Target Biopsy Research Articles

MP09-15 INVESTIGATION OF FROZEN SECTION BIOPSY UTILIZATION IN MAGNETIC RESONANCE IMAGING–ULTRASONOGRAPHY FUSION-TARGETED PROSTATE BIOPSY FOR HIGH-RISK PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP09-15 INVESTIGATION OF FROZEN SECTION BIOPSY UTILIZATION IN MAGNETIC RESONANCE IMAGING–ULTRASONOGRAPHY FUSION-TARGETED PROSTATE BIOPSY FOR HIGH-RISK PROSTATE CANCER Seung Bin Kim, Jong Hyun Tae, Hyun Jung Jin, Tae Il Noh, Ji Sung Shim, Seok Ho Kang, Jun Cheon, Jeong Gu Lee, and Sung Gu Kang Seung Bin KimSeung Bin Kim More articles by this author , Jong Hyun TaeJong Hyun Tae More articles by this author , Hyun Jung JinHyun Jung Jin More articles by this author , Tae Il NohTae Il Noh More articles by this author , Ji Sung ShimJi Sung Shim More articles by this author , Seok Ho KangSeok Ho Kang More articles by this author , Jun CheonJun Cheon More articles by this author , Jeong Gu LeeJeong Gu Lee More articles by this author , and Sung Gu KangSung Gu Kang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The current guidelines for targeted prostate biopsy recommend an additional systematic biopsy regardless of clinical risk assessment.To evaluate frozen section biopsy utilization in targeted prostate biopsy to omit systematic biopsies in cases of positive frozen section results of patients with clinical features suggestive of high-risk prostate cancer. METHODS: In this prospective, single-center study, we enrolled patients with a Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion on magnetic resonance imaging (MRI) with clinical evidence suggestive of high-risk prostate cancer (either an extracapsular extension or prostate-specific antigen level >20 ng/ml). All patients underwent 2–4 core targeted biopsies utilizing frozen section biopsy with immediate results, allowing patients with a positive result to omit a systematic biopsy. In case of a negative result, additional systematic biopsies were performed. The primary endpoint was the detection rate of targeted biopsy. Patient demographics, clinical variables were analyzed using SPSS version 20. RESULTS: Sixty-six patients were enrolled in this study. Among them, 63 patients were diagnosed with cancer without the need for an additional systematic biopsy. Three patients were non-diagnostic with target biopsy alone. Hence an additional systematic biopsy was performed. Two of these patients were diagnosed with prostate cancer and one tested negative for cancer. CONCLUSIONS: In this report we looked into the necessity of taking a routine systematic biopsy in patients with high risk features of prostate cancer. We found that utilizing frozen section biopsy for targeted biopsy reduces unneccessary systematic biopsy in 97% of cases and still provides a means for systematic biopsy when targeted biopsy alone fails to make the diagnosis. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e141 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seung Bin Kim More articles by this author Jong Hyun Tae More articles by this author Hyun Jung Jin More articles by this author Tae Il Noh More articles by this author Ji Sung Shim More articles by this author Seok Ho Kang More articles by this author Jun Cheon More articles by this author Jeong Gu Lee More articles by this author Sung Gu Kang More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP57-06 EXTERNAL VALIDATION AND COMPARISON OF TWO NOMOGRAMS PREDICTING THE PROBABILITY OF LYMPH NODE INVASION IN PATIENTS SUBJECTED TO ROBOTIC RADICAL PROSTATECTOMY AND CONCOMITANT LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 May 2022MP57-06 EXTERNAL VALIDATION AND COMPARISON OF TWO NOMOGRAMS PREDICTING THE PROBABILITY OF LYMPH NODE INVASION IN PATIENTS SUBJECTED TO ROBOTIC RADICAL PROSTATECTOMY AND CONCOMITANT LYMPH NODE DISSECTION Nicola Frego, Paciotti Marco, Davide Maffei, Pier Paolo Avolio, Roberto Contieri, Alessandro Uleri, Massimo Lazzeri, Alberto Saita, Paolo Casale, Nicolò Maria Buffi, and Giovanni Lughezzani Nicola FregoNicola Frego More articles by this author , Paciotti MarcoPaciotti Marco More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Pier Paolo AvolioPier Paolo Avolio More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend an extended Pelvic Lymph Node Dissection (ePLND) in Prostate Cancer (PCa) patients with a non negligible risk of Lymph Node Invasion (LNI), according to available nomograms. The Briganti 2012 nomogram has been recently updated in Briganti 2019, to include information on Magnetic Resonance Imaging (MRI) and targeted biopsy (TB). The aim of the study is to validate and compare Briganti 2012 and 2019 nomograms in an external cohort of contemporary patients. METHODS: We retrospectively collected data of consecutive patients treated with Robot Assisted Radical Prostatectomy and ePLND at our center, between December 2014 and August 2021. Data included clinical, MRI, and pathological characteristics. The risk of LNI was calculated with the published regression coefficients. The Receiver Operator Characteristics (ROC) curve and Area Under the Curve (AUC) were used to evaluate the accuracy, while deLong method was used to compare models' accuracy. Calibration plot was used to evaluate the extend of over and under estimation of the models. Multivariate Logistic Regression Analysis (MVA) was performed to evaluate potential predictive factors of LNI. RESULTS: Overall, we analyzed data on 842 patients. Of them, 377 (44.8%) underwent MRI and TB. Median age at surgery was 64 years (IQR 59-69) and median tPSA was 7.04 ng/mL (IQR 5.11-10.4). Extra Capsular Extension and Seminal Vesicles Invasion (SVI) at MRI were observed in 15.4% and 5.4% of patients, respectively. The median primary and secondary GS were 3 and 4, respectively. The median percentage of positive cores was 