1
|
Vergara R, Chouvel R, Vergier B, Le Bail B, Négrier-Leibreich ML, Belleannée G, Rullier A, Marty M. Reducing reflex first-line prescriptions in a surgical pathology laboratory: toward sustainable practice with positive economic and clinical effects. Virchows Arch 2024:10.1007/s00428-024-03817-5. [PMID: 38730093 DOI: 10.1007/s00428-024-03817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/22/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Abstract
In surgical pathology departments, reflex first-line techniques (RFLTs) are aimed at reducing workloads and addressing recent shortages of medical personnel. However, the impacts thereof on economic and diagnostic factors have been poorly addressed. Also, in the era of global warming, environmental considerations are crucial. This study assessed the economic and diagnostic efficacies of routine pathological RFLT and the quality of care and sustainability. Ten RFLTs of the Bordeaux University Hospital pathology department (six special stains, one cytology technique, and three immunohistochemical tests) were studied. First, a retrospective economic analysis evaluated the average cost of these RFLTs per slide and per year. Second, diagnostic relevance was prospectively surveyed. Third, the effects of changes made were analyzed over 2 years. The ten RFLTs were associated with average annual costs of €46,708. Diagnostic relevance analysis indicated that most stains were unnecessary; only 17% were requested as second-line techniques. Elimination of 7/10 tests afforded annual cost savings of €22,522 and reduced the workload by 5568 tests/year, without compromising the workflow or diagnostic quality. Seven of ten RFLTs could be eliminated without compromising diagnostic quality or the workflow. This afforded not only financial benefits but also positive social and environmental impacts. We offer valuable insights into appropriate practices in surgical pathology laboratories. Collaboration between the medical and technical teams was crucial; other healthcare sectors would also benefit from our approach.
Collapse
Affiliation(s)
- Rémi Vergara
- Pathology Department, Bordeaux University Hospital, Bordeaux, France.
| | - Rudy Chouvel
- Fédération Hospitalière de France, Paris, France
| | - Béatrice Vergier
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
- BoRdeaux Institute of onCology (BRIC)-UMR 1312 INSERM University of Bordeaux, Bordeaux, France
| | - Brigitte Le Bail
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
- BoRdeaux Institute of onCology (BRIC)-UMR 1312 INSERM University of Bordeaux, Bordeaux, France
| | | | | | - Anne Rullier
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
| | - Marion Marty
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
2
|
Loeb S. Engaging in Clinical Research and Practice Approaches that Reduce Environmental Impact. Eur Urol Oncol 2024:S2588-9311(24)00099-3. [PMID: 38688768 DOI: 10.1016/j.euo.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Telemedicine, virtual conferences, and reducing waste in the operating room are ways in which urologists can reduce their environmental impact in daily practice. Patient counseling should also consider advice that simultaneously promotes overall, urological, and planetary health, such as plant-based diets and active transport.
Collapse
Affiliation(s)
- Stacy Loeb
- Department of Urology and Population Health, New York University Langone Health and Manhattan Veterans Affairs, New York, NY, USA.
| |
Collapse
|
3
|
Fazekas T, Shim SR, Basile G, Baboudjian M, Kói T, Przydacz M, Abufaraj M, Ploussard G, Kasivisvanathan V, Rivas JG, Gandaglia G, Szarvas T, Schoots IG, van den Bergh RCN, Leapman MS, Nyirády P, Shariat SF, Rajwa P. Magnetic Resonance Imaging in Prostate Cancer Screening: A Systematic Review and Meta-Analysis. JAMA Oncol 2024:2817308. [PMID: 38576242 PMCID: PMC10998247 DOI: 10.1001/jamaoncol.2024.0734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/22/2024] [Indexed: 04/06/2024]
Abstract
Importance Prostate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway. Objective To systematically evaluate the existing evidence regarding screening pathways incorporating MRI with targeted biopsy and assess their diagnostic value compared with prostate-specific antigen (PSA)-based screening with systematic biopsy strategies. Data Sources PubMed/MEDLINE, Embase, Cochrane/Central, Scopus, and Web of Science (through May 2023). Study Selection Randomized clinical trials and prospective cohort studies were eligible if they reported data on the diagnostic utility of prostate MRI in the setting of PCa screening. Data Extraction Number of screened individuals, biopsy indications, biopsies performed, clinically significant PCa (csPCa) defined as International Society of Urological Pathology (ISUP) grade 2 or higher, and insignificant (ISUP1) PCas detected were extracted. Main Outcomes and Measures The primary outcome was csPCa detection rate. Secondary outcomes included clinical insignificant PCa detection rate, biopsy indication rates, and the positive predictive value for the detection of csPCa. Data Synthesis The generalized mixed-effect approach with pooled odds ratios (ORs) and random-effect models was used to compare the MRI-based and PSA-only screening strategies. Separate analyses were performed based on the timing of MRI (primary/sequential after a PSA test) and cutoff (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3 or ≥4) for biopsy indication. Results Data were synthesized from 80 114 men from 12 studies. Compared with standard PSA-based screening, the MRI pathway (sequential screening, PI-RADS score ≥3 cutoff for biopsy) was associated with higher odds of csPCa when tests results were positive (OR, 4.15; 95% CI, 2.93-5.88; P ≤ .001), decreased odds of biopsies (OR, 0.28; 95% CI, 0.22-0.36; P ≤ .001), and insignificant cancers detected (OR, 0.34; 95% CI, 0.23-0.49; P = .002) without significant differences in the detection of csPCa (OR, 1.02; 95% CI, 0.75-1.37; P = .86). Implementing a PI-RADS score of 4 or greater threshold for biopsy selection was associated with a further reduction in the odds of detecting insignificant PCa (OR, 0.23; 95% CI, 0.05-0.97; P = .048) and biopsies performed (OR, 0.19; 95% CI, 0.09-0.38; P = .01) without differences in csPCa detection (OR, 0.85; 95% CI, 0.49-1.45; P = .22). Conclusion and relevance The results of this systematic review and meta-analysis suggest that integrating MRI in PCa screening pathways is associated with a reduced number of unnecessary biopsies and overdiagnosis of insignificant PCa while maintaining csPCa detection as compared with PSA-only screening.
