Gleason grade group ≥2," "the lymphocyte counts/the monocyte counts," and "the eosinophil counts/the lymphocyte counts," respectively. Median (interquartile range) of serum prostate-specific antigen(PSA) level and prostatic volume before TRUS-Bx were 7.59 (5.02-13.12) ng/ml and 38.2 (29.0-52.9) ml, respectively. Benign prostatic lesions, clinically insignificant prostate cancers (CIPCs), and CSPCs were detected in 1179 (67.8%), 180 (10.3%), and 381 (21.9%) patients, respectively. The patients with CSPCs had older age, a higher prevalence of diabetes mellitus or hypertension, a higher rate of digital rectal examination abnormality, higher serum PSA level, lower serum testosterone level, and lower LMR than those with benign lesions or CIPCs. However, there was no difference in ELR among the three (benign lesions, CIPCs and CSPCs). In all the patients, multivariate regression analysis showed that lower LMR was an independent predictor of CSPCs compared with ELR. In the subset of men with prostate volume ≥39.3 ml, lower LMR was an independent predictor of CSPCs compared with ELR. In the subset of men with prostate volume <39.3 ml, men with lower LMR showed the tendency of having a higher probability of CSPCs without any statistical significance on the contrary to ELR. Our data indicate that LMR can play an independent predictive role in the detection of CSPCs at initial 12-core-TRUS-Bx compared with ELR. The predictive role of the LMR appears to be significant for men with larger prostate volume rather than those with smaller prostate volume.

Educational intervention to improve quality of care in Barrett’s esophagus: the AQUIRE randomized controlled trial

Despite quality measures in upper endoscopy (EGD) for Barrett's esophagus (BE), considerable variability remains in practice among gastroenterologists. This randomized controlled trial evaluated the role of structured intensive training on the quality of EGD in BE. In this multicenter study, 8 sites (from the GI Quality Consortium) were cluster randomized (1:1) to receive AQUIRE (A Quality Improvement program in cancer care during Endoscopy) training (intervention) or continue local standard practices (control). The primary outcome was compliance with the Seattle biopsy protocol. Secondary outcomes were change in knowledge of BE detection and sampling assessed by questionnaire and dysplasia detection rate (DDR) before and after completion of the 6-month study period. The intervention sites (n= 4) had 31 gastroenterologists and the control sites (n= 4) had 34. There was a significant improvement in the compliance rates with the Seattle biopsy protocol from baseline to the end of the study in the intervention sites (64.8%-73.2%, P= .002) but not in the control sites (69.5%-69.4%, P= .953). The accurate response rate on the questionnaire at the intervention sites increased from 73% at baseline to 88% after AQUIRE training (difference, 14.8%; standard deviation, 18.7; P= .008). DDR did not change significantly from baseline to 6 months in either the control or intervention groups (P= .06). This study confirms the capacity of a structured educational intervention to improve utilization of a standard biopsy protocol and knowledge of standards of care in BE but without significant change in DDR.

MRI-Targeted or Standard Biopsy in Prostate Cancer Screening

BackgroundHigh rates of overdiagnosis are a critical barrier to organized prostate cancer screening. Magnetic resonance imaging (MRI) with targeted biopsy has shown the potential to address this challenge, but the implications of its use in the context of organized prostate cancer screening are unknown.MethodsWe conducted a population-based noninferiority trial of prostate cancer screening in which men 50 to 74 years of age from the general population were invited by mail to participate; participants with prostate-specific antigen (PSA) levels of 3 ng per milliliter or higher were randomly assigned, in a 2:3 ratio, to undergo a standard biopsy (standard biopsy group) or to undergo MRI, with targeted and standard biopsy if the MRI results suggested prostate cancer (experimental biopsy group). The primary outcome was the proportion of men in the intention-to-treat population in whom clinically significant cancer (Gleason score ≥7) was diagnosed. A key secondary outcome was the detection of clinically insignificant cancers (Gleason score 6).ResultsOf 12,750 men enrolled, 1532 had PSA levels of 3 ng per milliliter or higher and were randomly assigned to undergo biopsy: 603 were assigned to the standard biopsy group and 929 to the experimental biopsy group. In the intention-to-treat analysis, clinically significant cancer was diagnosed in 192 men (21%) in the experimental biopsy group, as compared with 106 men (18%) in the standard biopsy group (difference, 3 percentage points; 95% confidence interval [CI], −1 to 7; P<0.001 for noninferiority). The percentage of clinically insignificant cancers was lower in the experimental biopsy group than in the standard biopsy group (4% [41 participants] vs. 12% [73 participants]; difference, −8 percentage points; 95% CI, −11 to −5).ConclusionsMRI with targeted and standard biopsy in men with MRI results suggestive of prostate cancer was noninferior to standard biopsy for detecting clinically significant prostate cancer in a population-based screening-by-invitation trial and resulted in less detection of clinically insignificant cancer. (Funded by the Swedish Research Council and others; STHLM3-MRI ClinicalTrials.gov number, NCT03377881.)