35% (IQR 21.4-50). Finally, median Gleason Group at TB was 2 (IQR 2-3) and the median percentage of clinically significant random cores was 21% (IQR 0-42). A median of 13 (IQR 9-18) nodes per patient were removed, and 85 (10.1%) patients had LNI at final pathology. The AUCs for Briganti 2012 and 2019 were 0.84 and 0.79, respectively. The calibration plots showed a good correlation between the predicted probabilities and the observed proportion of LNI for both models. In patients with both SB and TB, Briganti 2012 accuracy was 0.815, and no significant difference was found between the two nomograms (p = 0.66). At MVA only PSA >20 ng/mL and the evidence of SVI at MRI were independent predictors of LNI. CONCLUSIONS: The direct comparison of the two nomograms showed that Briganti 2019 nomogram was no more accurate than Briganti 2012, and that the role of MRI and MRI TB may be negligible in the prediction of LNI. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e983 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicola Frego More articles by this author Paciotti Marco More articles by this author Davide Maffei More articles by this author Pier Paolo Avolio More articles by this author Roberto Contieri More articles by this author Alessandro Uleri More articles by this author Massimo Lazzeri More articles by this author Alberto Saita More articles by this author Paolo Casale More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP55-08 HIGH INTENSITY FOCUSED ULTRASOUND AND CRYOABLATION FOCAL THERAPY FOR INTERMEDIATE RISK PROSTATE CANCER: ONCOLOGIC AND FUNCTIONAL OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP55-08 HIGH INTENSITY FOCUSED ULTRASOUND AND CRYOABLATION FOCAL THERAPY FOR INTERMEDIATE RISK PROSTATE CANCER: ONCOLOGIC AND FUNCTIONAL OUTCOMES Masatomo Kaneko, Alireza Ghoreifi, Samuel Peretsman, Dordaneh Sugano, Giovanni Cacciamani, Amir Lebastchi, Suzanne Palmer, Manju Aron, Osamu Ukimura, Inderbir Gill, and Andre Abreu Masatomo KanekoMasatomo Kaneko More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Samuel PeretsmanSamuel Peretsman More articles by this author , Dordaneh SuganoDordaneh Sugano More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Amir LebastchiAmir Lebastchi More articles by this author , Suzanne PalmerSuzanne Palmer More articles by this author , Manju AronManju Aron More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre AbreuAndre Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002634.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate oncologic and functional outcomes following High Intensity Focused Ultrasound (HIFU) and Cryoablation (CRYO) focal therapy (FT) for localized prostate cancer (PCa). METHODS: We identified consecutive patients who underwent hemi-gland HIFU (h-HIFU) or hemi-gland CRYO (h-CRYO) FT as primary treatment for D’Amico intermediate risk PCa (IRB# HS-17-00749). Patients were selected by 12-core systematic and target biopsy and had unilateral index lesion. Follow up biopsy (FU-PBx) was performed from 6-12M and every 2Y thereafter. Primary endpoint was Treatment Failure (TF) defined as radical (any whole-gland) treatment, systemic therapy, metastases, or PCa-specific mortality. Secondary endpoints were survival-free from i) biochemical failure (BF, PSA nadir+2 ng/mL); ii) Grade Group (GG) ≥2 on FU-PBx, iii) repeat FT, iv) radical treatment, and v) systemic therapy. Kaplan-Meier method was used for survival evaluation. International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) and continence (zero pad) were also evaluated. Statistically significant if p <0.05. RESULTS: 184 patients met inclusion criteria: 121 (66%) h-CRYO and 63 (34%) h-HIFU. The baseline characteristics were comparable among h-HIFU vs h-CRYO, respectively, as follows: median age (65 vs 67 Y, p =0.15), PSA (5.9 vs 6.7 ng/mL, p = 0.081), PSA density (0.18 vs 0.17 ng/mL2, p = 0.61), number of positive cores (3 vs 3, p=0.14) and maximum PCa core % (50% vs 50%, p=0.59). h-CRYO had higher rate of GG3, as follows: GG1 (2% vs 7%), GG2 (79% vs 50%) and GG3 (19% vs 42%); p <0.001. The median follow up was longer for h-CRYO (30 M) vs h-HIFU (24M); p=0.005. PSA nadir was 1.1 ng/mL for h-HIFU vs 0.91 ng/mL for h-CRYO, p=0.53. The 3-year TF-free survival was: 88% for h-HIFU and 95% for h-CRYO, p=0.32. The 3-year free survival was, for h-HIFU vs h-CRYO, respectively: BF (80% vs 70%, p=0.89); GG≥2 on FU-PBx (63% vs 90%, p <0.001), repeat FT (93% vs 98%, p=0.40), radical treatment (87% vs 99%, p=0.04) and systemic therapy (100% vs 96%, p=0.23). One patient on h-CRYO developed bone metastases, but no patient died. Median difference from pre- to post-FT IPSS (0 vs 1.5; p=0.99) and IIEF-5 (0 vs 2; p=0.14) were similar for h-HIFU vs h-CRYO, respectively. Continence was maintained in 100% h-HIFU vs 98% h-CRYO, p=1.00. CONCLUSIONS: Hemi-gland HIFU or CRYO for intermediate risk PCa provide acceptable short-medium term oncologic outcomes with excellent function outcomes. Hemi-gland CRYO provided longer radical treatment-free survival than hemi-gland HIFU. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e940 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masatomo Kaneko More articles by this author Alireza Ghoreifi More articles by this author Samuel Peretsman More articles by this author Dordaneh Sugano More articles by this author Giovanni Cacciamani More articles by this author Amir Lebastchi More articles by this author Suzanne Palmer More articles by this author Manju Aron More articles by this author Osamu Ukimura More articles by this author Inderbir Gill More articles by this author Andre Abreu More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP15-06 RISK OF ADVERSE RADICAL PROSTATECTOMY OUTCOMES IN PATIENTS DIAGNOSED WITH IUSP ≤2 PROSTATE CANCER ON MRI/TRUS FUSION BIOPSY

