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van den Kroonenberg DL, Stoter JD, Jager A, Veerman H, Hagens MJ, Schoots IG, Postema AW, Hoekstra RJ, Oprea-Lager DE, Nieuwenhuijzen JA, van Leeuwen PJ, Vis AN. The Impact of Omitting Contralateral Systematic Biopsy on the Surgical Planning of Patients with a Unilateral Suspicious Lesion on Magnetic Resonance Imaging Undergoing Robot-assisted Radical Prostatectomy for Prostate Cancer. EUR UROL SUPPL 2024; 63:13-18. [PMID: 38558763 PMCID: PMC10981034 DOI: 10.1016/j.euros.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Background and objective A combined approach of magnetic resonance imaging (MRI)-targeted biopsy (TBx) and bilateral systematic biopsy (SBx) is advised in patients who have an increased risk of prostate cancer (PCa). The diagnostic gain of SBx in detecting PCa for treatment planning of patients undergoing robot-assisted radical prostatectomy (RARP) is unknown. This study aims to determine the impact of omitting contralateral SBx on the surgical planning of patients undergoing RARP in terms of nerve-sparing surgery (NSS) and extended pelvic lymph node dissection (ePLND). Methods Case files from 80 men with biopsy-proven PCa were studied. All men had a unilateral suspicious lesion on MRI, and underwent TBx and bilateral SBx. Case files were presented to five urologists for the surgical planning of RARP. Each case file was presented randomly using two different sets of information: (1) results of TBx + bilateral SBx, and (2) results of TBx + ipsilateral SBx. The urologists assessed whether they would perform NSS and/or ePLND. Key findings and limitations A change in the surgical plan concerning NSS on the contralateral side was observed in 9.0% (95% confidence interval [CI] 6.4-12.2) of cases. Additionally, the indication for ePLND changed in 5.3% (95% CI 3.3-7.9) of cases. Interobserver agreement based on Fleiss' kappa changed from 0.44 to 0.15 for the indication of NSS and from 0.84 to 0.83 for the indication of ePLND. Conclusions and clinical implications In our series, the diagnostic information obtained from contralateral SBx has limited impact on the surgical planning of patients with a unilateral suspicious lesion on MRI scheduled to undergo RARP. Patient summary In patients with one-sided prostate cancer on magnetic resonance imaging, omitting biopsies on the other side rarely changed the surgical plan with respect to nerve-sparing surgery and the indication to perform extended lymph node dissection.
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Affiliation(s)
| | | | - Auke Jager
- Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
| | - Hans Veerman
- Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
| | - Marinus J. Hagens
- Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ivo G. Schoots
- Department of Radiology and Nuclear medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Arnoud W. Postema
- Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Robert J. Hoekstra
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
- Prosper Prostate Clinic, Nijmegen, The Netherlands
| | | | - Jakko A. Nieuwenhuijzen
- Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
| | - Pim J. van Leeuwen
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - André N. Vis
- Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Prostate Cancer Network Netherlands, Amsterdam, The Netherlands
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2
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Jager A, Postema AW, Mischi M, Wijkstra H, Beerlage HP, Oddens JR. Corrigendum to "Clinical Trial Protocol: Developing an Image Classification Algorithm for Prostate Cancer Diagnosis on Three-dimensional Multiparametric Transrectal Ultrasound" [Eur. Urol. Open Sci. 49 (2023) 32-43]. EUR UROL SUPPL 2023; 54:65. [PMID: 37397278 PMCID: PMC10314218 DOI: 10.1016/j.euros.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.euros.2022.12.018.].
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Affiliation(s)
- Auke Jager
- Amsterdam UMC location University of Amsterdam, Urology, Amsterdam, The Netherlands
| | - Arnoud W. Postema
- Amsterdam UMC location University of Amsterdam, Urology, Amsterdam, The Netherlands
| | - Massimo Mischi
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hessel Wijkstra
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Harrie P. Beerlage
- Amsterdam UMC location University of Amsterdam, Urology, Amsterdam, The Netherlands
| | - Jorg R. Oddens
- Amsterdam UMC location University of Amsterdam, Urology, Amsterdam, The Netherlands
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3
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Jager A, Postema AW, van der Linden H, Nooijen PTGA, Bekers E, Kweldam CF, Daures G, Zwart W, Mischi M, Beerlage HP, Oddens JR. Reliability of whole mount radical prostatectomy histopathology as the ground truth for artificial intelligence assisted prostate imaging. Virchows Arch 2023; 483:197-206. [PMID: 37407736 PMCID: PMC10412486 DOI: 10.1007/s00428-023-03589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
The development of artificial intelligence-based imaging techniques for prostate cancer (PCa) detection and diagnosis requires a reliable ground truth, which is generally based on histopathology from radical prostatectomy specimens. This study proposes a comprehensive protocol for the annotation of prostatectomy pathology slides. To evaluate the reliability of the protocol, interobserver variability was assessed between five pathologists, who annotated ten radical prostatectomy specimens consisting of 74 whole mount pathology slides. Interobserver variability was assessed for both the localization and grading of PCa. The results indicate excellent overall agreement on the localization of PCa (Gleason pattern ≥ 3) and clinically significant PCa (Gleason pattern ≥ 4), with Dice similarity coefficients (DSC) of 0.91 and 0.88, respectively. On a per-slide level, agreement for primary and secondary Gleason pattern was almost perfect and substantial, with Fleiss Kappa of .819 (95% CI .659-.980) and .726 (95% CI .573-.878), respectively. Agreement on International Society of Urological Pathology Grade Group was evaluated for the index lesions and showed agreement in 70% of cases, with a mean DSC of 0.92 for all index lesions. These findings show that a standardized protocol for prostatectomy pathology annotation provides reliable data on PCa localization and grading, with relatively high levels of interobserver agreement. More complicated tissue characterization, such as the presence of cribriform growth and intraductal carcinoma, remains a source of interobserver variability and should be treated with care when used in ground truth datasets.