PD50-06 A COMPARISON OF MRI FUSION BIOPSY PI-RADS SCORING SYSTEM TO EXACTVU MICRO-ULTRASOUND PRI-MUS SCORING SYSTEM IN IDENTIFYING PROSTATE CANCER: A SINGLE INSTITUTION RETROSPECTIVE ANALYSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-06 A COMPARISON OF MRI FUSION BIOPSY PI-RADS SCORING SYSTEM TO EXACTVU MICRO-ULTRASOUND PRI-MUS SCORING SYSTEM IN IDENTIFYING PROSTATE CANCER: A SINGLE INSTITUTION RETROSPECTIVE ANALYSIS Michael Hailemariam, Douglas Kelly, and Joshua Langston Michael HailemariamMichael Hailemariam More articles by this author , Douglas KellyDouglas Kelly More articles by this author , and Joshua LangstonJoshua Langston More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric MRI in combination with ultrasound fusion technology is becoming standard in many urology practices. Advances in ultrasound technology with the high resolution (HiRes) ExactVuTM 29MHz micro-ultrasound system question the need for MRI with real time identification of lesions during ultrasound guided biopsy. This study seeks to compare the PI-RADs and PRI-MUS scoring systems associated with prostate MRI and HiRes ultrasound respectively. METHODS: This is a retrospective review of all men between the ages of 18-89 who underwent transrectal ultrasound guided biopsy of the prostate either with HiRes or MRI/ultrasound fusion using the UroNavR platform at our center during the period of January 1, 2006 through October 23, 2020. This study is comprised of 1236 subjects. 442 underwent HiRes ultrasound guided biopsy; and 797 underwent MRI/ultrasound fusion biopsy. All patients concomitantly underwent a standard 12 core biopsy. Data was collected including PI-RADs or PRI-MUS score, grade, and location of prostate cancer (region of interest vs standard template). Chi-squared test was performed to determine if PI-RADs 3, 4 and 5 lesions are equal to PRI-MUS 3, 4, and 5. RESULTS: With MRI fusion biopsy cancer was found at PIRADs 3, 4, and 5 ROIs in 31%, 59% and 78% of patients respectively. With HiRes ultrasound biopsy cancer was found at PRI-MUS 3, 4, and 5 ROIs in 18%, 40% and 54% of patients respectively. MRI-fusion biopsy found 16% more cancers than standard biopsy alone. High resolution biopsy found 5% more cancers than standard biopsy alone. Chi-squared analysis with alpha of 0.05 found that PI-RADS 3, 4, and 5 lesions and PRI-MUS 3, 4, and 5 lesions are not equal with regards to cancer yields. CONCLUSIONS: Our study found significant differences between PIRADs and PRI-MUS lesions and increased cancer detection with MRI-fusion biopsy vs HiRes biopsy. Multiple providers were involved in performing both types of biopsy and differences could be due to the subjective nature of HiRes biopsy. Both modalities increased cancer yield vs standard biopsy. More studies are needed to determine the role of MRI fusion vs HiRes biopsy; however, a combination of the two modalities holds significant potential. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e853-e854 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Hailemariam More articles by this author Douglas Kelly More articles by this author Joshua Langston More articles by this author Expand All Advertisement Loading ...