You have accessJournal of UrologyCME1 May 2022MP15-06 RISK OF ADVERSE RADICAL PROSTATECTOMY OUTCOMES IN PATIENTS DIAGNOSED WITH IUSP ≤2 PROSTATE CANCER ON MRI/TRUS FUSION BIOPSY Claudia Kesch, Vlad Pantea, Timo Soeterik, Alessandro Marquis, Giulia La Bombarda, Allesandro Morlacco, Francesco Barletta, Felix Preisser, Fabio Zattoni, Giancarlo Marra, Roderik C.N. van den Bergh, Jan Philipp Radtke, Boris Hadaschik, and Giorgio Gandaglia Claudia KeschClaudia Kesch More articles by this author , Vlad PanteaVlad Pantea More articles by this author , Timo SoeterikTimo Soeterik More articles by this author , Alessandro MarquisAlessandro Marquis More articles by this author , Giulia La BombardaGiulia La Bombarda More articles by this author , Allesandro MorlaccoAllesandro Morlacco More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Felix PreisserFelix Preisser More articles by this author , Fabio ZattoniFabio Zattoni More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Roderik C.N. van den BerghRoderik C.N. van den Bergh More articles by this author , Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Boris HadaschikBoris Hadaschik More articles by this author , and Giorgio GandagliaGiorgio Gandaglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002544.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To avoid overtreatment, active surveillance (AS) is recommended for prostate cancer (PC) patients with low- to favorable intermediate-risk features. However, previous studies based on 12-core transrectal ultrasound (TRUS) biopsy have demonstrated high upgrading rates (up to 70%) at radical prostatectomy (RP) in men potentially suitable for AS. We aim at exploring rate and risk factors for adverse pathologic outcomes in patients with multiparmetric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy confirmed ISUP ≤2 PC. METHODS: Multicentre, retrospective analysis of 477 consecutive patients with ISUP ≤2 PC on mpMRI/TRUS fusion biopsy treated with RP. Adverse outcomes (AO) were defined as any ISUP upgrading, upgrading to ISUP ≥3, ≥pT3 at RP, any AO (=ISUP upgrading to ≥ 3 and/or ≥pT3 and/or N1) or biochemical recurrence (BCR) in men with available follow-up (n=327). Rates of AO were calculated for the overall cohort, biopsy ISUP 1 (n=149) and biopsy ISUP 2 (n=328) PC. Groups were compared using Qui-square test. Logistic regression was used to determine predictive factors. RESULTS: The overall rates of ISUP upgrading, ISUP upgrading to ≥ 3, ≥pT3 on RP and any AO were 39%, 21%, 32% and 43%, respectively. Compared to biopsy ISUP 2, men with biopsy ISUP 1 PC experienced more frequently ISUP upgrading (27% vs. 67%, p<0.001), but less ISUP upgrading to ≥ 3 (27% vs. 10%, p<0.001) and any AO (48% vs. 32%, p=0.001). No differences were recorded for ≥pT3 on RP (34% vs. 26%, p=0.052). PSA density, PIRADS score on mpMRI, number of positive targeted biopsy (TB) cores, ISUP of TB cores, overall number of biopsy cores and positive biopsy cores were all predictive factors for ISUP upgrading to ≥3, ≥pT3 at RP as well as for any AO. Neither PSA nor positive digital rectal examination significantly predicted AOs. Median time of follow-up was 12 months. The 1-year BCR-free survival was 94%. No significant differences in BCR rates were observed comparing men with biopsy ISUP 1 and biopsy ISUP 2 (5% vs. 7%, p=0.518). Positive TB cores, ISUP at RP, ISUP upgrading, ISUP upgrading to ≥3, ≥pT3 on RP and any AO were all predictive for BCR. CONCLUSIONS: In men with mpMRI/TRUS fusion biopsy confirmed ISUP ≤ 2 PC adverse outcomes at RP are still frequent. When counseling patients regarding AS, especially PSA density, ISUP, mpMRI findings and number of positive biopsy cores should be taken into account to identify the men at higher risk of AO. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e243 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claudia Kesch More articles by this author Vlad Pantea More articles by this author Timo Soeterik More articles by this author Alessandro Marquis More articles by this author Giulia La Bombarda More articles by this author Allesandro Morlacco More articles by this author Francesco Barletta More articles by this author Felix Preisser More articles by this author Fabio Zattoni More articles by this author Giancarlo Marra More articles by this author Roderik C.N. van den Bergh More articles by this author Jan Philipp Radtke More articles by this author Boris Hadaschik More articles by this author Giorgio Gandaglia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Evaluation of an all-in-one hybrid model (EUS Magic Box) for stepwise teaching and training in multiple interventional EUS procedures.