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Affiliation(s)
- Auke Jager
- Amsterdam UMC, University of Amsterdam, Department of Urology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Arnoud W Postema
- Amsterdam UMC, University of Amsterdam, Department of Urology, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hans van der Linden
- Pathology DNA, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223, GZ, 's-Hertogenbosch, The Netherlands
| | - Peet T G A Nooijen
- Pathology DNA, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223, GZ, 's-Hertogenbosch, The Netherlands
| | - Elise Bekers
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Gautier Daures
- Angiogenesis Analytics, JADS Venture Campus, 's-Hertogenbosch, AA, The Netherlands
| | - Wim Zwart
- Angiogenesis Analytics, JADS Venture Campus, 's-Hertogenbosch, AA, The Netherlands
| | - M Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Harrie P Beerlage
- Amsterdam UMC, University of Amsterdam, Department of Urology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jorg R Oddens
- Amsterdam UMC, University of Amsterdam, Department of Urology, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Henderickx MMEL, Hendriks N, Baard J, Beerlage HP, Boom DT, Bosschieter J, Bouma-Houwert AC, Legemate JD, Nieuwenhuijzen JA, Postema AW, Rongen LH, Ronkes BL, Scheltema MJV, van der Sluis TM, Wagstaff PGK, Kamphuis GM. Is It the Load That Breaks You or the Way You Carry It: How Demanding Is Endourology? J Endourol 2023; 37:718-728. [PMID: 37029790 DOI: 10.1089/end.2022.0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Objective: Surgical outcomes are dependent on multiple factors. Besides patient-related or procedure-related factors, several surgeon-related factors contribute to surgical outcomes. The Surgery Task Load Index (SURG-TLX) questionnaire helps to assess the impact of several stressors on the perceived demands of surgeons during surgery. In this study, we evaluate the applicability of the SURG-TLX questionnaire for endourologic procedures and set a first point of reference. Materials and Methods: Between March and August 2022, 15 urologists and urology residents at a tertiary referral center for endourology completed the SURG-TLX questionnaire after endourologic procedures. After data acquisition, all participants were asked to evaluate the applicability of the questionnaire for endourologic procedures. Results: A total of 130 procedures were included between March and August 2022. Situational stress had the lowest median score (3.0/20; interquartile range [IQR] 2.0-7.0) and task complexity the highest (5.0/20; IQR 3.0-8.0). After weighing, the dimensions showed different proportions when compared with the nonweighted scores. Distractions received the highest score (15.0/100; IQR 7.5-32.8), temporal demands (6.0/100; IQR 3.0-12.5), and situational stress the lowest (6.0/100; IQR 2.0-21.0). This was caused by the higher weight that was attributed to distractions (3.4/5), as opposed to task complexity (2.6/5). In the questionnaire regarding applicability of the SURG-TLX, the overall satisfaction (6.0/10; IQR 5.0-7.0) and clarity (6.5/10; IQR 5.0-7.5) were moderate. The user-friendliness and applicability of the questionnaire were rated high (7.0/10; IQR 5.5-8.0 and 7.0/10; IQR 6.0-8.0, respectively) and task load (3.0/10; IQR 2.0-5.0) and time load (2.0/10; IQR 2.0-3.5) low. Conclusion: The SURG-TLX questionnaire is appropriate to assess the different dimensions of workload during endourologic procedures. Furthermore, the perceived workload during endourologic procedures is relatively low.
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Affiliation(s)
- Michaël M E L Henderickx
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Nora Hendriks
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Joyce Baard
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Harrie P Beerlage
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Daphne T Boom
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Judith Bosschieter
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - A Carolien Bouma-Houwert
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap D Legemate
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jakko A Nieuwenhuijzen
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W Postema
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lieske H Rongen
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Brechje L Ronkes
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs J V Scheltema
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Tim M van der Sluis
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Peter G K Wagstaff
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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5
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van Riel LA, Jager A, Meijer D, Postema AW, Smit RS, Vis AN, de Reijke TM, Beerlage HP, Oddens JR. Predictors of clinically significant prostate cancer in biopsy-naïve and prior negative biopsy men with a negative prostate MRI: improving MRI-based screening with a novel risk calculator. Ther Adv Urol 2022; 14:17562872221088536. [PMID: 35356754 PMCID: PMC8958520 DOI: 10.1177/17562872221088536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/03/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose: A pre-biopsy decision aid is needed to counsel men with a clinical suspicion for clinically significant prostate cancer (csPCa), despite normal prostate magnetic resonance imaging (MRI). Methods: A risk calculator (RC) for csPCa (International Society of Urological Pathology grade group (ISUP) ⩾ 2) presence in men with a negative-MRI (Prostate Imaging–Reporting and Data System (PI-RADS) ⩽ 2) was developed, and its performance was compared with RCs of the European Randomized Study of Screening for Prostate Cancer (ERSPC), Prostate Biopsy Collaborative Group (PBCG), and Prospective Loyola University mpMRI (PLUM). All biopsy-naïve and prior negative biopsy men with a negative-MRI followed by systematic prostate biopsy were included from October 2015 to September 2021. The RC was developed using multivariable logistic regression with the following parameters: age (years), family history of PCa (first- or second-degree family member), ancestry (African Caribbean/other), digital rectal exam (benign/malignant), MRI field strength (1.5/3.0 Tesla), prior negative biopsy status, and prostate-specific antigen (PSA) density (ng/ml/cc). Performance of RCs was compared using receiver operating characteristic (ROC) curve analysis. Results: A total of 232 men were included for analysis, of which 18.1% had csPCa. Parameters associated with csPCa were family history of PCa (p < 0.0001), African Caribbean ancestry (p = 0.005), PSA density (p = 0.002), prior negative biopsy (p = 0.06), and age at biopsy (p = 0.157). The area under the curve (AUC) of the developed RC was 0.76 (95% CI 0.68–0.85). This was significantly better than the RCs of the ERSPC (AUC: 0.59; p = 0.001) and PBCG (AUC: 0.60; p = 0.002), yet similar to PLUM (AUC: 0.69; p = 0.09). Conclusion: The developed RC (Prostate Biopsy Cohort Amsterdam (‘PROBA’ RC), integrated predictors for csPCa at prostate biopsy in negative-MRI men and outperformed other widely used RCs. These findings require external validation before introduction in daily practice.
