Suspicion Score Research Articles

MRI-US fusion targeted biopsy results in patients with a history of a prior negative biopsy.

90 Background: Patients with an elevated PSA but negative prostate biopsy present a diagnostic and management dilemma. We evaluated the capability of multi-parametric (MP) MRI and MRI-USG Fusion prostate biopsy to detect clinically significant (CS) prostate cancer in men who have had a prior negative 12-core standard biopsy. Methods: Between 12/2012 and 06/2015, 374 men with an indication for prostate biopsy underwent pre-biopsy mpMRI followed by 12-core standard trans-rectal mapping biopsy (Mbx) and MRI-Ultrasound fusion targeted biopsy (Tbx) of lesions identified on mpMRI. The combination of Mbx and Tbx, when both occurred, constitutes a fusion biopsy (Fbx). Men who underwent both Mbx with or without Tbx using the Artemis/Pro-Fuse system with a previous biopsy but no diagnosis of prostate cancer were included. Patients without a lesion on MRI underwent Mbx only. Maximum Gleason scores (GS) was assigned on a per patient basis with Mbx GS available for all patients in the cohort and Tbx GS available only for patients with a lesion visible on MP-MRI. CS cancer was defined as GS ≥ 3+4. GS per patient was compared by chi-square and McNemar’s test. Results: 138 men (mean age = 64.0, mean psa = 11.6) met inclusion criteria. Fbx cancer detection rate in this population was 42%. 17 men (12%) were missed by Mbx but picked up on Tbx. Of these 17 men, 13 had Gleason ≥ 7.In comparison, 15 men were missed by Tbx, but only 2 were Gleason ≥ 7. Tbx had a higher rate of detection of CS cancer than Mbx, but this did not reach statistical significance (86% vs 68%, p = 0.09). MRI suspicion level correlated with the detection of CS cancer (p = 0.012). None of the 20 men with a negative MRI had GS ≥ 7 cancer detected on Mbx. The number of prior negative biopsies was not related to the likelihood of finding CS cancer on Fbx (p = 0.47). Conclusions: MRI suspicion score predicts detection of CS prostate cancer when paired with MRI-USG Fbx of the prostate, with a negative MRI correlating with no evidence of CS cancer on biopsy. MRI is a biomarker in this population that may, with more corroborative data, allow for men with a negative MRI to avoid repeat biopsies. [Table: see text]

Prostate cancer detection rates of negative MP-MRIs.

91 Background: Increased lesion suspicion score on MRI is known to be associated with increased grade of prostate cancer. However, the negative predictive value (NPV) of MRI is still being investigated. To determine the NPV of mpMRI, we evaluated the frequency of prostate cancer (CaP) detection by 12-core template mapping biopsy (Mbx) in men whose mpMRI showed no suspicious regions. Methods: 374 men undergoing MRI-US fusion biopsy from 12/2012 to 06/2015 were enrolled in an IRB-approved database and met inclusion criteria for this study. The mpMRI sequences T2-weighted, diffusion-weighted imaging, and dynamic contrast enhancement were used to identify and classify targets as low, medium, and high suspicion. Men with negative mpMRI received a template 12-core template mapping biopsy. Only patients with complete mpMRI sequences were included. Results: 53 men with a negative MRI were identified (mean age=63.5 years, PSA=7.53 ng/mL, mean prostate volume=67.2 mL). The NPV of negative MRI was 64.2% for any cancer and 96.2% for clinically significant cancer (Gleason≥7). Men on active surveillance had the highest CDR 56.3%, compared to 38.9% for biopsy-naive men, and 15.8% for men with prior negative biopsy (Figure 1). Clinically significant CaP was found in two patients: Gleason 4+3 in a patient on Active Surveillance, and 4+4 in a biopsy naïve patient. Conclusions: Negative MRI has a high NPV (96%) for clinically significant CaP found in 12-core template mapping biopsy. If we did not biopsy mpMRI negative men, we would have missed 16 patients with Gleason 6 and 2 patients with ≥ Gleason 7. Clinicians can use this information in patient counseling to discuss the likelihood of detecting significant cancer – though these findings should be reproduced widely before a negative MRI is used to recommend against biopsy. Sources of funding: NIH-National Institute of Diabetes and Digestive and Kidney Diseases [Table: see text]

Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment.

