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Ricci C, Ambrosi F, Franceschini T, Giunchi F, Grillini A, Franchini E, Grillini M, Schiavina R, Massari F, Mollica V, Tateo V, Bianchi FM, Bianchi L, Droghetti M, Maloberti T, Tallini G, Colecchia M, Acosta AM, Lobo J, Trpkov K, Fiorentino M, de Biase D. Evaluation of an institutional series of low-grade oncocytic tumor (LOT) of the kidney and review of the mutational landscape of LOT. Virchows Arch 2023; 483:687-698. [PMID: 37845471 PMCID: PMC10673759 DOI: 10.1007/s00428-023-03673-9] [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: 07/31/2023] [Revised: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
The 2022 WHO classification of urinary and male genital tumors introduced several novel kidney entities exhibiting eosinophilic/oncocytic features with specific mutational backgrounds. Thus, molecular techniques, such as next-generation sequencing (NGS), became more commonly used for their evaluation. We studied 12 low-grade oncocytic tumors (LOT) of the kidney (from 11 patients), identified in a cohort of 210 eosinophilic/oncocytic renal tumors, diagnosed in our institution between October 2019 and May 2023, which represented 5.7% (12/210) of all eosinophilic/oncocytic renal tumors during this period. We reviewed their clinicopathologic, histologic, and immunohistochemical features, as well as their mutational profiles. We also reviewed the literature on NGS-derived data of LOT, by selecting papers in which LOT diagnosis was rendered according to the criteria proposed initially. Median age was 65 years (mean: 63.5; range 43-79) and median tumor size was 2.0 cm (mean: 2.2; range: 0.9-3.1). All tumors were positive for PAX8, CK7, and GATA3, and negative or focally positive for CD117/KIT. We found the following gene mutations: MTOR ((6/11), 54.5%)), TSC1 ((2/11), 18.2%)), and 1 had both NOTCH1 and NOTCH4 ((1/11), 9.1%)). Wild-type status was found in 2/11 (18.2%) patients and one tumor was not analyzable. A review of 8 previous studies that included 79 LOTs revealed frequent mutations in the genes that regulate the mammalian target of rapamycin (mTOR) pathway: MTOR (32/79 (40.5%)), TSC1 (21/79 (26.6%)), and TSC2 (9/79 (11.4%)). Other mutated genes included PIK3CA, NF2, and PTEN, not typically known to affect the mTOR pathway, but potentially acting as upstream and downstream effectors. Our study shows that LOT is increasingly diagnosed in routine practice when applying the appropriate diagnostic criteria. We also confirm that the mTOR pathway is strongly implicated in the pathogenesis of this tumor mainly through MTOR, TCS1, and TSC2 mutations, but other genes could also be involved in the pathway activation, especially in LOTs without "canonical" mutations.
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Affiliation(s)
- Costantino Ricci
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Francesca Ambrosi
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | | | - Francesca Giunchi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | | | - Marco Grillini
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Massari
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Veronica Mollica
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Valentina Tateo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Lorenzo Bianchi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Thais Maloberti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Maurizio Colecchia
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andres Martin Acosta
- Department of Pathology, Indiana University School of Medicine, Indianapolis, USA
| | - João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), Porto, Portugal
- Cancer Biology and Epigenetics Group, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (P.CCC), Research Center of IPO Porto (GEBC CI-IPOP)/RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Department of Pathology and Molecular Immunology, ICBAS-School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, Canada
| | - Michelangelo Fiorentino
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
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Ricci C, Ambrosi F, Franceschini T, Giunchi F, Di Filippo G, Franchini E, Massari F, Mollica V, Tateo V, Bianchi FM, Colecchia M, Acosta AM, Fiorentino M. FoxA2 is a reliable marker for the diagnosis of yolk sac tumour postpubertal-type. Histopathology 2023; 83:465-476. [PMID: 37317674 DOI: 10.1111/his.14968] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 02/27/2023] [Revised: 04/17/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