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Affiliation(s)
- Luigi A.M.J.G. van Riel
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Auke Jager
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Dennie Meijer
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W. Postema
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth S. Smit
- Department of Radiology, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - André N. Vis
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo M. de Reijke
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Harrie P. Beerlage
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jorg R. Oddens
- Department of Urology, Prostate Cancer Network in the Netherlands, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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6
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Mannaerts CK, Engelbrecht MRW, Postema AW, van Kollenburg RAA, Hoeks CMA, Savci-Heijink CD, Van Sloun RJG, Wildeboer RR, De Reijke TM, Mischi M, Wijkstra H. Detection of clinically significant prostate cancer in biopsy-naïve men: direct comparison of systematic biopsy, multiparametric MRI- and contrast-ultrasound-dispersion imaging-targeted biopsy. BJU Int 2020; 126:481-493. [PMID: 32315112 DOI: 10.1111/bju.15093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare and evaluate a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) strategy, contrast-ultrasound-dispersion imaging (CUDI)-TBx strategy and systematic biopsy (SBx) strategy for the detection of clinically significant prostate cancer (csPCa) in biopsy-naïve men. PATIENTS AND METHODS A prospective, single-centre paired diagnostic study included 150 biopsy-naïve men, from November 2015 to November 2018. All men underwent pre-biopsy mpMRI and CUDI followed by a 12-core SBx taken by an operator blinded from the imaging results. Men with suspicious lesions on mpMRI and/or CUDI also underwent MRI-TRUS fusion-TBx and/or cognitive CUDI-TBx after SBx by a second operator. A non-inferiority analysis of the mpMRI- and CUDI-TBx strategies in comparison with SBx for International Society of Urological Pathology Grade Group [GG] ≥2 PCa in any core with a non-inferiority margin of 1 percentage point was performed. Additional analyses for GG ≥2 PCa with cribriform growth pattern and/or intraductal carcinoma (CR/IDC), and GG ≥3 PCa were performed. Differences in detection rates were tested using McNemar's test with adjusted Wald confidence intervals. RESULTS After enrolment of 150 men, an interim analysis was performed. Both the mpMRI- and CUDI-TBx strategies were inferior to SBx for GG ≥2 PCa detection and the study was stopped. SBx found significantly more GG ≥2 PCa: 39% (56/142), as compared with 29% (41/142) and 28% (40/142) for mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). SBx found significantly more GG = 1 PCa: 14% (20/142) compared to 1% (two of 142) and 3% (four of 142) with mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). Detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa did not differ significantly between the strategies. The mpMRI- and CUDI-TBx strategies were comparable in detection but the mpMRI-TBx strategy had less false-positive findings (18% vs 53%). CONCLUSIONS In our study in biopsy-naïve men, the mpMRI- and CUDI-TBx strategies had comparable PCa detection rates, but the mpMRI-TBX strategy had the least false-positive findings. Both strategies were inferior to SBx for the detection of GG ≥2 PCa, despite reduced detection of insignificant GG = 1 PCa. Both strategies did not significantly differ from SBx for the detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa.
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Affiliation(s)
- Christophe K Mannaerts
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc R W Engelbrecht
- Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W Postema
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob A A van Kollenburg
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline M A Hoeks
- Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Cemile Dilara Savci-Heijink
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud J G Van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rogier R Wildeboer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Theo M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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7
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van Sloun RJG, Wildeboer RR, Mannaerts CK, Postema AW, Gayet M, Beerlage HP, Salomon G, Wijkstra H, Mischi M. Deep Learning for Real-time, Automatic, and Scanner-adapted Prostate (Zone) Segmentation of Transrectal Ultrasound, for Example, Magnetic Resonance Imaging-transrectal Ultrasound Fusion Prostate Biopsy. Eur Urol Focus 2019; 7:78-85. [PMID: 31028016 DOI: 10.1016/j.euf.2019.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although recent advances in multiparametric magnetic resonance imaging (MRI) led to an increase in MRI-transrectal ultrasound (TRUS) fusion prostate biopsies, these are time consuming, laborious, and costly. Introduction of deep-learning approach would improve prostate segmentation. OBJECTIVE To exploit deep learning to perform automatic, real-time prostate (zone) segmentation on TRUS images from different scanners. DESIGN, SETTING, AND PARTICIPANTS Three datasets with TRUS images were collected at different institutions, using an iU22 (Philips Healthcare, Bothell, WA, USA), a Pro Focus 2202a (BK Medical), and an Aixplorer (SuperSonic Imagine, Aix-en-Provence, France) ultrasound scanner. The datasets contained 436 images from 181 men. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Manual delineations from an expert panel were used as ground truth. The (zonal) segmentation performance was evaluated in terms of the pixel-wise accuracy, Jaccard index, and Hausdorff distance. RESULTS AND LIMITATIONS The developed deep-learning approach was demonstrated to significantly improve prostate segmentation compared with a conventional automated technique, reaching median accuracy of 98% (95% confidence interval 95-99%), a Jaccard index of 0.93 (0.80-0.96), and a Hausdorff distance of 3.0 (1.3-8.7) mm. Zonal segmentation yielded pixel-wise accuracy of 97% (95-99%) and 98% (96-99%) for the peripheral and transition zones, respectively. Supervised domain adaptation resulted in retainment of high performance when applied to images from different ultrasound scanners (p > 0.05). Moreover, the algorithm's assessment of its own segmentation performance showed a strong correlation with the actual segmentation performance (Pearson's correlation 0.72, p < 0.001), indicating that possible incorrect segmentations can be identified swiftly. CONCLUSIONS Fusion-guided prostate biopsies, targeting suspicious lesions on MRI using TRUS are increasingly performed. The requirement for (semi)manual prostate delineation places a substantial burden on clinicians. Deep learning provides a means for fast and accurate (zonal) prostate segmentation of TRUS images that translates to different scanners. PATIENT SUMMARY Artificial intelligence for automatic delineation of the prostate on ultrasound was shown to be reliable and applicable to different scanners. This method can, for example, be applied to speed up, and possibly improve, guided prostate biopsies using magnetic resonance imaging-transrectal ultrasound fusion.