IntroductionMultiparametric-MRI (mp-MRI) is an evolving noninvasive imaging modality that increases the accurate localization of prostate cancer at the time of MRI targeted biopsy, thereby enhancing clinical risk assessment, and improving the ability to appropriately counsel patients regarding therapy.Material and methodsWe used MEDLINE/PubMed to conduct a comprehensive search of the English medical literature. Articles were reviewed, data was extracted, analyzed, and summarized. In this review, we discuss the mp-MRI prostate exam, its role in targeted prostate biopsy, along with clinical applications and outcomes of MRI targeted biopsies.ResultsMp-MRI, consisting of T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and possibly MR spectroscopy, has demonstrated improved specificity in prostate cancer detection as compared to conventional T2-weighted images alone. An MRI suspicion score has been developed and is depicted using an institutional Likert or, more recently, a standardized reporting scale (PI-RADS). Techniques of MRI-targeted biopsy include in-gantry MRI guided biopsy, TRUS-guided visual estimation biopsy, and software co-registered MRI-US guided biopsy (MRI-US fusion). Among men with no previous biopsy, MRI-US fusion biopsy demonstrates up to a 20% increase in detection of clinically significant cancers compared to systematic biopsy while avoiding a significant portion of low risk disease. These data suggest a potential role in reducing over-detection and, ultimately, over-treatment. Among men with previous negative biopsy, 72–87% of cancers detected by MRI targeted biopsy are clinically significant. Among men with known low risk cancer, repeat biopsy by MR-targeting improves risk stratification in selecting men appropriate for active surveillance secondarily reducing the need for repetitive biopsy during surveillance.ConclusionsUse of mp-MRI for targeting prostate biopsies has the potential to reduce the sampling error associated with conventional biopsy by providing better disease localization and sampling. MRI-ultrasound fusion-targeted prostate biopsy may improve the identification of clinically significant prostate cancer while limiting detection of indolent disease, ultimately facilitating more accurate risk stratification. Literature supports the clinical applications of MRI-targeted biopsy in men who have never been biopsied before, those with a prior negative biopsy, and those with low risk disease considering active surveillance.

Serial Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: Incremental Value

We assessed whether changes in serial multiparametric magnetic resonance imaging can help predict the pathological progression of prostate cancer in men on active surveillance. A retrospective cohort study was conducted of 49 consecutive men with Gleason 6 prostate cancer who underwent multiparametric magnetic resonance imaging at baseline and again more than 6 months later, each followed by a targeted prostate biopsy, between January 2011 and May 2015. We evaluated whether progression on multiparametric magnetic resonance imaging (an increase in index lesion suspicion score, increase in index lesion volume or decrease in index lesion apparent diffusion coefficient) could predict pathological progression (Gleason 3 + 4 or greater on subsequent biopsy, in systematic or targeted cores). Diagnostic performance of multiparametric magnetic resonance imaging was determined with and without clinical data using a binary logistic regression model. The mean interval between baseline and followup multiparametric magnetic resonance imaging was 28.3 months (range 11 to 43). Pathological progression occurred in 19 patients (39%). The sensitivity, specificity, positivepredictive value and negative predictive value of multiparametric magnetic resonance imaging was 37%, 90%, 69% and 70%, respectively. Areaunderthereceiver operating characteristic curve was 0.63. A logistic regression model using clinical information (maximum cancer core length greater than3mm on baseline biopsy or a prostate specific antigen densitygreater than 0.15 ng/ml(2) at followup biopsy) had an AUC of 0.87 for predicting pathological progression. The addition of serial multiparametric magnetic resonance imaging data significantly improved the AUC to 0.91(p=0.044). Serial multiparametric magnetic resonance imaging adds incremental value to prostate specific antigen density and baseline cancer core length for predicting Gleason 6 upgrading in men on active surveillance.

Automatic software fault localization based on artificial bee colony

Software debugging accounts for a vast majority of the financial and time costs in software developing and maintenance.Thus, approaches of software fault localization that can help automate the debugging process have become a hot topic in the field of software engineering. Given the great demand for software fault localization, an approach based on the artificial bee colony(ABC) algorithm is proposed to be integrated with other related techniques. In this process, the source program is initially instrumented after analyzing the dependence information. The test case sets are then compiled and run on the instrumented program, and execution results are input to the ABC algorithm. The algorithm can determine the largest fitness value and best food source by calculating the average fitness of the employed bees in the iterative process. The program unit with the highest suspicion score corresponding to the best test case set is regarded as the final fault localization. Experiments are conducted with the TCAS program in the Siemens suite. Results demonstrate that the proposed fault localization method is effective and efficient. The ABC algorithm can efficiently avoid the local optimum, and ensure the validity of the fault location to a larger extent.

Diagnostic Algorithm for Patients With Suspected Giant Cell Arteritis.