AIMS Yolk sac tumour postpubertal-type (YSTpt) shows a wide range of histological patterns and is challenging to diagnose. Recently, forkhead box transcription factor A2 (FoxA2) emerged as a driver of YSTpt formation and a promising marker for diagnosing YSTpt. However, FoxA2 has not been tested in the different patterns of YSTpt. This study aimed to assess the staining pattern of FoxA2 in te different patterns of YSTpt and other germ cell tumours of the testis (GCTT), comparing it with glypican-3 (GPC3) and α-fetoprotein (AFP). METHODS AND RESULTS FOXA2, GPC3 and AFP immunohistochemistry was performed on 24 YSTpt (24 microcystic/reticular, 10 myxoid, two macrocystic, five glandular/alveolar, two endodermal sinus/perivascular, four solid, two polyembryoma/embryoid body and two polyvesicular vitelline) and 81 other GCTT. The percentage of positive cells (0, 1+, 2+, 3+) and the intensity (0, 1, 2, 3) were evaluated regardless of and within each YSTpt pattern. FoxA2 was positive in all YSTpt (24 of 24) and all but one (23 of 24) exhibited 2+/3+ stain, with higher intensity [median value (mv): 2.6] than AFP (1.8) and GPC3 (2.5). Both FoxA2 and GPC3 were positive in all microcystic/reticular (24 of 24), myxoid (10 of 10), macrocystic (two of two), endodermal sinus/perivascular (four of four) and polyembryoma/embryoid body (two of two) patterns. Nevertheless, only FoxA2 was positive in all glandular/alveolar (five of five), solid (four of four) and polyvesicular vitelline (two of two) patterns. The intensity of FoxA2 was higher than AFP and GPC3 in almost all YST patterns. In the other GCTT, FoxA2 was positive only in teratoma postpubertal-type (Tpt) [13 of 20 (65%)], with staining almost exclusively confined to the mature gastrointestinal/respiratory tract epithelium. CONCLUSIONS FoxA2 is a highly sensitive and specific biomarker that supports the diagnosis of YSTpt. FoxA2 is superior to GPC3 and AFP, especially in rare and difficult-to-diagnose histological patterns of YSTpt, but mature glands of Tpt could represent a potential diagnostic pitfall.
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Affiliation(s)
- Costantino Ricci
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesca Ambrosi
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Francesca Giunchi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Francesco Massari
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Veronica Mollica
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Tateo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Maurizio Colecchia
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andres Martin Acosta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelangelo Fiorentino
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Melotti S, Ambrosi F, Franceschini T, Giunchi F, Filippo GD, Franchini E, Massari F, Mollica V, Tateo V, Bianchi FM, Colecchia M, Acosta AM, Lobo J, Fiorentino M, Ricci C. TAMs PD-L1(+) in the reprogramming of germ cell tumors of the testis. Pathol Res Pract 2023; 247:154540. [PMID: 37209574 DOI: 10.1016/j.prp.2023.154540] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND In recent years, several studies focused on the process of reprogramming of seminoma (S) cells, which regulates the transition from pure S (P-S) to S component (S-C) of mixed germ cell tumors of the testis (GCTT) and finally to embryonal carcinoma (EC) and other nonseminomatous GCTT (NS-GCTT). The accepted pathogenetic model is driven and regulated by cells (macrophages, B- and T-lymphocytes) and molecules of the tumor microenvironment (TME). Herein, we tested a series of GCTT with double staining (DS) for CD68-PD-L1 to evaluate tumor-associated macrophages (TAMs) expressing programmed death-ligand 1 (PD-L1) [TAMs PD-L1(+)] and clarify if these cells may be involved in establishing the fate of GCTT. METHODS We collected 45 GCTT (comprising a total of 62 different components of GCTT). TAMs PD-L1(+) were evaluated with three different scoring systems [TAMs PD-L1(+)/mm2, TAMs PD-L1(+)/mm2H-score, TAMs PD-L1(+) %], and compared using pertinent statistic tests (Student's t-test and Mann-Whitney U test). RESULTS We found that TAMs PD-L1(+) values were higher in S rather than EC (p = 0.001, p = 0.015, p = 0.022) and NS-GCTT (p < 0.001). P-S showed statistically significant differences in TAMs PD-L1(+) values compared to S-C (p < 0.001, p = 0.006, p = 0.015), but there were no differences between S-C and EC (p = 0.107, p = 0.408, p = 0.800). Finally, we found statistically significant differences also in TAMs PD-L1(+) values between EC and other NS-GCTT (p < 0.001). CONCLUSIONS TAMs PD-L1(+) levels gradually decrease during the reprogramming of S cells {P-S [(high values of TAMs PD-L1(+)] → S-C and EC [(intermediate values of TAMs PD-L1(+)] → other NS-GCTT [(low values of TAMs PD-L1(+)], supporting a complex pathogenetic model where the interactions between tumor cells and TME components [and specifically TAMs PD-L1(+)] play a key role in determining the fate of GCTT.