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Affiliation(s)
- Ruud J G van Sloun
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Rogier R Wildeboer
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Christophe K Mannaerts
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W Postema
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Maudy Gayet
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Harrie P Beerlage
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Georg Salomon
- Martini Klinik-Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Hessel Wijkstra
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Mischi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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8
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van Sloun RJG, Demi L, Schalk SG, Caresio C, Mannaerts C, Postema AW, Molinari F, van der Linden HC, Huang P, Wijkstra H, Mischi M. Contrast-enhanced ultrasound tractography for 3D vascular imaging of the prostate. Sci Rep 2018; 8:14640. [PMID: 30279545 PMCID: PMC6168586 DOI: 10.1038/s41598-018-32982-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/19/2018] [Indexed: 02/02/2023] Open
Abstract
Diffusion tensor tractography (DTT) enables visualization of fiber trajectories in soft tissue using magnetic resonance imaging. DTT exploits the anisotropic nature of water diffusion in fibrous structures to identify diffusion pathways by generating streamlines based on the principal diffusion vector. Anomalies in these pathways can be linked to neural deficits. In a different field, contrast-enhanced ultrasound is used to assess anomalies in blood flow with the aim of locating cancer-induced angiogenesis. Like water diffusion, blood flow and transport of contrast agents also shows a principal direction; however, this is now determined by the local vasculature. Here we show how the tractographic techniques developed for magnetic resonance imaging DTT can be translated to contrast-enhanced ultrasound, by first estimating contrast flow velocity fields from contrast-enhanced ultrasound acquisitions, and then applying tractography. We performed 4D in-vivo contrast-enhanced ultrasound of three human prostates, proving the feasibility of the proposed approach with clinically acquired datasets. By comparing the results to histopathology after prostate resection, we observed qualitative agreement between the contrast flow tracts and typical markers of cancer angiogenic microvasculature: higher densities and tortuous geometries in tumor areas. The method can be used in-vivo using a standard contrast-enhanced ultrasound protocol, opening up new possibilities in the area of vascular characterization for cancer diagnostics.
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Affiliation(s)
- Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Libertario Demi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Stefan G Schalk
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cristina Caresio
- Department of Electronics and Telecommunications, Biolab, Polytechnic University of Turin, Turin, Italy
| | - Christophe Mannaerts
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Filippo Molinari
- Department of Electronics and Telecommunications, Biolab, Polytechnic University of Turin, Turin, Italy
| | - Hans C van der Linden
- Department of Pathology/DNA laboratories, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Pingtong Huang
- Department of Ultrasound, Second Affiliated University Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
| | - Hessel Wijkstra
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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9
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Stoelinga B, Dooper AMC, Juffermans LJM, Postema AW, Wijkstra H, Brölmann HAM, Huirne JAF. Use of Contrast-Enhanced Ultrasound in the Assessment of Uterine Fibroids: A Feasibility Study. Ultrasound Med Biol 2018. [PMID: 29735316 DOI: 10.1016/j.ultrasmedbio] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is an innovative ultrasound technique capable of visualizing both the macro- and microvasculature of tissues. In this prospective pilot study, we evaluated the feasibility of using CEUS to visualize the microvasculature of uterine fibroids and compared CEUS with conventional ultrasound. Four women with fibroids underwent gray-scale ultrasound, sonoelastography and power/color Doppler scans followed by CEUS examination. Analysis of CEUS images revealed initial perfusion of the peripheral rim, that is, a pseudo-capsule, followed by enhancement of the entire lesion through vessels traveling from the exterior to the interior of the fibroid. The pseudo-capsules exhibited slight hyper-enhancement, making a clear delineation of the fibroids possible. The centers of three fibroids exhibited areas lacking vascularization, information not obtainable with the other imaging techniques. CEUS is a feasible technique for imaging and quantifying the microvasculature of fibroids. In comparison with conventional ultrasound imaging modalities, CEUS can provide additional diagnostic information based on the microvasculature.
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Affiliation(s)
- Barbara Stoelinga
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
| | - Anniek M C Dooper
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
| | - Lynda J M Juffermans
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands.
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands; Signal Processing Systems, Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
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10
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Stoelinga B, Dooper AMC, Juffermans LJM, Postema AW, Wijkstra H, Brölmann HAM, Huirne JAF. Use of Contrast-Enhanced Ultrasound in the Assessment of Uterine Fibroids: A Feasibility Study. Ultrasound Med Biol 2018; 44:1901-1909. [PMID: 29735316 DOI: 10.1016/j.ultrasmedbio.2018.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/23/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is an innovative ultrasound technique capable of visualizing both the macro- and microvasculature of tissues. In this prospective pilot study, we evaluated the feasibility of using CEUS to visualize the microvasculature of uterine fibroids and compared CEUS with conventional ultrasound. Four women with fibroids underwent gray-scale ultrasound, sonoelastography and power/color Doppler scans followed by CEUS examination. Analysis of CEUS images revealed initial perfusion of the peripheral rim, that is, a pseudo-capsule, followed by enhancement of the entire lesion through vessels traveling from the exterior to the interior of the fibroid. The pseudo-capsules exhibited slight hyper-enhancement, making a clear delineation of the fibroids possible. The centers of three fibroids exhibited areas lacking vascularization, information not obtainable with the other imaging techniques. CEUS is a feasible technique for imaging and quantifying the microvasculature of fibroids. In comparison with conventional ultrasound imaging modalities, CEUS can provide additional diagnostic information based on the microvasculature.
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Affiliation(s)
- Barbara Stoelinga
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
| | - Anniek M C Dooper
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
| | - Lynda J M Juffermans
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands.