To identify clinical and laboratory factors contributing to the diagnosis of giant cell arteritis (GCA) and develop a diagnostic algorithm for the evaluation of GCA. Retrospective review of 213 consecutive cases of temporal artery biopsy (TAB) seen at a single academic center over a 10-year period (2000-2009). Pathologic specimens were re-reviewed and agreement between the original and second readings was assessed. A composite clinical suspicion score was created by adding 1 point for each of the following criteria: anterior extracranial circulation ischemia, new onset headache, abnormal laboratory results (erythrocyte sedimentation rate, C-reactive protein (CRP), or platelet count), jaw claudication, abnormal or tender superficial temporal artery, constitutional symptoms, and polymyalgia rheumatica; one point was subtracted if a comorbid condition could explain a criterion. Of the 204 TABs analyzed, pathologic findings were confirmatory in 49 (24.0%) and suggestive in 12 (5.9%). TAB-positive patients were more likely to be older (age 75.2 ± 7.8 vs 69.7 ± 11.0 years, P = 0.0002), complain of jaw claudication (relative-risk = 3.26, P = 0.0014), and have thrombocytosis (relative-risk = 3.3, P = 0.0072) and elevated CRP (relative-risk = 1.8, P = 0.037). None of the patients with a clinical score less than 2 had a positive TAB. Diabetes mellitus and kidney disease were often the explanation for the symptoms and abnormal clinical finding(s) that led to a negative TAB. We propose a clinical algorithm that is highly predictive for a positive TAB and can be valuable in the evaluation process of suspected cases of GCA.

Prebiopsy MRI and MRI-ultrasound Fusion–targeted Prostate Biopsy in Men With Previous Negative Biopsies: Impact on Repeat Biopsy Strategies

To report outcomes of magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy (MRF-TB) and 12-core systematic biopsy (SB) over a 26-month period in men with prior negative prostate biopsy. Between June 2012 and August 2014, 210 men presenting to our institution for prostate biopsy with≥1 prior negative biopsy underwent multiparametric MRI followed by MRF-TB and SB and were entered into a prospective database. Clinical characteristics, maximum mpMRI suspicion scores (mSS), and biopsy results were queried from the database, and the detection rates of Gleason≥7 prostate cancer (PCa) and overall PCa were compared between biopsy techniques using McNemar's test. Forty seven (29%) of 161 men meeting inclusion criteria (mean age, 65±8years; mean prostate-specific antigen, 8.9±8.9) were found to have PCa. MRF-TB and SB had overall cancer detection rates (CDRs) of 21.7% and 18.6% (P = .36), respectively, and CDR for Gleason score (GS)≥7 disease of 14.9% and 9.3% (P = .02), respectively. Of 26 men with GS≥7 disease, MRF-TB detected 24 (92.3%) whereas SB detected 15 (57.7%; P < .01). Using UCSF-CAPRA criteria, only 1 man was restratified from low risk to higher risk based on SB results compared to MRF-TB alone. Among men with mSS<4, 72% of detected cancers were low risk by UCSF-CAPRA criteria. In men with previous negative biopsies and persistent suspicion of PCa, SB contributes little to the detection of GS≥7 disease by MRF-TB, and avoidance of SB bears consideration. Based on the low likelihood of detecting GS≥7 cancer and overall low-risk features of PCa in men with mSS<4, limiting biopsy to men with mSS≥4 warrants further investigation.

Exception Prioritization in the Continuous Auditing Environment: A Framework and Experimental Evaluation

ABSTRACTResearchers have found that the volume of exceptions generated by a continuous auditing system can be overwhelming for an internal audit department to handle. In this paper, we propose and validate a framework that systematically prioritizes exceptions based on the likelihood of an exception being erroneous or fraudulent and evaluate the framework using an experiment. The framework consists of six stages: (1) generation of exceptions using defined rules, (2) assignment of suspicion scores to exceptions using belief functions, (3) exception prioritization, (4) exception investigation, (5) rule confidence level update utilizing back propagation, and (6) rule(s) addition utilizing a rule learner algorithm. We also simulate the proposed framework using an experiment. The experiment results provide evidence that the framework can be effective in prioritizing exceptions and thus maximizing audit efficiency.

Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion–targeted Prostate Biopsy Outcomes

BackgroundIncreasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion–targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB). ObjectiveTo compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI. Design, setting, and participantsRetrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included. InterventionsAll men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB. OutcomesDetection rates for all PCa and high-grade PCa (Gleason score [GS] ≥7) were compared using the McNemar test. Results and limitationsMRF-TB detected fewer GS 6 PCas (75 vs 121; p<0.001) and more GS ≥7 PCas (158 vs 117; p<0.001) than SB. Higher mSS was associated with higher detection of GS ≥7 PCa (p<0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS ≥7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS ≥7 PCas in men with no prior biopsy (88 vs 72; p=0.012), in men with a prior negative biopsy (28 vs 16; p=0.010), and in men with a prior cancer diagnosis (42 vs 29; p=0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p<0.001) and men with prior cancer (30 vs 46; p=0.034). Limitations include the retrospective design and the potential for selection bias given a referral population. ConclusionsMRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted. Patient summaryWe examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.