Collapse
Affiliation(s)
- Tamás Fazekas
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Giuseppe Basile
- Unit of Urology, Urological Research Institute, Division of Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Michael Baboudjian
- Department of Urology, Assistance Publique des Hôpitaux de Marseille, North Academic Hospital, Marseille, France
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Mathematics, Department of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan
| | | | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, England
| | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Giorgio Gandaglia
- Unit of Urology, Urological Research Institute, Division of Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Tibor Szarvas
- Department of Urology, Semmelweis University, Budapest, Hungary
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium–University Hospital Essen, Essen, Germany
| | - Ivo G. Schoots
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roderick C. N. van den Bergh
- Department of Urology, St Antonius Hospital, Utrecht, the Netherlands
- Department of Urology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Péter Nyirády
- Department of Urology, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Shahrokh F. Shariat
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna, Austria
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, New York
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Pawel Rajwa
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| |
Collapse
|
4
|
Chaban YV, Vosshenrich J, McKee H, Gunasekaran S, Brown MJ, Atalay MK, Heye T, Markl M, Woolen SA, Simonetti OP, Hanneman K. Environmental Sustainability and MRI: Challenges, Opportunities, and a Call for Action. J Magn Reson Imaging 2024; 59:1149-1167. [PMID: 37694980 DOI: 10.1002/jmri.28994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
The environmental impact of magnetic resonance imaging (MRI) has recently come into focus. This includes its enormous demand for electricity compared to other imaging modalities and contamination of water bodies with anthropogenic gadolinium related to contrast administration. Given the pressing threat of climate change, addressing these challenges to improve the environmental sustainability of MRI is imperative. The purpose of this review is to discuss the challenges, opportunities, and the need for action to reduce the environmental impact of MRI and prepare for the effects of climate change. The approaches outlined are categorized as strategies to reduce greenhouse gas (GHG) emissions from MRI during production and use phases, approaches to reduce the environmental impact of MRI including the preservation of finite resources, and development of adaption plans to prepare for the impact of climate change. Co-benefits of these strategies are emphasized including lower GHG emission and reduced cost along with improved heath and patient satisfaction. Although MRI is energy-intensive, there are many steps that can be taken now to improve the environmental sustainability of MRI and prepare for the effects of climate change. On-going research, technical development, and collaboration with industry partners are needed to achieve further reductions in MRI-related GHG emissions and to decrease the reliance on finite resources. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.