Background and study aims While multiple interventional endoscopic ultrasound (EUS)-guided procedures have evolved over the past two decades, there is no model that allows for training in all of these procedures. We aimed to develop and validate an all-in-one hybrid model for stepwise learning in multiple EUS interventions. Methods A hybrid model was created utilizing a pig esophagus and stomach, a silicon-based duodenum and pancreato-biliary system, a pseudocyst, and biopsy targets. This model was designed to provide hands-on training in multiple interventional EUS procedures, such as EUS-guided fine-needle biopsy (EUS-FNB), biliary drainage (BD), pancreatic duct drainage (PD), pseudocyst drainage (PSD), and gastro-enterostomy (GE). Thirty-six trainees underwent training on this model over 6 days, in two batches. Lumen apposing metal stents were used for PSD and GE. Trainees were assessed for objective criteria of technical difficulties. Subjective assessment by trainees was done via a questionnaire. Results All the trainees were able to complete the requisite steps for all the procedures under supervision. On subjective assessment, 30 trainees (83 %) graded the model as good or excellent. A total of 107 technical difficulties were noted (scope position 55, duct puncture 27, guidewire-related problems 25). Time taken to complete the requisite steps of biopsy, PSD, and GE (10.5 minutes; range 3.5 to 22) was significantly less than that for BD and PD (28 minutes; range 17 to 40) ( P < 0.001). Conclusions The hybrid model provided training for multiple EUS interventions with good acceptance by trainees. Stepwise mentoring with the possibility of performing multiple procedures in a single model with or without X-ray could prove useful in conference as well as institutional settings.

PD11-07 AWARENESS OF RISK OF PROSTATE CANCER (PCA) REMAINS POOR IN FAMILIES WITH GERMLINE MUTATIONS IN DNA-REPAIR GENES

You have accessJournal of UrologyCME1 May 2022PD11-07 AWARENESS OF RISK OF PROSTATE CANCER (PCA) REMAINS POOR IN FAMILIES WITH GERMLINE MUTATIONS IN DNA-REPAIR GENES Giuseppe Chiarelli, Rodolfo Hurle, Paolo Casale, Alberto Saita, Giovanni Lughezzani, Vittorio Fasulo, Alessio Benetti, Giorgio Guazzoni, Massimo Lazzeri, NicolòMaria Buffi, Monica Zuradelli, and Massimo Lazzeri Giuseppe ChiarelliGiuseppe Chiarelli More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Paolo CasalePaolo Casale More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Alessio BenettiAlessio Benetti More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , NicolòMaria BuffiNicolòMaria Buffi More articles by this author , Monica ZuradelliMonica Zuradelli More articles by this author , and Massimo LazzeriMassimo Lazzeri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002537.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: About 5-10% of PCa correlate with an inherited susceptibility. Germline mutations in DNA-repair genes (DRG) were found in approximately 5% of localized PCa and in 12% of metastatic castration-resistant PCa. As DRG mutations correlate with PCa aggressiveness there is an urgent need to test individuals suspected to be carriers who most benefit from early diagnosis and personalized therapies. The aim of the present study is to investigate the awareness of risk of PCa in families with germline mutations in DRG. METHODS: This is a prospective, monocentric study of families with DRG mutations. Those families ere selected from all families of women with breast and/or ovarian cancer treated in the last 5 years at the Breast Unit of our tertiary University Hospital. To test the awareness of risk of PCa we used the ratio between the number of families (where at least one man was present, who was offered the test for mutation detection) and probands who were really tested. Willingness to be tested was stratified according demographic, educational status and geographical residence. Healthy men with DRG mutations were offered a dedicated annual PCa screening consisting of digital rectal examination (DRE), blood test for Prostate Health Index (PHI) and multiparametric MRI with software assisted target biopsy plus systematic biopsy in suspected cases. RESULTS: Reviewing the genealogical trees of all breast/ovarian cancer patients who attended our Genetic Counselling Clinic from January 2016 to May 2021, we identified, over 1083 families, 132 positive ones for mutations in DRG. Over 132 families, we found that all the male members of 62 rejected to be tested. The original parent branch of mutation was unknown in 24 families and limited the interest in male relatives. In 9 families no male relatives were present; in 5 families, all men were already tested negative; probands were missed in 8. Finally, we selected 29 families (25%) with at least one male relative willing to be tested. We identified 59 men with a DRG mutation, of whom 27 met the inclusion criteria for screening and started it. Living in Northern Italy, higher educational levels, being married, the presence of offspring and at least one first-degree relative affected with cancer correlated with a higher willingness to be tested (p <0.05). No correlation between age at genetic counselling and test acceptance was found. CONCLUSIONS: Our analysis showed that only 25% of men with a high-risk of developing PCa accepted a genetic profiling, limiting their access to a dedicated PCa screening. This observation strongly supports the urgent need to implement awareness of genetic risk for PCa within male population. Source of Funding: This work was supported by AIRC (Associazione Italiana Ricerca sul Cancro), grant number IG 2020 ID 25027 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e192 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Chiarelli More articles by this author Rodolfo Hurle More articles by this author Paolo Casale More articles by this author Alberto Saita More articles by this author Giovanni Lughezzani More articles by this author Vittorio Fasulo More articles by this author Alessio Benetti More articles by this author Giorgio Guazzoni More articles by this author Massimo Lazzeri More articles by this author NicolòMaria Buffi More articles by this author Monica Zuradelli More articles by this author Massimo Lazzeri More articles by this author Expand All Advertisement PDF DownloadLoading ...