Magnetic Resonance Imaging-Ultrasound Fusion Targeted Prostate Biopsy in a Consecutive Cohort of Men with No Previous Biopsy: Reduction of Over Detection through Improved Risk Stratification

MRF-TB (magnetic resonance imaging-ultrasound fusion targeted prostate biopsy) may improve the detection of prostate cancer in men presenting for prostate biopsy. We report clinical outcomes of 12-core systematic biopsy and MRF-TB in men who presented for primary biopsy and further describe pathological characteristics of cancers detected by systematic biopsy and not by MRF-TB. Clinical outcomes of 452 consecutive men who underwent prebiopsy multiparametric magnetic resonance imaging followed by MRF-TB and systematic biopsy at our institution between June 2012 and June 2015 were captured in an institutional review board approved database. Clinical characteristics, biopsy results and magnetic resonance imaging suspicion scores were queried from the database. Prostate cancer was detected in 207 of 382 men (54.2%) with a mean±SD age of 64±8.5 years and mean±SEM prostate specific antigen 6.8±0.3 ng/ml who met study inclusion criteria. The cancer detection rate of systematic biopsy and MRF-TB was 49.2% and 43.5%, respectively (p=0.006). MRF-TB detected more Gleason score 7 or greater cancers than systematic biopsy (117 of 132 or 88.6% vs 102 of 132 or 77.3%, p=0.037). Of 41 cancers detected by systematic biopsy but not by MRF-TB 34 (82.9%) demonstrated Gleason 6 disease, and 26 (63.4%) and 34 (82.9%) were clinically insignificant by Epstein criteria and a UCSF CAPRA (University of California-San Francisco-Cancer of the Prostate Risk Assessment) score of 2 or less, respectively. In men presenting for primary prostate biopsy MRF-TB detects more high grade cancers than systematic biopsy. Most cancers detected by systematic biopsy and not by MRF-TB are at clinically low risk. Prebiopsy magnetic resonance imaging followed by MRF-TB decreases the detection of low risk cancers while significantly improving the detection and risk stratification of high grade disease.

Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging.

To evaluate accuracy and interobserver variability with the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2.0 for detection of prostate cancer at multiparametric magnetic resonance (MR) imaging in a biopsy-naïve patient population. This retrospective HIPAA-compliant study was approved by the local ethics committee, and written informed consent was obtained from all patients for use of their imaging and histopathologic data in future research studies. In 101 biopsy-naïve patients with elevated prostate-specific antigen levels who underwent multiparametric MR imaging of the prostate and subsequent transrectal ultrasonography (US)-MR imaging fusion-guided biopsy, suspicious lesions detected at multiparametric MR imaging were scored by five readers who were blinded to pathologic results by using to the newly revised PI-RADS and the scoring system developed in-house. Interobserver agreement was evaluated by using κ statistics, and the correlation of pathologic results with each of the two scoring systems was evaluated by using the Kendall τ correlation coefficient. Specimens of 162 lesions in 94 patients were sampled by means of transrectal US-MR imaging fusion biopsy. Results for 87 (54%) lesions were positive for prostate cancer. Kendall τ values with the PI-RADS and the in-house-developed scoring system, respectively, at T2-weighted MR imaging in the peripheral zone were 0.51 and 0.17 and in the transitional zone, 0.45 and -0.11; at diffusion-weighted MR imaging, 0.42 and 0.28; at dynamic contrast material-enhanced MR imaging, 0.23 and 0.24, and overall suspicion scores were 0.42 and 0.49. Median κ scores among all possible pairs of readers for PI-RADS and the in-house-developed scoring system, respectively, for T2-weighted MR images in the peripheral zone were 0.47 and 0.15; transitional zone, 0.37 and 0.07; diffusion-weighted MR imaging, 0.41 and 0.57; dynamic contrast-enhanced MR imaging, 0.48 and 0.41; and overall suspicion scores, 0.46 and 0.55. Use of the revised PI-RADS provides moderately reproducible MR imaging scores for detection of clinically relevant disease.