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Affiliation(s)
- Sofia Melotti
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesca Ambrosi
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Francesca Giunchi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Francesco Massari
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Veronica Mollica
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Tateo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Maurizio Colecchia
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andres Martin Acosta
- Department of Pathology, Indiana University School of Medicine, Indianapolis, USA
| | - João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), Porto, Portugal; Cancer Biology and Epigenetics Group, Research Center of IPO Porto (GEBC CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center (P.CCC), Porto, Portugal; Department of Pathology and Molecular Immunology, ICBAS-School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - Michelangelo Fiorentino
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| | - Costantino Ricci
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Ricci C, Ambrosi F, Franceschini T, Giunchi F, Maracci ME, Sirolli M, Orsatti A, Chiarucci F, Franchini E, Borsato M, Massari F, Mollica V, Bianchi FM, Colecchia M, Acosta AM, Fiorentino M. H&E and OCT4/CD34 for the assessment of lympho-vascular invasion in seminoma and embryonal carcinoma. Pathol Res Pract 2023; 242:154337. [PMID: 36706585 DOI: 10.1016/j.prp.2023.154337] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Lymphovascular invasion (LVI) is a relevant prognostic factor in germ cell tumors of the testis (GCTT), and it is included in the pT stage. However, its detection on hematoxylin and eosin (H&E) slides is very challenging, and previous studies reported fair to moderate inter-observer agreement among dedicated uropathologists. In the present study, we tested H&E and a recently developed in-house double staining for OCT4/CD34 to detect LVI in GCTT. METHODS Nine authors [5 non-uropathologists and 4 uropathologists] independently evaluated 34 consecutive and retrospectively enrolled cases of GCTT. We assessed the inter-observer agreement (Fleiss's Kappa) with both H&E and OCT4/CD34. Besides, we compared the consensus diagnosis on both H&E and OCT4/CD34-stained sections with the original diagnosis to evaluate the pT re-staging (McNemar test) and identify the sources of disagreement. RESULTS The inter-observer agreement among uropathologists plus non-uropathologists was fair with both H&E (KF=0.398; p < 0.001) and OCT4/CD34 (KF=0.312; p < 0.001). OCT4/CD34 (KF=0.290; p < 0.001) slightly reduces the inter-observer agreement compared to H&E (KF=0.321; p < 0.001) for non-uropathologists; in contrast, OCT4/CD34 (KF=0.293; p < 0.001) significantly reduces the inter-observer agreement compared to H&E (KF=0.529; p < 0.001) for uropathologists, changing it from moderate to fair. Consensus diagnosis with H&E modified the LVI status of the original diagnosis in 8/34 (23.5 %) cases (p: 0.070), with pT re-staging in 2/34 (5.9 %) cases (p: 0.500). Consensus diagnosis with OCT4/CD34 modified the LVI status of the original diagnosis in 8/34 (23.5 %) cases (p: 0.289), with pT re-staging in 3/34 (8.8 %) cases (p: 0.250). The consensus diagnosis with OCT4/CD34 modified the consensus diagnosis with H&E in 8/34 (23.5 %) cases (p: 0.727), and these findings resulted in pT-restaging in 3/34 (8.8 %) cases (p: 0.500). The sources of disagreement among uropathologists were: H&E [artefactual clefts misinterpreted as LVI in 4/6 (66.7 %) cases and true foci of LVI misinterpreted as clusters of histiocytes within the vessels in 2/6 (33.3 %) cases], OCT4/CD34 [artefactual clefts misinterpreted as LVI in 2/8 (25 %) cases, true LVI misinterpreted as artefactual clefts in 2/8 (25 %) cases or floaters in 4/8 (50 %) cases]. CONCLUSIONS OCT4/CD34 does not improve the inter-observer agreement for the assessment of LVI in OCT4(+) GCTT. Consensus diagnosis with H&E modifies the LVI status in a significant number of cases, resulting in changes of the pT stage in a relatively small subgroup. Consensus diagnosis with OCT4/CD34 provides little additional benefit since it cannot exclude mimickers of LVI such as floaters and artefactual clefts. These results argue against the adoption of this diagnostic tool for the routine assessment of OCT4(+) GCTT.