Collapse
Affiliation(s)
- Yuri V Chaban
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Hayley McKee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suvai Gunasekaran
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maura J Brown
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael K Atalay
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tobias Heye
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Sean A Woolen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | | | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Jiang X, Chen M, Tian J, Li X, Liu R, Wang Y, Zhao Y, Peng S, Niu Y, Xu Y. Comparison of Regional Saturation Biopsy, Targeted Biopsy, and Systematic Biopsy in Patients with Prostate-specific Antigen Levels of 4-20 ng/ml: A Prospective, Single-center, Randomized Controlled Trial. Eur Urol Oncol 2023:S2588-9311(23)00283-3. [PMID: 38158249 DOI: 10.1016/j.euo.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/19/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Despite the use of multiparametric magnetic resonance imaging (mpMRI)-guided targeted biopsy (TB) to identify suspicious prostate lesions, it may still miss clinically significant prostate cancer (csPCa) or result in false-negative findings. Recent evidence suggests that combining biopsies taken from within and around magnetic resonance imaging (MRI) lesions can improve the detection of csPCa. OBJECTIVE This study aimed to compare the diagnostic performance of the regional saturation biopsy (RSB) method, involving template-based nine-core biopsies for suspected regions, with that of the MRI-directed TB and/or the systematic biopsy (SB) methods in biopsy-naïve patients with prostate-specific antigen (PSA) levels ranging from 4 to 20 ng/ml. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-center, randomized controlled trial included 434 biopsy-naïve patients with suspected lesions on mpMRI and PSA levels between 4 and 20 ng/ml (from January 2022 to July 2023). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The detection rates of csPCa for the RSB, TB, and SB methods were analyzed using the McNemar test for intrapatient comparisons. The Fisher's exact test was used for comparisons between RSB and TB. RESULTS AND LIMITATIONS The RSB approach yielded a significantly higher detection rate of csPCa than both the TB approach (44.1% vs 31.8%, p = 0.01) and the SB approach (44.1% vs 34.1%, p = 0.03). The RSB approach exhibited a comparable detection rate of csPCa (44.1% vs. 40.7%, p = 0.3) to the combined approach (TB + SB), while requiring fewer biopsy cores and a higher positive core number to avoid sampling the entire prostate gland (32.7% vs 18.3%, p < 0.001). Upon conducting a whole-mount histopathological analysis, it was observed that the RSB approach successfully identified 97% (32 out of 33) of the prostate cancer foci as the index lesion, whereas only 59.18% (29 out of 49) were classified as index lesions using the SB approach. Furthermore, mpMRI underestimated the average diameter of histological tumor size by a median of 0.76 cm, highlighting the importance of an optimal biopsy area for the RSB procedure. CONCLUSIONS For patients with suspected lesions on mpMRI and PSA levels between 4 and 20 ng/ml, the RSB approach has shown improved detection of clinically significant prostate cancer, accurately identifying index lesions, and minimizing biopsy cores compared with the MRI-directed TB and SB approaches. PATIENT SUMMARY For patients with suspected lesions on multiparametric magnetic resonance imaging and prostate-specific antigen levels between 4 and 20 ng/ml, the regional saturation biopsy method provides enhanced detection of clinically significant prostate cancer, as well as precise identification of index lesions, surpassing both magnetic resonance imaging-directed targeted biopsy and the systematic biopsy method.
Collapse
Affiliation(s)
- Xingkang Jiang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
| | - Mingzhe Chen
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jing Tian
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaohua Li
- Department of Pharmaceutical Clinical Trial, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ranlu Liu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yong Wang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yang Zhao
- Department of Radiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shuanghe Peng
- Department of Pathology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuanjie Niu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
| | - Yong Xu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
| |
Collapse
|
6
|
Trecourt A, Cottinet PJ, Donzel M, Favretto M, Bancel B, Decaussin-Petrucci M, Traverse-Glehen A, Devouassoux-Shisheboran M, Meyronet D, Belleannée G, Rullier A, Lê MQ, Rival G, Grinberg D, Tilmant C, Gaillot-Durand L. Carbon footprint evaluation of routine anatomic pathology practices using eco-audit: Current status and mitigation strategies. Ann Diagn Pathol 2023; 67:152210. [PMID: 37734347 DOI: 10.1016/j.anndiagpath.2023.152210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Alexis Trecourt
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud Charles Mérieux, UR 3738, CICLY, Lyon, France.
| | - Pierre-Jean Cottinet
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France
| | - Marie Donzel
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR 5286, Lyon, France
| | - Marion Favretto
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France
| | - Béatrice Bancel
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France
| | - Myriam Decaussin-Petrucci
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR 5286, Lyon, France
| | - Alexandra Traverse-Glehen
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR 5286, Lyon, France
| | - Mojgan Devouassoux-Shisheboran
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, CRCL, INSERM U1052, CNRS UMR 5286, Lyon, France
| | - David Meyronet
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France; Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, CRCL, INSERM U1052, CNRS UMR 5286, Lyon, France
| | | | - Anne Rullier
- CHU de Bordeaux, Hôpital Pellegrin, Service de Pathologie, Bordeaux, France
| | - Minh-Quyen Lê
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France
| | - Guilhem Rival
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France
| | - Daniel Grinberg
- Université de Lyon, INSA-Lyon, Laboratoire de Génie Electrique et Férroélectricité (LGEF), EA682, F-69621 Villeurbanne, France; Hospices Civils de Lyon, Hôpital cardiologique « Louis Pradel », Service de chirurgie cardiaque, Lyon, France
| | - Cyprien Tilmant
- Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Pathologie, Lille, France
| | - Lucie Gaillot-Durand
- Hospices Civils de Lyon, Service de Pathologie Multi-Site et Université Claude Bernard Lyon I, France
| |
Collapse
|
7
|
Leapman MS. Confronting the Climate Emergency in Urology. Eur Urol Focus 2023; 9:855-856. [PMID: 38042650 DOI: 10.1016/j.euf.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
8
|
Stone L. Calculating the environmental cost of care. Nat Rev Urol 2023; 20:130. [PMID: 36750654 DOI: 10.1038/s41585-023-00733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|