V14-07 TRANSPERINEAL ULTRASOUND WITH TRANSPERINEAL NEEDLES FOR MRI FUSION PROSTATE BIOPSY: DEMONSTRATION OF A NOVEL TECHNIQUE

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-07 TRANSPERINEAL ULTRASOUND WITH TRANSPERINEAL NEEDLES FOR MRI FUSION PROSTATE BIOPSY: DEMONSTRATION OF A NOVEL TECHNIQUE Luke P. O'Connor, Patrick T. Gomella, Michael A. Daneshvar, Cheyenne Williams, Nabila Khondakar, Jeunice Owens-Walton, Nitin K. Yerram, Sandeep Gurram, Michael Ahdoot, Nicole Varble, Sheng Xu, Baris Turkbey, Peter A. Pinto, and Bradford J. Wood Luke P. O'ConnorLuke P. O'Connor More articles by this author , Patrick T. GomellaPatrick T. Gomella More articles by this author , Michael A. DaneshvarMichael A. Daneshvar More articles by this author , Cheyenne WilliamsCheyenne Williams More articles by this author , Nabila KhondakarNabila Khondakar More articles by this author , Jeunice Owens-WaltonJeunice Owens-Walton More articles by this author , Nitin K. YerramNitin K. Yerram More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Michael AhdootMichael Ahdoot More articles by this author , Nicole VarbleNicole Varble More articles by this author , Sheng XuSheng Xu More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Peter A. PintoPeter A. Pinto More articles by this author , and Bradford J. WoodBradford J. Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There has been a push towards transperineal approaches for prostate biopsy to help reduce risk of sepsis related complications seen in transrectal ultrasound (TRUS) guided procedures. Current commercial platforms allow urologists to perform transperineal MRI/TRUS fusion biopsies (TRUS-TP); however, this requires the use of a TRUS probe which can be a source of discomfort to patients leading to avoidance of repeat surveillance biopsies. We pioneered a novel technique that allows a completely TP approach, without any entry into the rectum. In this video, we demonstrate the transperineal freehand ultrasound and guided needle TP (TPUS-TP) biopsy technique using our custom in-house software. METHODS: We present the case of a 64-year-old-male who was self-referred to our institution for a second opinion regarding his Grade Group (GG) 1 prostate cancer. He has been on active surveillance after initial standard biopsy revealed GG1 disease in 1/14 biopsy cores. After repeat MRI at our institution, the patient was found to have two suspicious lesions. He underwent a subsequent TP biopsy given the anterior location of these lesions. RESULTS: The patient first underwent systematic TP biopsy using a modified 12 core Barzell template followed by targeted fusion biopsy via a standard TRUS-TP with grid. The patient then underwent a TPUS-TP guided biopsy as demonstrated in this video. In this technique, the TPUS ultrasound probe and guided biopsy needle are placed directly on the perineum. The patient was discharged home same-day without any post-operative complications. Upon pathologic review, TPUS-TP biopsy detected GG2 cancer in both targeted lesions with TRUS-TP showing GG2 in only one target and atypical glands in the other. CONCLUSIONS: Transperineal freehand ultrasound and guided needle transperineal (TPUS-TP) prostate biopsy utilizing our custom in-house software offers a novel way to sample the prostate without the use of a transrectal ultrasound probe. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1167-e1167 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke P. O'Connor More articles by this author Patrick T. Gomella More articles by this author Michael A. Daneshvar More articles by this author Cheyenne Williams More articles by this author Nabila Khondakar More articles by this author Jeunice Owens-Walton More articles by this author Nitin K. Yerram More articles by this author Sandeep Gurram More articles by this author Michael Ahdoot More articles by this author Nicole Varble More articles by this author Sheng Xu More articles by this author Baris Turkbey More articles by this author Peter A. Pinto More articles by this author Bradford J. Wood More articles by this author Expand All Advertisement Loading ...