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands; Signal Processing Systems, Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Vrie Universiteit Medical Center and Academic Medical Center, Amsterdam, The Netherlands
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11
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Scheltema MJ, Postema AW, de Bruin DM, Buijs M, Engelbrecht MR, Laguna MP, Wijkstra H, de Reijke TM, de la Rosette JJMCH. Irreversible electroporation for the treatment of localized prostate cancer: a summary of imaging findings and treatment feedback. Diagn Interv Radiol 2018; 23:365-370. [PMID: 28830850 DOI: 10.5152/dir.2017.16608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Imaging plays a crucial role in ablative therapies for prostate cancer (PCa). Irreversible electroporation (IRE) is a new treatment modality used for focal treatment of PCa. We aimed to demonstrate what imaging modalities can be used by descriptively reporting contrast-enhanced ultrasonography (CEUS), multiparametric magnetic resonance imaging (mpMRI), and grey-scale transrectal ultrasound (TRUS) results. Furthermore, we aimed to correlate quantitatively the ablation zone seen on mpMRI and CEUS with treatment planning to provide therapy feedback. METHODS Imaging data was obtained from two prospective multicenter trials on IRE for localized low- to intermediate-risk PCa. The ablation zone volume (AZV) seen on mpMRI and CEUS was 3D reconstructed to correlate with the planned AZV. RESULTS Descriptive examples are provided using mpMRI, TRUS, and CEUS for treatment planning and follow-up after IRE. The mean AZV on T2-weighted imaging 4 weeks following IRE was 12.9 cm3 (standard deviation [SD]=7.0), 5.3 times larger than the planned AZV. Linear regression showed a positive correlation (r=0.76, P = 0.002). For CEUS the mean AZV was 20.7 cm3 (SD=8.7), 8.5 times larger than the planned AZV with a strong positive correlation (r=0.93, P = 0.001). Prostate volume is reduced over time (mean= -27.5%, SD=11.9%) due to ablation zone fibrosis and deformation, illustrated by 3D reconstruction. CONCLUSION The role of imaging in conjunction with IRE is of crucial importance to guide clinicians throughout the treatment protocol. CEUS and mpMRI may provide essential treatment feedback by visualizing the ablation zone dimensions and volume.
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12
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Wildeboer RR, Postema AW, Demi L, Kuenen MPJ, Wijkstra H, Mischi M. Multiparametric dynamic contrast-enhanced ultrasound imaging of prostate cancer. Eur Radiol 2017; 27:3226-3234. [PMID: 28004162 PMCID: PMC5491563 DOI: 10.1007/s00330-016-4693-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study is to improve the accuracy of dynamic contrast-enhanced ultrasound (DCE-US) for prostate cancer (PCa) localization by means of a multiparametric approach. MATERIALS AND METHODS Thirteen different parameters related to either perfusion or dispersion were extracted pixel-by-pixel from 45 DCE-US recordings in 19 patients referred for radical prostatectomy. Multiparametric maps were retrospectively produced using a Gaussian mixture model algorithm. These were subsequently evaluated on their pixel-wise performance in classifying 43 benign and 42 malignant histopathologically confirmed regions of interest, using a prostate-based leave-one-out procedure. RESULTS The combination of the spatiotemporal correlation (r), mean transit time (μ), curve skewness (κ), and peak time (PT) yielded an accuracy of 81% ± 11%, which was higher than the best performing single parameters: r (73%), μ (72%), and wash-in time (72%). The negative predictive value increased to 83% ± 16% from 70%, 69% and 67%, respectively. Pixel inclusion based on the confidence level boosted these measures to 90% with half of the pixels excluded, but without disregarding any prostate or region. CONCLUSIONS Our results suggest multiparametric DCE-US analysis might be a useful diagnostic tool for PCa, possibly supporting future targeting of biopsies or therapy. Application in other types of cancer can also be foreseen. KEY POINTS • DCE-US can be used to extract both perfusion and dispersion-related parameters. • Multiparametric DCE-US performs better in detecting PCa than single-parametric DCE-US. • Multiparametric DCE-US might become a useful tool for PCa localization.
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Affiliation(s)
- Rogier R Wildeboer
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Libertario Demi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
| | | | - Hessel Wijkstra
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Massimo Mischi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
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13
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van Sloun RJG, Demi L, Postema AW, Jmch De La Rosette J, Wijkstra H, Mischi M. Entropy of Ultrasound-Contrast-Agent Velocity Fields for Angiogenesis Imaging in Prostate Cancer. IEEE Trans Med Imaging 2017; 36:826-837. [PMID: 28113929 DOI: 10.1109/tmi.2016.2629851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Prostate cancer care can benefit from accurate and cost-efficient imaging modalities that are able to reveal prognostic indicators for cancer. Angiogenesis is known to play a central role in the growth of tumors towards a metastatic or a lethal phenotype. With the aim of localizing angiogenic activity in a non-invasive manner, Dynamic Contrast Enhanced Ultrasound (DCE-US) has been widely used. Usually, the passage of ultrasound contrast agents thought the organ of interest is analyzed for the assessment of tissue perfusion. However, the heterogeneous nature of blood flow in angiogenic vasculature hampers the diagnostic effectiveness of perfusion parameters. In this regard, quantification of the heterogeneity of flow may provide a relevant additional feature for localizing angiogenesis. Statistics based on flow magnitude as well as its orientation can be exploited for this purpose. In this paper, we estimate the microbubble velocity fields from a standard bolus injection and provide a first statistical characterization by performing a spatial entropy analysis. By testing the method on 24 patients with biopsy-proven prostate cancer, we show that the proposed method can be applied effectively to clinically acquired DCE-US data. The method permits estimation of the in-plane flow vector fields and their local intricacy, and yields promising results (receiver-operating-characteristic curve area of 0.85) for the detection of prostate cancer.
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14
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Barr RG, Cosgrove D, Brock M, Cantisani V, Correas JM, Postema AW, Salomon G, Tsutsumi M, Xu HX, Dietrich CF. WFUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography: Part 5. Prostate. Ultrasound Med Biol 2017; 43:27-48. [PMID: 27567060 DOI: 10.1016/j.ultrasmedbio.2016.06.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced guidelines for the use of elastography techniques, including basic science, breast, liver and thyroid elastography. Here we present elastography in prostate diseases. For each available technique, procedure, reproducibility, results and limitations are analyzed and recommendations are given. Finally, recommendations are given based on the level of evidence of the published literature and on the WFUMB expert group's consensus. This document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of prostate diseases.