Natural History of Pathologically Benign Cancer Suspicious Regions on Multiparametric Magnetic Resonance Imaging Following Targeted Biopsy

We determined the natural history of pathologically benign cancer suspicious regions on multiparametric magnetic resonance imaging following targeted biopsy. Between January 2012 and September 2014, 330 men underwent prostate multiparametric magnetic resonance imaging. A total of 533cancer suspicious regions were identified and scored on a Likert scale of 1 to 5 based on suspicion for malignancy with 5 indicating the highest suspicion level. Following multiparametric magnetic resonance imaging all men underwent magnetic resonance imaging-ultrasound fusion targeted prostate biopsy using ProFuse software and the ei-Nav|Artemis system (innoMedicus, Cham, Switzerland), and a computer generated 12-core random biopsy. We analyzed acohort of 34 men with a total of 51 cancer suspicious regions who had benign prostate biopsies and underwent repeat multiparametric magnetic resonance imaging and prostate specific antigen testing at 1 year. Changes in the greatest linear measurement, the suspicion score and serum prostate specific antigen were ascertained. During 1 year the suspicion score distribution and the mean greatest linear measurement of the cancer suspicious regions decreased significantly (p<0.0001) while mean prostate specific antigen did not significantly change (p= 0.632). Two (3.9%), 15 (29.4%) and 34 cancer suspicious regions (66.7%) showed an increase, no change and decrease in suspicion score, respectively. No (0%), 21 (42.0%) and 29 cancer suspicious regions (58.0%) showed an increase of 20% or greater, no change and a decrease of 20% or greater in greatest linear measurement, respectively. Of the 2 cancer suspicious regions exhibiting an increased suspicion score neither showed a prostate specific antigen increase of 0.5 ng/ml or greater. Our study provides compelling evidence that few benign cancer suspicious regions increase in suspicion score and/or the greatest linear measurement within 1 year independent of the baseline suspicion score. Therefore, routinely repeating multiparametric magnetic resonance imaging at 1 year in men with pathologically benign cancer suspicious regions should be discouraged since it is unlikely to influence management decisions.

Credit Card Fraud Prediction System

Identity crime is common, and pricey, and credit card fraud is a specific case of identity crime. The existing systems of known fraud matching and business rules have restrictions. To remove these negative aspects in real world, this paper proposes a data mining approach: Communal Detection (CD) and Spike Detection (SD). CD finds real social relationships to reduce the suspicion score, and is impervious to fake social relationships. This approach on a fixed set of attributes is whitelist-oriented. SD increases the suspicion score by finding discrepancies in duplicates. These data mining approaches can detect more types of attacks and removes the unnecessary attributes.

PD4-11 THE RELATIONSHIP OF INCREASING MRI SUSPICION SCORE AND THE IDENTIFICATION OF HIGH GRADE PROSTATE CANCER ON MRI FUSION TARGETED BIOPSY.

INTRODUCTION AND OBJECTIVES: Multi-parametric MRI (mpMRI) suspicion scores (mSS) can help predict the likelihood of prostate cancer (PCa) on prostate biopsy (PB). In combination with MRI fusion targeted biopsy (MRF-TB), mSS has the potential to reduce over-detection of indolent PCa through avoidance of low risk biopsies. In this study we report the relationship of mSS and PB outcomes among men undergoing systematic biopsy (SB) and MRF-TB following mpMRI. METHODS: Between 6/2012 and 8/2014, all 824 men presenting to our institution for prostate biopsy underwent pre-biopsy mpMRI followed by PB. Outcomes were recorded in an IRB-approved database. For this analysis, biopsy results and mSS were queried from those who underwent both SB and MRF-TB using the Artemis/Profuse (Eigen, Grass Valley) co-registration system. RESULTS: 604 men (mean age 65 8 years; BMI 27.1 4.3; PSA 6.7 7.2 ng/ml) met inclusion criteria. Overall, increasing mSS correlates with a step-wise increase in detection of GS 7 PCa with both SB [r1⁄4.95] and MRF-TB [r1⁄40.95]. This finding is not seen in GS6 PCa detection with either SB [r1⁄4-0.10] or MRF-TB [r1⁄4-0.23] (See figure 1). For mSS 4/5, MRF-TB detected fewer GS6 PCa [p1⁄40.013] and detected more GS 7 PCa [p1⁄40.001] as compared to SB. When evaluating the cohort by PB indication, for mSS 4/5, FB detected less GS6 PCa than SB only in biopsy naive men [p1⁄40.021], but was similar to SB in men with prior negative PB [p1⁄40.628] or on active surveillance [p1⁄40.114]. However, FB detected more GS 7 PCa compared to SB in all three cohorts with mSS 4/5 [p<0.05 in all 3 cohorts] (See table 1). CONCLUSIONS: Increasing mSS correlates with a higher likelihood of detection of high grade PCa in all men. While this correlation exists with both SB and MRF-TB, in men with mSS 4/5, MRFTB is better at detecting GS 7 PCa while avoiding over-detection of GS6 PCa. In addition, combining mSS and the difference in CDR by biopsy indication can ultimately help identify select men in whom prostate biopsy is unlikely to detect GS& 7 PCa, and PB may be avoided.