This Month in Adult Urology

This Month in Adult Urology

Can multi-parametric magnetic resonance imaging and prostate-specific antigen density accurately stratify patients prior to prostate biopsy?

Objective: This study examines the diagnostic accuracy of multi-parametric magnetic resonance imaging (mpMRI) in a high-volume centre to potentially stratify patients prior to prostate biopsy. Methods: All biopsy naïve patients who had mpMRI prostate and transperineal biopsy of prostate (TPBx) in 2017 and 2018 were included. There were no exclusion criteria. All patients, regardless of the mpMRI result, underwent systematic template biopsy under general anaesthesia with cognitive target biopsy if indicated. Clinicopathological data were extracted from medical records. The primary outcome was the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mpMRI prostate in the detection of prostate cancer (PCa) compared with template TPBx. Results: In total, 140 patients were included. Overall, 57.1% had a positive biopsy. A higher Prostate Imaging-Reporting and Data Systems (PI-RADS) score was associated with a higher risk of diagnosing clinically significant PCa (International Society of Urological Pathology (ISUP) ⩾ 2) ( p &lt; 0.001). The sensitivity, specificity, NPV, and PPV of mpMRI in detecting clinically significant PCa with a PI-RADS ⩾ 3 lesion, was 95% (95% confidence interval (CI) 83.0–99.3%), 41% (95% CI 31.3–51.3%), 95.3% (95% CI 84.2–99.4%) and 39.2% (95% CI 29.4–49.6%), respectively. Combining this with prostate-specific antigen density (PSAD) of &lt;0.15 further improved the NPV to 100% (86.3–100). Binomial logistic regression to understand the effects of PSA, DRE and PI-RADS score on predicting clinically significant PCa (ISUP ⩾ 2) found increasing PSA (odds ratio (OR) 1.06, (95% CI 1.00–1.11, p = 0.022)) and PI-RADS (OR 3.17, (95% CI 1.94–5.18, p &lt; 0.001)) to be significant predictors. Malignant DRE was not a significant predictor ( p = 0.087). Conclusion: This study demonstrates that the high sensitivity and NPV of mpMRI combined with PSAD may play a pivotal role in stratifying men for prostate biopsy and help avoid biopsy and its associated morbidity in select patients. Level of Evidence: 2b (Oxford Centre for Evidence-Based Medicine: Levels of Evidence)

Machine Learning-Based Prediction of Pathological Upgrade From Combined Transperineal Systematic and MRI-Targeted Prostate Biopsy to Final Pathology: A Multicenter Retrospective Study.

ObjectiveThis study aimed to evaluate the pathological concordance from combined systematic and MRI-targeted prostate biopsy to final pathology and to verify the effectiveness of a machine learning-based model with targeted biopsy (TB) features in predicting pathological upgrade.Materials and MethodsAll patients in this study underwent prostate multiparametric MRI (mpMRI), transperineal systematic plus transperineal targeted prostate biopsy under local anesthesia, and robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer (PCa) sequentially from October 2016 to February 2020 in two referral centers. For cores with cancer, grade group (GG) and Gleason score were determined by using the 2014 International Society of Urological Pathology (ISUP) guidelines. Four supervised machine learning methods were employed, including two base classifiers and two ensemble learning-based classifiers. In all classifiers, the training set was 395 of 565 (70%) patients, and the test set was the remaining 170 patients. The prediction performance of each model was evaluated by area under the receiver operating characteristic curve (AUC). The Gini index was used to evaluate the importance of all features and to figure out the most contributed features. A nomogram was established to visually predict the risk of upgrading. Predicted probability was a prevalence rate calculated by a proposed nomogram.ResultsA total of 515 patients were included in our cohort. The combined biopsy had a better concordance of postoperative histopathology than a systematic biopsy (SB) only (48.15% vs. 40.19%, p = 0.012). The combined biopsy could significantly reduce the upgrading rate of postoperative pathology, in comparison to SB only (23.30% vs. 39.61%, p < 0.0001) or TB only (23.30% vs. 40.19%, p < 0.0001). The most common pathological upgrade occurred in ISUP GG1 and GG2, accounting for 53.28% and 20.42%, respectively. All machine learning methods had satisfactory predictive efficacy. The overall accuracy was 0.703, 0.768, 0.794, and 0.761 for logistic regression, random forest, eXtreme Gradient Boosting, and support vector machine, respectively. TB-related features were among the most contributed features of a prediction model for upgrade prediction.ConclusionThe combined effect of SB plus TB led to a better pathological concordance rate and less upgrading from biopsy to RP. Machine learning models with features of TB to predict PCa GG upgrading have a satisfactory predictive efficacy.