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Affiliation(s)
- Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - David Cosgrove
- Division of Radiology, Imperial and Kings Colleges, London, UK
| | - Marko Brock
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - Jean Michel Correas
- Department of Adult Radiology, Paris-Descartes University and Necker University Hospital, Paris; Institut Langevin, Inserm U979, Paris, France
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Georg Salomon
- Martini Klinik am Universitätsklinikum Hamburg, Eppendorf, Germany
| | - Masakazu Tsutsumi
- Department of Urology, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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15
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van Sloun RJG, Demi L, Postema AW, de la Rosette JJMCH, Wijkstra H, Mischi M. Ultrasound-contrast-agent dispersion and velocity imaging for prostate cancer localization. Med Image Anal 2017; 35:610-619. [DOI: 10.1016/j.media.2016.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/21/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
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16
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Scheltema MJ, Tay KJ, Postema AW, de Bruin DM, Feller J, Futterer JJ, George AK, Gupta RT, Kahmann F, Kastner C, Laguna MP, Natarajan S, Rais-Bahrami S, Rastinehad AR, de Reijke TM, Salomon G, Stone N, van Velthoven R, Villani R, Villers A, Walz J, Polascik TJ, de la Rosette JJMCH. Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project. World J Urol 2016; 35:695-701. [PMID: 27637908 PMCID: PMC5397427 DOI: 10.1007/s00345-016-1932-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT). Methods An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results. Results mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers. Conclusions The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1932-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J Scheltema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
| | - K J Tay
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A W Postema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - J Feller
- Desert Medical Imaging, Indian Wells, CA, USA
| | - J J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - R T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel and Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cambridge University Hospitals Trust, Cambridge, UK
| | - M P Laguna
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Natarajan
- Department of Urology, Surgery and Bioengineering, University of California, Los Angeles, CA, USA
| | - S Rais-Bahrami
- Department of Urology and Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - A R Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T M de Reijke
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - N Stone
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R van Velthoven
- Department of Urology, Institut Jules Bordet, Brussels, Belgium
| | - R Villani
- Department of Radiology, North Shore University Hospital, Northwell Health, NY, USA
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - T J Polascik
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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17
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Postema AW, Catellani M, Scheltema MJV, van den Bos W, de la Rosette JJMCH. Surveillance following Focal Therapy interventions. ARCH ESP UROL 2016; 69:364-374. [PMID: 27416640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Focal therapy (FT) is a tissuesparing treatment paradigm for localized prostate cancer (PCa) with the potential to improve functional outcomes while maintaining oncologic safety. This paper aims to provide an overview of important considerations and practical recommendations relating to the follow-up after FT. METHODS Literature review of papers related to FT in PCa derived from Medline/Pubmed database. RESULTS The recommended minimum follow-up period after FT is 5 years. Standard history taking should include: signs of disease progression, treatment-related complications and psychological aspects. Oncological outcome is based on serial prostate specific antigen monitoring, follow-up imaging (most commonly with multiparametric magnetic resonance imaging) and repeat biopsies (systematic from entire gland or targeted from treated zone). Significant PCa has been found at biopsy in up to 17% of patients after FT. Functional outcomes are evaluated using standardized questionnaires that relate to urinary function, erectile function and quality of life. A systematic review reports urinary continence in 83-100% of patients, erections sufficient for penetration in 54-100%. Outcomes differ between ablative energies and treatment templates. The most common side effects after FT are urinary retention (0-17%), urinary tract infection (UTI) (0-17%) and urinary stricture (0-5%). Rectal fistula is a rare complication occurring in up to 0.1-2% of patients. Clavien-Dindo Grade 3-4 complications are reported in 0-4% of patients. Type and rate vary with treatment modality. Complications should be reported using standardized reporting systems. Most data on FT outcomes come from small heterogeneous trials. Pooling of standardized data is necessary to advance the field of FT. CONCLUSION Stringent follow-up after FT is required to confirm oncologic safety of the individual patient. Standardized data gathering and data pooling is necessary to evaluate whether FT can live up to its promise of improving functional outcomes while maintaining oncological safety.
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Affiliation(s)
- A W Postema
- Department of Urology. AMC University Hospital. Amsterdam. The Netherlands
| | - M Catellani
- Department of Urology. AMC University Hospital. Amsterdam. The Netherlands. Department of Urology. San Paolo Teaching Hospital. Milan. Italy
| | - M J V Scheltema
- Department of Urology. AMC University Hospital. Amsterdam. The Netherlands
| | - W van den Bos
- Department of Urology. AMC University Hospital. Amsterdam. The Netherlands
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18
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Scheltema MJV, van den Bos W, Wagstaff PGK, Postema AW, de Bruin DM, Laguna Pes MP, de la Rosette JJMCH. Irreversible electroporation, a new modality in Focal Therapy for prostate cancer. ARCH ESP UROL 2016; 69:337-344. [PMID: 27416637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The extensive use of prostate-specific antigen (PSA) testing and improved imaging technologies have resulted in an increased diagnosis of prostate cancer. Early diagnosis is often accompanied by an increased number of localized (i.e. unifocal or unilateral), small-volume and low-grade prostate cancers. Focal therapy is an emerging treatment option in prostate cancer, targeting individual cancer areas while sparing important functional and anatomical urological structures. Irreversible electroporation is an innovative treatment modality in focal therapy based on the process of cell membrane electroporation limiting damage to adjacent tissue and vital structures. The first phase I-II trials in humans have shown the safety of IRE for focal ablative therapy of prostate cancer and showed encouraging results considering functional preservation. Histological analysis after IRE showed fibrosis without glandular ducts and necrotic tissue with sharp demarcation between unaffected prostatic glandular tissue and the ablation zone. Short-term oncological results are promising; however more data on long-term oncological outcomes are necessary. New studies with IRE and other focal treatment modalities are initiated to explore opportunities for focal therapy in prostate cancer and to optimize current treatment protocols.
