The role of pre-biopsy mpMRI in lymph node staging for prostate cancer

2021 ◽  
pp. 039156032110168
Author(s):  
Nassib Abou Heidar ◽  
Robert El-Doueihi ◽  
Ali Merhe ◽  
Paul Ramia ◽  
Gerges Bustros ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Gleason Score ◽  
Gold Standard ◽  
Cross Sectional ◽  
Significant Difference ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Kappa Agreement

Introduction: Prostate cancer (PCa) staging is an integral part in the management of prostate cancer. The gold standard for diagnosing lymph node invasion is a surgical lymphadenectomy, with no superior imaging modality available at the clinician’s disposal. Our aim in this study is to identify if a pre-biopsy multiparametric MRI (mpMRI) can provide enough information about pelvic lymph nodes in intermediate and high risk PCa patients, and whether it can substitute further cross sectional imaging (CSI) modalities of the abdomen and pelvis in these risk categories. Methods: Patients with intermediate and high risk prostate cancer were collected between January 2015 and June 2019, while excluding patients who did not undergo a pre-biopsy mpMRI or a CSI. Date regarding biopsy result, PSA, MRI results, CSI imaging results were collected. Using Statistical Package for the Social Sciences (SPSS) version 24.0, statistical analysis was conducted using the Cohen’s Kappa agreement for comparison of mpMRI with CSI. McNemar’s test and receiver operator curve (ROC) curve were used for comparison of sensitivity of both tests when comparing to the gold standard of lymphadenectomy. Results: A total of 143 patients fit the inclusion criteria. We further stratified our patients into according to PSA level and Gleason score. Overall, agreement between mpMRI and all CSI was 0.857. When stratifying patients based on Gleason score and PSA, the higher the grade or PSA, the higher agreement between mpMRI and CSI. The sensitivity of mpMRI (73.7%) is similar to CSI (68.4%). When comparing CSI sensitivity to that of mpMRI, no significant difference was present by utilizing the McNemar test and very similar receiver operating characteristic curve. Conclusion: A pre-biopsy mpMRI can potentially substitute further cross sectional imaging in our cohort of patients. However, larger prospective studies are needed to confirm our findings.

scholarly journals Comparison of cross-sectional imaging techniques for the detection of prostate cancer lymph node metastasis: a critical review

2020 ◽  
Vol 9 (3) ◽  
pp. 1415-1427
Author(s):  
Amir H. Lebastchi ◽  
Nikhil Gupta ◽  
John M. DiBianco ◽  
Morand Piert ◽  
Matthew S. Davenport ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Critical Review ◽  
Imaging Techniques ◽  
Cross Sectional ◽  
Node Metastasis ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

The value of lymph node ultrasound and whole body PET/CT in stage IIB/C patients prior to SLNB.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22079-e22079
Author(s):  
Emma H.A. Stahlie ◽  
Bernies Van Der Hiel ◽  
Annemarie Bruining ◽  
Michel W.J.M. Wouters ◽  
Yvonne Schrage ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Whole Body ◽  
Preoperative Imaging ◽  
Cross Sectional ◽  
Primary Tumors ◽  
Pet Ct ◽  
Cross Sectional Imaging ◽  
Melanoma Patients ◽  
Sectional Imaging