What's in a node? The clinical and radiologic significance of Virchow's node.

In 1848, Rudolf Ludwig Karl Virchow described an association of left supraclavicular lymphadenopathy with abdominal malignancy. The left supraclavicular lymph node later became commonly referred to as Virchow's node. Charles-Emile Troisier went on to describe the physical exam finding of an enlarged left supraclavicular lymph node, later termed Troisier's sign. Subsequent studies confirmed a predilection of abdominal and pelvic malignancies to preferentially metastasize to the left supraclavicular node. Identification of a pathologically enlarged left supraclavicular node raises the suspicion for abdominopelvic malignancy, particularly in the absence of right supraclavicular lymphadenopathy, and provides a safe and easy target for biopsy. Supraclavicular lymph nodes also represent a great target for diagnosis of metastatic thoracic malignancies, although thoracic malignancies can involve either right or left supraclavicular nodes and do not show a predilection for either. This article presents a review of the history, anatomy, pathophysiology, clinical significance, radiological appearance, and biopsy of Virchow's node. Key points are illustrated with relevant cases.

Perineural spread of peripheral neurolymphomatosis to the cauda equina.

Neurolymphomatosis (NL) is a rare manifestation of lymphoma confined to the peripheral nervous system that is poorly understood. It can be found in the cauda equina, but extraspinal disease can be underappreciated. The authors describe how extraspinal NL progresses to the cauda equina by perineural spread and the implications of this on timely and safe diagnostic options. The authors used the Mayo Clinic medical records database to find cases of cauda equina NL with sufficient imaging to characterize the lumbosacral plexus diagnosed from tissue biopsy. Demographics (sex, age), clinical data (initial symptoms, cerebrospinal fluid, evidence of CNS involvement, biopsy location, primary or secondary disease), and imaging findings were reviewed. Ten patients met inclusion and exclusion criteria, and only 2 of 10 patients presented with cauda equina symptoms at the time of biopsy, with 1 patient undergoing a cauda equina biopsy. Eight patients were diagnosed with diffuse large B-cell lymphoma, 1 with low-grade B-cell lymphoma, and 1 with mantle cell lymphoma. Isolated spinal nerve involvement was identified in 5 of 10 cases, providing compelling evidence regarding the pathophysiology of NL. The conus medullaris was not radiologically involved in any case. Lumbosacral plexus MRI was able to identify extraspinal disease and offered diagnostically useful biopsy targets. FDG PET/CT was relatively insensitive for detecting disease in the cauda equina but was helpful in identifying extraspinal NL. The authors propose that perineural spread of extraspinal NL to infiltrate the cauda equina occurs in two phases. 1) There is proximal and distal spread along a peripheral nerve, with eventual spread to anatomically connected nerves via junction and branch points. 2) The tumor cells enter the spinal canal through corresponding neural foramina and propagate along the spinal nerves composing the cauda equina. To diffusely infiltrate the cauda equina, a third phase occurs in which tumor cells can spread circumdurally to the opposite side of the spinal canal and enter contralateral nerve roots extending proximally and distally. This spread of disease can lead to diffuse bilateral spinal nerve disease without diffuse leptomeningeal spread. Recognition of this phasic mechanism can lead to identification of safer extraspinal biopsy targets that could allow for greater functional recovery after appropriate treatment.

Human colorectal cancer tissue assessment using optical coherence tomography catheter and deep learning.

Optical coherence tomography (OCT) can differentiate normal colonic mucosa from neoplasia, potentially offering a new mechanism of endoscopic tissue assessment and biopsy targeting, with a high optical resolution and an imaging depth of ~1 mm. Recent advances in convolutional neural networks (CNN) have enabled application in ophthalmology, cardiology, and gastroenterology malignancy detection with high sensitivity and specificity. Here, we describe a miniaturized OCT catheter and a residual neural network (ResNet)-based deep learning model manufactured and trained to perform automatic image processing and real-time diagnosis of the OCT images. The OCT catheter has an outer diameter of 3.8 mm, a lateral resolution of ~7μm, and an axial resolution of ~6μm. A customized ResNet is utilized to classify OCT catheter colorectal images. An area under the receiver operating characteristic (ROC) curve (AUC) of 0.975 is achieved to distinguish between normal and cancerous colorectal tissue images.

A Nationwide Analysis of Risk of Prostate Cancer Diagnosis and Mortality following an Initial Negative Transrectal Ultrasound Biopsy with Long-Term Followup.