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Affiliation(s)
- M J V Scheltema
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - W van den Bos
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - P G K Wagstaff
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - A W Postema
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands. Department of Biomedical Engineering and Physics, AMC University Hospital, Amsterdam, The Netherlands
| | - M P Laguna Pes
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
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19
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van den Bos W, de Bruin DM, van Randen A, Engelbrecht MRW, Postema AW, Muller BG, Varkarakis IM, Skolarikos A, Savci-Heijink CD, Jurhill RR, Zondervan PJ, Laguna Pes MP, Wijkstra H, de Reijke TM, de la Rosette JJMCH. MRI and contrast-enhanced ultrasound imaging for evaluation of focal irreversible electroporation treatment: results from a phase I-II study in patients undergoing IRE followed by radical prostatectomy. Eur Radiol 2016; 26:2252-60. [PMID: 26449559 PMCID: PMC4902838 DOI: 10.1007/s00330-015-4042-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/15/2015] [Accepted: 09/21/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Irreversible electroporation (IRE) is an ablative therapy with a low side-effect profile in prostate cancer. The objective was: 1) To compare the volumetric IRE ablation zone on grey-scale transrectal ultrasound (TRUS), contrast-enhanced ultrasound (CEUS) and multiparametric MRI (mpMRI) with histopathology findings; 2) To determine a reliable imaging modality to visualize the IRE ablation effects accurately. METHODS A prospective phase I-II study was performed in 16 patients scheduled for radical prostatectomy (RP). IRE of the prostate was performed 4 weeks before RP. Prior to, and 4 weeks after the IRE treatment, imaging was performed by TRUS, CEUS, and mpMRI. 3D-analysis of the ablation volumes on imaging and on H&E-stained whole-mount sections was performed. The volumes were compared and the correlation was calculated. RESULTS Evaluation of the imaging demonstrated that with T2-weighted MRI, dynamic contrast enhanced (DCE) MRI, and CEUS, effects of IRE are visible. T2MRI and CEUS closely match the volumes on histopathology (Pearson correlation r = 0.88 resp. 0.80). However, IRE is not visible with TRUS. CONCLUSIONS mpMRI and CEUS are appropriate for assessing IRE effects and are the most feasible imaging modalities to visualize IRE ablation zone. The imaging is concordant with results of histopathological examination. KEY POINTS • mpMRI and contrast-enhanced ultrasound are appropriate imaging modalities for assessing IRE effects • mpMRI and CEUS are the most feasible imaging modalities to visualize IRE ablation zone • The imaging is concordant with results of histopathological examination after IRE • Grey-scale US is insufficient for assessing IRE ablations.
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Affiliation(s)
- Willemien van den Bos
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - D M de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A van Randen
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M R W Engelbrecht
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A W Postema
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - B G Muller
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - I M Varkarakis
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, 1 Sismanogliou Street, 151 26, Marousi, Greece
| | - A Skolarikos
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, 1 Sismanogliou Street, 151 26, Marousi, Greece
| | - C D Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R R Jurhill
- Department of Pathology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P J Zondervan
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M P Laguna Pes
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - H Wijkstra
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - T M de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J M C H de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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20
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Schalk SG, Demi L, Bouhouch N, Kuenen MPJ, Postema AW, de la Rosette JJMCH, Wijkstra H, Tjalkens TJ, Mischi M. Contrast-Enhanced Ultrasound Angiogenesis Imaging by Mutual Information Analysis for Prostate Cancer Localization. IEEE Trans Biomed Eng 2016; 64:661-670. [PMID: 28113214 DOI: 10.1109/tbme.2016.2571624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The role of angiogenesis in cancer growth has stimulated research aimed at noninvasive cancer detection by blood perfusion imaging. Recently, contrast ultrasound dispersion imaging was proposed as an alternative method for angiogenesis imaging. After the intravenous injection of an ultrasound-contrast-agent bolus, dispersion can be indirectly estimated from the local similarity between neighboring time-intensity curves (TICs) measured by ultrasound imaging. Up until now, only linear similarity measures have been investigated. Motivated by the promising results of this approach in prostate cancer (PCa), we developed a novel dispersion estimation method based on mutual information, thus including nonlinear similarity, to further improve its ability to localize PCa. METHODS First, a simulation study was performed to establish the theoretical link between dispersion and mutual information. Next, the method's ability to localize PCa was validated in vivo in 23 patients (58 datasets) referred for radical prostatectomy by comparison with histology. RESULTS A monotonic relationship between dispersion and mutual information was demonstrated. The in vivo study resulted in a receiver operating characteristic (ROC) curve area equal to 0.77, which was superior (p = 0.21-0.24) to that obtained by linear similarity measures (0.74-0.75) and (p <; 0.05) to that by conventional perfusion parameters (≤0.70). CONCLUSION Mutual information between neighboring time-intensity curves can be used to indirectly estimate contrast dispersion and can lead to more accurate PCa localization. SIGNIFICANCE An improved PCa localization method can possibly lead to better grading and staging of tumors, and support focal-treatment guidance. Moreover, future employment of the method in other types of angiogenic cancer can be considered.
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21
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Postema AW, De Reijke TM, Ukimura O, Van den Bos W, Azzouzi AR, Barret E, Baumunk D, Blana A, Bossi A, Brausi M, Coleman JA, Crouzet S, Dominguez-Escrig J, Eggener S, Ganzer R, Ghai S, Gill IS, Gupta RT, Henkel TO, Hohenfellner M, Jones JS, Kahmann F, Kastner C, Köhrmann KU, Kovacs G, Miano R, van Moorselaar RJ, Mottet N, Osorio L, Pieters BR, Polascik TJ, Rastinehad AR, Salomon G, Sanchez-Salas R, Schostak M, Sentker L, Tay KJ, Varkarakis IM, Villers A, Walz J, De la Rosette JJ. Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project. World J Urol 2016; 34:1373-82. [PMID: 26892160 PMCID: PMC5026990 DOI: 10.1007/s00345-016-1782-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.