MP11-11 SARCOPENIA AS A PROGNOSTIC BIOMARKER OF METASTATIC RENAL CELL CARCINOMA: ITS EFFECT ON SURVIVAL BENEFIT FROM CYTOREDUCTIVE NEPHRECTOMY

Epstein criteria which was developed using whole mount prostatectomy specimens. We estimated the detection rates of all CaP and clinically significant CaP. RESULTS: The median age and PSA were 64.9 years and 4.8 ng/mL respectively. Of the 63 men on AS that were eligible for analysis, the 87.3% (55/63) were classified as having CaP while 69.8% (44/63) were re-classified as having clinically significant. Fusion biopsy detected more clinically CaP compared with standard 12-core biopsy (60.3% vs 50.8%). Suspicion score on mpMRI was positively correlated with detection of clinically significant CaP (p1⁄40.0039; Figure 1). 100% of men with suspicion score of 5 on mpMRI had clinically significant CaP. CONCLUSIONS: Our results demonstrate that mpMRI may be useful in accurately identifying a significant proportion of men on AS who may harbor clinically significant CaP. Further evaluation in larger cohorts including randomized trials is needed to confirm these findings. As mpMRI data for CaP matures, we may be able to use these findings to better stratify patients for active surveillance and/or treatment.

MP17-09 TRENDS IN CANCER DETECTION RATE AND COMPLICATIONS AFTER MAGNETIC RESONANCE IMAGING-ULTRASOUND (MRI/US) FUSION-GUIDED PROSTATE BIOPSIES

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2015MP17-09 TRENDS IN CANCER DETECTION RATE AND COMPLICATIONS AFTER MAGNETIC RESONANCE IMAGING-ULTRASOUND (MRI/US) FUSION-GUIDED PROSTATE BIOPSIES Simpa Salami, Oksana Yaskiv, Baris Turkbey, Robert Villani, Eran Ben-Levi, and Ardeshir Rastinehad Simpa SalamiSimpa Salami More articles by this author , Oksana YaskivOksana Yaskiv More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Robert VillaniRobert Villani More articles by this author , Eran Ben-LeviEran Ben-Levi More articles by this author , and Ardeshir RastinehadArdeshir Rastinehad More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We hypothesized that as the quality of MRI interpretation and experience improves, the procedure duration and cancer detection rate (CDR) of Magnetic Resonance Imaging-Ultrasound (MRI/US) Fusion-Guided Prostate Biopsies will improve. METHODS We prospectively enrolled men with abnormal PSA and/or DRE, or on AS for CaP who underwent a 3T mpMRI (T2, DWI, and DCE) with an endorectal coil. Three radiologists (EB, RV, AR) reviewed and graded all lesions using the 5-point Likert scale as proposed by European Symposium on Urogenital Radiology, 2012. The UroNav system (Invivo, Florida ®) was used to perform MR/TRUS fusion-guided prostate biopsies under local anesthesia, obtaining one biopsy core in axial and sagittal planes from each lesion. A 12-core biopsy was performed at the same setting. All biopsies were performed by a fellowship-trained urologic oncologist with experience with fusion biopsies. Our institution's pathologist reviewed all biopsy slides. We divided the cohort into equal quartiles based on date of enrollment. We estimate the CDR, mean procedure time, and complication rate. RESULTS A total of 376 men were eligible for analysis. The median age and PSA were 65.2 years and 6.6 ng/mL respectively. The overall CDR was 66% (248/376). Suspicion score on mpMRI was positively correlated with detection of CaP (p<0.0001); 100% of those with a suspicion score of 5 had clinically significant CaP. The CDR for the 1st, 2nd, 3rd, and 4th quartiles (each n = 94) were 73.4%, 62.8%, 71.3%, 56.4% respectively (M-H p-value = 0.052). The mean procedure times for each quartile were 16, 17, 14, and 14 minutes respectively. The complications were: urinary tract infections/sepsis (2.7%) and urinary retention (1.3%). CONCLUSIONS We report that the CDR of fusion biopsy does not change significantly over time in the hands of an experienced urologist. The procedure time appears to improve with experience. Fusion biopsy is not associated with significant increase in complication risks compared with the general population. Further studies are needed to determine the learning curve in an inexperienced hands. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e179 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simpa Salami More articles by this author Oksana Yaskiv More articles by this author Baris Turkbey More articles by this author Robert Villani More articles by this author Eran Ben-Levi More articles by this author Ardeshir Rastinehad More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP86-04 NOVEL TECHNIQUES OF THREE-DIMENSIONALLY DOCUMENTED BIOPSY-MAPPING ALLOW SERIAL MONITORING OF CELL-CYCLE PROGRESSION BY RE-VISITING CANCER FOCI

sample, externally validated with the remaining 20%, bias-corrected using bootstrap resampling, and Akaike information criterion was used to select best-fit models. RESULTS: A total of 524 patients with complete records were included for analysis (median age 66 years, PSA 5.5 ng/ml, prostate volume 51 cc). Statistically significant independent positive predictors of CaP on targeted and systematic PB were found to be prostate volume, biopsy history, and MRI suspicion score (MRIss). CaP probability nomograms generated using the predictors are shown in Figure 1. Model performance characteristics bias-corrected areas under the receiver-operating characteristic curves (AUC) are shown in Table 1. CONCLUSIONS: Prostate volume, biopsy history, and MRI suspicion score predict CaP on MRI-targeted and systematic biopsy. Our CaP probability nomograms may allow further individualization of the decision to perform PB in men with clinical suspicion of prostate cancer or those with known prostate cancer considering surveillance.