Magnetic resonance imaging (MRI) targeted prostate biopsy has been shown to find many high-grade prostate cancers in men with concurrent negative transrectal ultrasound (TRUS) systematic biopsy. The oncologic risk of such tumors can be explored by looking at long-term outcomes of men with negative TRUS biopsy followed without MRI. The aim was to analyze the mortality after initial and second negative TRUS biopsy. All men who underwent initial TRUS biopsies between January 1, 1995 and December 31, 2016 in Denmark were included. A total of 37,214 men had a negative initial TRUS biopsy and 6,389 underwent a re-biopsy. Risk of cause-specific mortality was analyzed with competing risks. Diagnosis of Gleason score ≥7 prostate cancer following negative biopsies was analyzed with multivariable logistic regression including time to re-biopsy, prostate specific antigen (PSA), age and digital rectal examination. The 15-year prostate cancer-specific mortality was 1.9% (95% CI: 1.7-2.1). Prostate cancer-specific mortality was 1.3% (95% CI: 0.9-1.6) and 4.6% (95% CI: 3.4-5.8) for men with PSA <10 and >20 ng/ml, respectively. Of the TRUS re-biopsies 12% were Gleason score ≥7 and risk of Gleason score ≥7 increased with longer time to re-biopsy (p <0.001). Mortality after re-biopsy was similar to after initial biopsy. Men with negative TRUS biopsies have a very low prostate cancer-specific mortality, especially with PSA <10 ng/ml. This raises serious questions about the routine use of MRI targeting for initial prostate biopsy and suggests that MRI targeting should only be recommended for men with PSA >10 ng/ml after negative biopsy.

Prognostic Value of Circulating Tumour DNA in Asian Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Background Circulating tumour DNA (ctDNA) is a noninvasive method of detecting tumours, and its prognostic significance in hepatocellular carcinoma (HCC) patients is controversial. We conducted a systematic review of published research data to evaluate the prognostic value of ctDNA in HCC patients. Methods The PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases were searched to identify eligible studies reporting disease-free survival (DFS) and overall survival (OS) stratified by ctDNA prior to January 2022. We evaluated the quality and design of these studies. The hazard ratio (HR) was used to combine the survivorship curve and univariate and multivariate results of the included studies. Results In total, 8 articles were included, encompassing 577 HCC patients. The results of survival curve analysis showed that ctDNA was related to poor OS and DFS, and the effect sizes were HR = 2.44, 95% CI (1.42, 4.20), P=0.001; HR = 2.63, 95% CI (1.96, 3.53), P < 0.001. The univariate analysis results showed that ctDNA was related to poor OS (HR = 4.48, 95% CI (1.17, 13.70), P=0.003). The combined results of multivariate analysis showed that ctDNA was related to a shorter risk of OS (HR = 3.74, 95% CI (1.45, 9.65), P=0.006). The univariate and multivariate descriptive analysis results showed that ctDNA was related to shorter DFS, and the effect sizes were HR = 3.28, 95% CI (1.23, 11.30), P=0.011; HR = 3.01, 95% CI (1.11, 10.5), P < 0.001. Conclusion The evidence provided by this analysis suggests that ctDNA may be a prognostic biomarker and is negatively correlated with the survival of HCC patients. Mutations in the TERT and SOCS3 promoters in ctDNA are associated with poor prognosis and are expected to become good targets for liquid biopsy and to help select treatment strategies.

Frameless Stereotactic Biopsy with Intraoperative Computed Tomography "Assessment of Efficacy and Real Target Registration Error".

Frameless stereotactic brain biopsy (FSB) with navigation system has been widely used. We reported preliminary experience of FSB with intraoperative computed tomography (iCT) and examined the usefulness of this novel adjuvant technique and real target registration error (rTRE) of FSB. The FSB with 5-aminolevulinic acid (5-ALA) and iCT was performed on 10 patients. The gadolinium-enhanced lesions on magnetic resonance image were defined as the biopsy target. In the procedure, iCTs were scanned twice, for autoregistration of the navigation system and for confirmation of the position of the actual inserted biopsy needle. The red fluorescence of the samples was observed under excitation with violet-blue light through a low-cut filter of neurosurgical microscope. The distance between the planned target and the tip of the biopsy needle in the image of iCT was calculated in a workstation for the assessment of rTRE. The median volume of the target was 12.13 mL (0.06-39.15 mL). We performed the surgical procedure in a prone position in four patients. None to faint 5-ALA-induced fluorescence was observed in six samples. There existed no sampling errors. The mean target distance between the planned and real targets of the mean rTRE of FSB was 2.7 ± 0.56 mm. The real TRE of FSB was first reported and was larger than the reported rTRE exactly calculated from the fiducial registration error. iCT guarantees accurate tumor sampling with autoregistration regardless of the surgical position and prevents inaccurate biopsy to occur even with ALA fluorescence assistance.

Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer.