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Affiliation(s)
- A W Postema
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands.
| | - T M De Reijke
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - O Ukimura
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - W Van den Bos
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - A R Azzouzi
- Department of Urology, Angers University Hospital, Angers, France
| | - E Barret
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - D Baumunk
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - A Blana
- Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Brausi
- Department of Urology, Ospedale Civile Ramazzini, Carpi, Italy
| | - J A Coleman
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - S Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - J Dominguez-Escrig
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - R Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - S Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - I S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R T Gupta
- Departments of Radiology, Duke University Medical Center, Durham, NC, USA
| | - T O Henkel
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - M Hohenfellner
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - J S Jones
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cancer Directorate, Cambridge University Hospitals Trust, Cambridge, UK
| | - K U Köhrmann
- Department of Urology, Theresien Krankenhaus Mannheim, Mannheim, Germany
| | - G Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany
| | - R Miano
- Division of Urology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - R J van Moorselaar
- Department of Urology, Free University Medical Centre, Amsterdam, The Netherlands
| | - N Mottet
- Department of Urology, University Hospital St Etienne, Saint-Étienne, France
| | - L Osorio
- Department of Urology, Porto Hospital Centre, Porto, Portugal
| | - B R Pieters
- Departments of Radiation Oncology, AMC University Hospital, Amsterdam, The Netherlands
| | - T J Polascik
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A R Rastinehad
- Department of Urology, Hofstra North Shore-Lij, Hofstra University, Hempstead, NY, USA
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - R Sanchez-Salas
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - M Schostak
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - L Sentker
- Urologische Gemeinschaftspraxis, Sinsheim, Germany
| | - K J Tay
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - I M Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - J J De la Rosette
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
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22
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Postema AW, Frinking PJA, Smeenge M, De Reijke TM, De la Rosette JJMCH, Tranquart F, Wijkstra H. Dynamic contrast-enhanced ultrasound parametric imaging for the detection of prostate cancer. BJU Int 2015; 117:598-603. [PMID: 25754526 DOI: 10.1111/bju.13116] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the value of dynamic contrast-enhanced (DCE)-ultrasonography (US) and software-generated parametric maps in predicting biopsy outcome and their potential to reduce the amount of negative biopsy cores. MATERIALS AND METHODS For 651 prostate biopsy locations (82 consecutive patients) we correlated the interpretation of DCE-US recordings with and without parametric maps with biopsy results. The parametric maps were generated by software which extracts perfusion parameters that differentiate benign from malignant tissue from DCE-US recordings. We performed a stringent analysis (all tumours) and a clinical analysis (clinically significant tumours). We calculated the potential reduction in biopsies (benign on imaging) and the resultant missed positive biopsies (false-negatives). Additionally, we evaluated the performance in terms of sensitivity, specificity negative predictive value (NPV) and positive predictive value (PPV) on a per-prostate level. RESULTS Based on DCE-US, 470/651 (72.2%) of biopsy locations appeared benign, resulting in 40 false-negatives (8.5%), considering clinically significant tumours only. Including parametric maps, 411/651 (63.1%) of the biopsy locations appeared benign, resulting in 23 false-negatives (5.6%). In the per-prostate clinical analysis, DCE-US classified 38/82 prostates as benign, missing eight diagnoses. Including parametric maps, 31/82 prostates appeared benign, missing three diagnoses. Sensitivity, specificity, PPV and NPV were 73, 58, 50 and 79%, respectively, for DCE-US alone and 91, 56, 57 and 90%, respectively, with parametric maps. CONCLUSION The interpretation of DCE-US with parametric maps allows good prediction of biopsy outcome. A two-thirds reduction in biopsy cores seems feasible with only a modest decrease in cancer diagnosis.
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Affiliation(s)
- Arnoud W Postema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Martijn Smeenge
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - Theo M De Reijke
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Hessel Wijkstra
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
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23
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Mischi M, Demi L, Smeenge M, Kuenen MPJ, Postema AW, de la Rosette JJMCH, Wijkstra H. Transabdominal contrast-enhanced ultrasound imaging of the prostate. Ultrasound Med Biol 2015; 41:1112-1118. [PMID: 25701535 DOI: 10.1016/j.ultrasmedbio.2014.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/22/2014] [Accepted: 10/24/2014] [Indexed: 06/04/2023]
Abstract
Numerous age-related pathologies affect the prostate gland, the most menacing of which is prostate cancer (PCa). The diagnostic tools for prostate investigation are invasive, requiring biopsies when PCa is suspected. Novel dynamic contrast-enhanced ultrasound (DCE-US) imaging approaches have been proposed recently and appear promising for minimally invasive localization of PCa. Ultrasound imaging of the prostate is traditionally performed with a transrectal probe because the location of the prostate allows for high-resolution images using high-frequency transducers. However, DCE-US imaging requires lower frequencies to induce bubble resonance and, thus, improve contrast-to-tissue ratio. For this reason, in this study we investigate the feasibility of quantitative DCE-US imaging of the prostate via the abdomen. The study included 10 patients (age = 60.7 ± 5.7 y) referred for a needle biopsy study. After having given informed consent, patients underwent DCE-US with both transabdominal and transrectal probes. Time-intensity contrast curves were derived using both approaches and their model-fit quality was compared. Although further improvements are expected by optimization of the transabdominal settings, the results of transabdominal and transrectal DCE-US are closely comparable, confirming the feasibility of transabdominal DCE-US; transabdominal curve fitting revealed an average determination coefficient r(2) = 0.91 (r(2) > 0.75 for 78.6% of all prostate pixels) compared with r(2) = 0.91 (r(2) > 0.75 for 81.6% of all prostate pixels) by the transrectal approach. Replacing the transrectal approach with more acceptable transabdominal scanning for prostate investigation is feasible. This approach would improve patient comfort and represent a useful option for PCa localization and monitoring.
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Affiliation(s)
- Massimo Mischi
- Electrical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Libertario Demi
- Electrical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn Smeenge
- Urology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten P J Kuenen
- Electrical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands; Urology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud W Postema
- Urology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Hessel Wijkstra
- Electrical Engineering Department, Eindhoven University of Technology, Eindhoven, The Netherlands; Urology Department, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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