MP14-17 IMMEDIATE REPEAT BIOPSY IS NOT NECESSARY IN PATIENTS WITH ATYPICAL SMALL ACINAR PROLIFERATION (ASAP): A MULTI-INSTITUTIONAL REVIEW

larger. Analysis for predictors of a lesion becoming RBþ demonstrated that any lesion growth on MRI was a significantly associated with a lesion being RBþ (p1⁄40.012, odds ratio 1⁄4 4.8, 95% CI [1.5, 15.4]). Initial MRI suspicion score, upgrading of MRI suspicion score, initial lesion size < 0.7 cm, and MRI parameters were not significantly associated. CONCLUSIONS: Targeted biopsy negative lesions almost always were benign on serial biopsy. When a lesion was RBþ the vast majority demonstrated low risk disease. Biopsy negative lesions should be re-sampled if they increase in size at an interval of 2 years.

MP17-08 MRI-FUSION PROSTATE BIOPSY IN FIRST-TIME BIOPSY COHORT YIELDS INCREASED DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER USING A SIMPLIFIED MRI GRADING SCALE

INTRODUCTION AND OBJECTIVES: Prostate cancer (PCa) is the most common solid organ malignancy in men and the second leading cause of cancer related death; however, it remains the only tumor diagnosed by a random sampling method. Multiparametric MRI (MP-MRI) has been reported in evaluation of men with a persistently elevated PSA after a negative biopsy (bx) and in active surveillance (AS) cohorts, but its role in initial diagnosis has not been independently reported. We describe cancer detection rates (CDR) with MRI-fusion for first-time prostate bx using a simplified 3-point Likert scale for grading prostatic lesions. METHODS: Consecutive patients had an MRI fusion prostate bx for elevated PSA, abnormal DRE, AS, or prior negative bx with persistently elevated PSA. Regions of interest (ROIs) identified on MRI were assigned increasing cancer suspicion levels using a simplified 3point Likert scale by a team of dedicated pelvic radiologists. The Artemis system was used to create an MRI-US fusion 3D model of the prostate and a single urologist (PS) performed both a 12-core transrectal systematic bx as well as a targeted bx of any ROI. RESULTS: A total of 191 patients underwent MRI and fusion bx between 12/2012 and 8/2014. For the entire cohort, overall CDR for systematic bx was 52.3% and for fusion biopsy was 55.0%. However, the detection rate for clinically significant PCa (Gleason 7 or greater) with systematic bx was 28.7% and that for targeted bx was 43.8% (p1⁄40.02). The first-time prostate bx cohort comprised 73 patients. In this group, overall CDR was 73.9% with cancer detected in 79.6% of patients with ROI as opposed to 33.3% of patients without ROI. Furthermore, in this cohort, the targeted bx CDR was 67.1% and systematic bx CDR was 56.2%. Most importantly, clinically significant cancer was detected in 38/73 (52.1%) patients with 36/64 (56%) detected on targeted bx and 27/73 (37%) detected on systematic bx. Evaluation of cancer suspicion level for each ROI revealed that patients with high suspicion scores had a higher overall CDR (p <0.0001) and higher risk of detecting clinically significant cancer (p1⁄40.0001). CONCLUSIONS: MRI fusion prostate bx using MP-MRI as a first-time bx has a higher overall and clinically significant CDR than systematic bx, and correlates with MP-MRI suspicion level. A simplified Likert grading scale in the hands of experienced radiologists correlates with cancer detection and clinically significant cancer. The high CDR of MRI fusion bx in a first-time cohort may alleviate the need for repeat bx and its associated morbidity.

MP77-18 OUTCOMES OF MRI-US FUSION TARGETED PROSTATE BIOPSY IN MEN WITH HISTORY OF PROSTATIC INTRAEPITHELIAL NEOPLASIA AND/OR ATYPICAL SMALL ACINAR PROLIFERATION: EVIDENCE FOR AN ALTERATION OF CURRENT PRACTICE.