e22079 Background: Stage IIB/IIC (pT3b-T4N0) patients are known to have high-risk primary tumors, even higher risk than some stage IIIA/B melanomas (AJCC Staging System 8th edition), however they follow the same routine to sentinel lymph node biopsy (SLNB) as more low-risk tumors. A priori the risk of finding SLNB or other metastases is much higher for these thick and/or ulcerated primary melanomas compared to the thinner ones. Guidelines are not conclusive regarding the use of preoperative imaging in these cases. Recently, a trend to more frequently use cross-sectional imaging has been noticed. However, others have previously shown that preoperative ultrasound was the most sensitive. The aim of this pilot study was to assess the value of ultrasound (US) and Positron Emission Tomography/Computerized Tomography (PET/CT) prior to SLNB for stage IIB/C (pT3b-T4N0) melanoma patients. Methods: Starting 2019-04, all patients with a pT3b melanoma or higher (8th AJCC) were included. All patients underwent US and PET/CT before their planned lymphoscintigraphy and routine SLNB. Suspected metastases were confirmed with cytologic puncture. Results: A total of 20 patients were screened. Seven patients (35%) had metastases detected by imaging: one by PET/CT, three by US and three by both imaging modalities. Three of these metastases were detected by US as well as PET/CT. All metastases were nodal. For all seven patients treatment was altered to lymph node dissection with adjuvant therapy. Of the 13 patients in whom no metastases were identified by imaging, six (46%) still had a positive sentinel node (SN). Conclusions: This study showed that this select group of patients had a high risk of metastases prior to SLNB and that all recurrences except one, were detected by ultrasound. This suggests that nodal staging with US is sufficient and can replace the need for SLNB when metastases is proven with cytology. Despite negative imaging, SLNB cannot be foregone for pT3b-pT4N0 melanoma patients, as many still have an involved SN. Cross-sectional imaging can be reserved for patients after positive cytology or SN to confirm the absence of distant visceral metastases.

Use of the Prostate Health Index for the Detection of Aggressive Prostate Cancer at Radical Prostatectomy

2015 ◽  
Vol 95 (4) ◽  
pp. 390-399 ◽  
Author(s):  
Luigi Mearini ◽  
Elisabetta Nunzi ◽  
Carla Ferri ◽  
Guido Bellezza ◽  
Carolina Lolli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Health Index ◽  
Final Pathology ◽  
High Risk Disease ◽  
Prostate Health Index ◽  
Prostate Health

Introduction: In current study, we compared the accuracy of the PSA isoform p2PSA and its derivatives, the percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI) in the detection of prostate cancer (PC) characteristics at the final pathology with respect to reference standards. Materials and Methods: This was an observational prospective study evaluating 43 consecutive PC patients treated with laparoscopic/robotic radical prostatectomy (RP). Logistic regression models were fitted to test the predictors of pT3 stage, pathologic Gleason score ≥8 or Gleason score upgrading, margin status, lymph node invasion, and the presence of high-risk disease (pT3 disease and/or Gleason score ≥8 and/or positive lymph node). The comparative base model included tPSA, clinical stage, biopsy Gleason score, and percentage of positive core. Results: Seventeen patients (39.5%) were affected by pT3 disease or had a pathologic Gleason score ≥8; positive margins were detected in 12 patients (27.9%), lymph node invasion was found in 2 patients (4.7%), and 15 patients (34.8%) harbored high-risk disease. In the univariate analysis, p2PSA, %p2PSA, and PHI were significant predictors of pT3 disease, pathologic Gleason score, and the presence of high-risk disease (all p < 0.05), whereas only PHI was an independent predictor of pT3 disease, margin status, and presence of high-risk disease, increasing the accuracy of a base multivariable model by 6.3% (p < 0.05) and 4.2% (p < 0.05) for the prediction of pT3 and high-risk disease, respectively. Conclusions: p2PSA and its derivatives, primarily PHI, were significant predictors of unfavorable PC characteristics as detected at the final pathology, thus improving the clinical performance of standard prognostic factors for aggressive disease.

Su1468 – Can Regional Lymph Node Metastases from Pancreatic Cancer Be Predicted with Cross-Sectional Imaging?