34 Background: Growing evidence proved the efficacy of multiparametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-guided targeted biopsy (TB) in prostate cancer (PCa) diagnosis, but there is no direct comparison between mpMRI-TB and PSMA PET/CT-TB. Gastrin-releasing peptide receptor (GRPR) highly expressed in PCa, which can compensate for the unstable expression of PSMA in PCa. Therefore, we designed a study to compare the efficiency of mpMRI-TB, dual-Tracer (GRPR and PSMA) PET/CT-TB, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer. Methods: 112 suspicious PCa patients were enrolled from September 2020 and June 2021 in this prospective and comparative effectiveness study. Patients with positive dual-tracer PET/CT or mpMRI results underwent TB and all enrolled patients underwent SB after TB. The primary outcome was the detection rates of PCa in different biopsy strategies. Secondary outcomes were the performance of three imaging methods, omission diagnostic rates, and upgrading and downgrading of biopsy samples relative to those of prostatectomy specimens in different biopsy strategies. Results: In 112 men, clinically significant PCa (grade group≥2) accounted for 34.82% (39/112) and nonclinically significant PCa (grade group = 1) accounted for 4.46% (5/112). 68Ga-PSMA PET/CT-TB achieved higher PCa detection rate (69.77%) and positive ratio of biopsy cores (0.44) compared with SB (39.29% and 0.12) and mpMRI-TB (36.14% and 0.23), respectively (P &lt; 0.005). Dual-tracer PET/CT as a triage test avoided 52.67% (59/112) unnecessary biopsy, whereas dual-tracer PET/CT-TB plus SB achieved high detection rate (77.36%) without misdiagnosis of csPCa. Conclusions: Dual-tracer PET/CT could screen patients for avoiding unnecessary biopsy. Dual-tracer PET/CT-TB plus SB might be a more effective and promising strategy for definite diagnosis of clinically significant PCa than mpMRI-TB.

Investigation of Urinary Exosome Metabolic Patterns in Membranous Nephropathy by Titania‐Assisted Intact Exosome Mass Spectrometry

Exosomes are regarded as the emerging potential targets for liquid biopsy and bioprocess study owing to their abundant inclusive cargos that carry significant disease information. In addition, metabolites have been promising biomarkers for diagnosis. However, little metabolic research on exosomes is carried out by now. Herein, the mix‐crystal titania‐assisted laser desorption/ionization mass spectrometry (LDI‐MS) method is established, which features fast speed, high throughput, and efficiency, to directly extract urinary exosome metabolic patterns of healthy controls (HC) and membrane nephropathy (MN) patients. Besides, this method is also adopted to acquire the primitive urinary metabolic patterns from the same samples for comparison. By taking advantage of principal component analysis, unpaired parametric t‐test, and orthogonal partial least squares discriminant analysis on the exosome metabolic patterns, 27 significant m/z signals are filtrated, which possess more prominent differentiation capacity toward HC and MN patients (AUC = 0.942), and hold greater potential in MN diagnosis, compared to primitive urine (AUC = 0.801). The work reveals the important clinical value of exosome metabolic analysis, and paves a way to exosome‐based diagnosis at metabolomic level toward large‐scale clinical use.

The "funitel" technique for endoscopic target biopsy at a biliary bifurcation.

The "funitel" technique for endoscopic target biopsy at a biliary bifurcation.

The role of computed tomography in the development and implementation of minimally invasive surgery methods in the clinic of bone pathology

The evaluation of the CT efficacy for the elaboration and realization of low invasive diagnosis and treatment in bone pathology was performed. Sixty two patients, aged from 6 to 80, were examined. The method of stereotaxic determination of pathologic locus localization with CT controlled manipulation (target biopsy, anchor navigation in disorder focus, injection of contrast matter and introduction of plastic materials into the focus) was used. The efficacy of those method made up 89.6% for target biopsy corresponding to the high degree accuracy of pathological process identification and 100%) for the preoperative marking. New elaborated method is accurate and safe for the patients.

Feasibility of a prototype carbon nanotube enabled stationary digital chest tomosynthesis system for identification of pulmonary nodules by pulmonologists.

BackgroundScreen detected and incidental pulmonary nodules are increasingly common. Current guidelines recommend tissue sampling of solid nodules >8 mm. Bronchoscopic biopsy poses the lowest risk but is paired with the lowest diagnostic yield when compared to CT-guided biopsy or surgery. A need exists for a safe, mobile, low radiation dose, intra-procedural method to localize biopsy instruments within target nodules. This retrospective cross sectional reader feasibility study evaluates the ability of clinicians to identify pulmonary nodules using a prototype carbon nanotube radiation enabled stationary digital chest tomosynthesis system.MethodsPatients with pulmonary nodules on prior CT imaging were recruited and consented for imaging with stationary digital chest tomosynthesis. Five pulmonologists of varying training levels participated as readers. Following review of patient CT and a thoracic radiologist’s interpretation of nodule size and location the readers were tasked with interpreting the corresponding tomosynthesis scan to identify the same nodule found on CT.ResultsFifty-five patients were scanned with stationary digital chest tomosynthesis. The median nodule size was 6 mm (IQR =4–13 mm). Twenty nodules (37%) were greater than 8 mm. The radiation entrance dose for s-DCT was 0.6 mGy. A significant difference in identification of nodules using s-DCT was seen for nodules <8 vs. ≥8 mm in size (57.7% vs. 90.9%, CI: −0.375, −0.024; P<0.001). Inter-reader agreement was fair, and better for nodules ≥8 mm [0.278 (SE =0.043)].ConclusionsWith system and carbon nanotube array optimization, we hypothesize the detection rate for nodules will improve. Additional study is needed to evaluate its use in target and tool co-localization and target biopsy.