You have accessJournal of UrologyProstate Cancer: Detection and Screening VI1 Apr 2015MP77-18 OUTCOMES OF MRI-US FUSION TARGETED PROSTATE BIOPSY IN MEN WITH HISTORY OF PROSTATIC INTRAEPITHELIAL NEOPLASIA AND/OR ATYPICAL SMALL ACINAR PROLIFERATION: EVIDENCE FOR AN ALTERATION OF CURRENT PRACTICE. Neil Mendhiratta, Andrew B. Rosenkrantz, Xiaosong Meng, Michael Fenstermaker, Richard Huang, James S. Wysock, Fang-Ming Deng, Ming Zhou, William C. Huang, Herbert Lepor, and Samir S. Taneja Neil MendhirattaNeil Mendhiratta More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz More articles by this author , Xiaosong MengXiaosong Meng More articles by this author , Michael FenstermakerMichael Fenstermaker More articles by this author , Richard HuangRichard Huang More articles by this author , James S. WysockJames S. Wysock More articles by this author , Fang-Ming DengFang-Ming Deng More articles by this author , Ming ZhouMing Zhou More articles by this author , William C. HuangWilliam C. Huang More articles by this author , Herbert LeporHerbert Lepor More articles by this author , and Samir S. TanejaSamir S. Taneja More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.558AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES On contemporary prostate biopsy, high grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) are common findings which often prompt repeat biopsy. We investigated the detection of prostate cancer (PCa) in men with a history of HGPIN, ASAP, or both (HGPIN/ASAP) who underwent combined MRI-ultrasound fusion targeted (MRF-TB) and 12-core systematic prostate biopsy (SB). METHODS From an IRB-approved database of patients undergoing MRF-TB, we queried clinical data including MRI suspicion score (mSS) and biopsy results from all men with a history of negative systematic biopsy who underwent MRF-TB and SB using the Artemis/Pro-fuseTM (Eigen, Grass Valley) system between 6/12 and 8/14 to identify those with history of HGPIN or ASAP. Maximum Gleason scores (GS) detected per patient were compared by McNemar's test. RESULTS Of 173 men with a history of previous negative biopsy, 27 (16%), 11 (6%), and 16 (9%) men had histories of HGPIN alone, ASAP alone, and HGPIN/ASAP, for a total of 54 men meeting inclusion criteria (mean age 64±7.6 years; mean PSA 7.3, SEM 1.1 ng/mL). mSS of 2-5 were found in 20 (37%), 17 (32%), 11 (20%), and 6 (11%) men, respectively. Overall 16/54 men (30%) were found to have PCa. Cancer detection rates of MRF-TB and SB were 22% and 13%, respectively (p = 0.39). MRF-TB detected more GS≥7 cancers than SB (p = 0.02, Table 1). 7/9 (78%) GS≥7 cancers and 4/4 (100%) dominant Gleason grade (dGG) ≥4 cancers were detected in men with mSS≥4 lesions, making the negative predictive value of mSS < 4 for GS≥7 and dGG ≥4 cancer 95% and 100%, respectively. In multivariate analysis of the 173 men with prior negative biopsies, mSS, but not HGPIN, ASAP, or HGPIN/ASAP, was an independent predictor of PCa (p < 0.001, p = 0.69, p = 0.09, p = 0.12, respectively). CONCLUSIONS Pre-biopsy MRI results should be considered prior to empiric repeat biopsy in men with history of HGPIN and/or ASAP. Adequate detection of clinically significant cancers with fewer biopsy cores may be achieved in men with mSS≥4 lesions using MRF-TB only, while men with mSS≤4 lesions may not benefit from repeat biopsy despite a history of HGPIN or ASAP. A history of HGPIN and/or ASAP does not confer a higher risk of PCa independently of mSS. Table 1. Cancer Detection Rates: HGPIN/ASAP (n= 54) Targeted biopsy CDR n(%) Gleason ≥ 7 Gleason 6 Negative Total Gleason ≥ 7 1 (2%) 1 (2%) 0 (0%) 2 (4%)† Systematic biopsy CDR n(%) Gleason 6 0 (0%) 1 (2%) 4 (7%) 5 (9%) Negative 7 (13%) 2 (4%) 38 (70%) 47 (87%) Total 8 (15%)† 4 (7%) 42 (78%) 54 (100%) † p < 0.05, McNemar's Test, SB vs MRF-TB for Gleason ≥ 7 PCa © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1000 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neil Mendhiratta More articles by this author Andrew B. Rosenkrantz More articles by this author Xiaosong Meng More articles by this author Michael Fenstermaker More articles by this author Richard Huang More articles by this author James S. Wysock More articles by this author Fang-Ming Deng More articles by this author Ming Zhou More articles by this author William C. Huang More articles by this author Herbert Lepor More articles by this author Samir S. Taneja More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...