2019 ◽  
Vol 156 (6) ◽  
pp. S-1446
Author(s):  
katelyn flick ◽  
Ted A. Seltman ◽  
Nicholas J. Zyromski ◽  
Eugene P. Ceppa ◽  
Christian Schmidt ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Regional Lymph Node ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Node Metastases ◽  
Sectional Imaging

scholarly journals Association of ABO Blood Types and Clinicopathological Features of Prostate Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Fang-Ming Wang ◽  
Yan Zhang ◽  
Gui-Ming Zhang ◽  
Ya-Nan Liu ◽  
Li-Jiang Sun ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Regression Analysis ◽  
High Risk ◽  
Gleason Score ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
High Risk Group ◽  
Blood Type ◽  
Blood Types ◽  
Significant Difference

Purpose. To investigate the association between ABO blood types and clinicopathological characteristics in patients with prostate cancer (PC). Methods. A total of 237 pathologically diagnosed PC patients were enrolled. All patients were classified as low–middle or high-risk group. The correlation of ABO blood types with high-risk PC was determined by univariate and multivariate regression analysis. Results. Data indicated 144 (85.7%) patients were stratified as high risk in the non-O group, while 50 (72.5%) patients in the O group (p=0.025). However, there was no significant difference regarding PSA, Gleason score, stage, or metastasis between O and non-O group (p>0.05). Univariate logistic regression analyses revealed PSA, Gleason score, and blood type non-O were all correlated with high-risk PC (OR = 1.139, p<0.001; OR = 9.465, p<0.001; OR = 2.280, p=0.018, resp.). In the stepwise multivariate regression analysis, the association between blood type non-O and high-risk PC remained significant (OR = 33.066, 95% CI 2.391–457.323, and p=0.009) after adjusting for confounding factors as well as PSA and Gleason score. Conclusion. The present study firstly demonstrated that non-O blood type was at higher risk of aggressive PC compared with O type, suggesting that PC patients with non-O blood type should receive more attention in clinical practice.

scholarly journals Influence of Biopsy Gleason Score on the Risk of Lymph Node Invasion in Patients With Intermediate-Risk Prostate Cancer Undergoing Radical Prostatectomy

2021 ◽  
Vol 8 ◽  
Author(s):  
Mike Wenzel ◽  
Felix Preisser ◽  
Benedikt Hoeh ◽  
Maria N. Welte ◽  
Clara Humke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
International Society ◽  
Low Risk ◽  
Intermediate Risk ◽  
Risk Prostate Cancer ◽  
Biopsy Gleason Score

Objective: To analyze the influence of biopsy Gleason score on the risk for lymph node invasion (LNI) during pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy (RP) for intermediate-risk prostate cancer (PCa).Materials and Methods: We retrospectively analyzed 684 patients, who underwent RP between 2014 and June 2020 due to PCa. Univariable and multivariable logistic regression, as well as binary regression tree models were used to assess the risk of positive LNI and evaluate the need of PLND in men with intermediate-risk PCa.Results: Of the 672 eligible patients with RP, 80 (11.9%) men harbored low-risk, 32 (4.8%) intermediate-risk with international society of urologic pathologists grade (ISUP) 1 (IR-ISUP1), 215 (32.0%) intermediate-risk with ISUP 2 (IR-ISUP2), 99 (14.7%) intermediate-risk with ISUP 3 (IR-ISUP3), and 246 (36.6%) high-risk PCa. Proportions of LNI were 0, 3.1, 3.7, 5.1, and 24.0% for low-risk, IR-ISUP1, IR-ISUP 2, IR-ISUP-3, and high-risk PCa, respectively (p &lt; 0.001). In multivariable analyses, after adjustment for patient and surgical characteristics, IR-ISUP1 [hazard ratio (HR) 0.10, p = 0.03], IR-ISUP2 (HR 0.09, p &lt; 0.001), and IR-ISUP3 (HR 0.18, p &lt; 0.001) were independent predictors for lower risk of LNI, compared with men with high-risk PCa disease.Conclusions: The international society of urologic pathologists grade significantly influence the risk of LNI in patients with intermediate- risk PCa. The risk of LNI only exceeds 5% in men with IR-ISUP3 PCa. In consequence, the need for PLND in selected patients with IR-ISUP 1 or IR-ISUP2 PCa should be critically discussed.

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