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Affiliation(s)
- Costantino Ricci
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Francesca Ambrosi
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | | | - Francesca Giunchi
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Maria Sirolli
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Agnese Orsatti
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Matteo Borsato
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy
| | - Francesco Massari
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Veronica Mollica
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Maurizio Colecchia
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andres Martin Acosta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Michelangelo Fiorentino
- Pathology Unit, Maggiore Hospital-AUSL Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
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Di Sciascio L, Ambrosi F, Franceschini T, Giunchi F, Franchini E, Massari F, Bianchi FM, Colecchia M, Fiorentino M, Ricci C. Could double stain for p53/CK20 be a useful diagnostic tool for the appropriate classification of flat urothelial lesions? Pathol Res Pract 2022; 234:153937. [DOI: 10.1016/j.prp.2022.153937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Bianchi L, Mineo Bianchi F, Chessa F, Barbaresi U, Casablanca C, Piazza P, Mottaran A, Droghetti M, Roveroni C, Balestrazzi E, Gentile G, Gaudiano C, Bertaccini A, Marcelli E, Porreca A, DE Concilio B, Serra C, Celia A, Brunocilla E, Schiavina R. Percutaneous tumor ablation versus partial nephrectomy for small renal mass: the impact of histologic variant and tumor size. Minerva Urol Nephrol 2020; 73:581-590. [PMID: 33256358 DOI: 10.23736/s2724-6051.20.03983-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim, of this study was to investigate recurrence rates in patients with T1 renal cell carcinoma (RCC) undergone partial nephrectomy (PN), radiofrequency ablation (RFA) or cryoablation (Cryo). METHODS We retrospectively evaluated data from 665 (81.4%), 68 (8.3%) and 83 (10.3%) patients who underwent PN, RFA and Cryo, respectively. Kaplan-Meier curves depict recurrence-free survival (RFS) rates in the overall population and after stratifying according to tumor's histology (namely, clear cell RCC and non-clear RCC) and size (namely <2 cm and 2-4 cm). Multivariable Cox regression model was used to identify predictors of recurrence. Cumulative-incidence plots evaluated disease recurrence and other causes of mortality (OCM). RESULTS Patients referred to PN experienced higher RFS rate compared to those treated with RFA and Cryo at 60-month in the overall population (96.4% vs. 79.4% vs. 87.8%), in patients with clear cell RCC (93.3% vs. 75% vs. 80.4%) and in those with tumor of 2-4 cm (97.3% vs. 78% and 84.4%; all P≤0.01). In patients with non-clear cell RCC and with tumor <2cm, PN showed higher RFS rate at 60-month as compared to RFA (97.9% vs. 84.4% and 95.1% vs. 78.1%, respectively: all P≤0.02). At multi-variate analysis, ablative techniques (RFA [HR=4.03] and Cryo [HR=3.86]) were independent predictors of recurrence (all P<0.03). At competing risks analysis, recurrence rate and OCM were 7.3% and 1.3% vs. 25% and 7.2% vs. 19.9% and 19.9% for PN, RFA and Cryo, respectively. CONCLUSIONS PN and Cryo showed similar RFS rates in patients with non-clear cell RCC and with renal mass <2cm.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy - .,University of Bologna, Bologna, Italy -
| | - Federico Mineo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Roveroni
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giorgio Gentile
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Angelo Porreca
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
| | | | - Carla Serra
- Unit of Interventional Ultrasound, Department of Organ Failure and Transplantations, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Eugenio Brunocilla
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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Bianchi L, Mineo Bianchi F, Chessa F, Barbaresi U, Casablanca C, Piazza P, Mottaran A, Droghetti M, Roveroni C, Balestrazzi E, Gentile G, Gaudiano C, Bertaccini A, Marcelli E, Porreca A, De Concilio B, Serra C, Celia A, Brunocilla E, Schiavina R. Percutaneous tumor ablation versus partial nephrectomy for small renal mass: the impact of histologic variant and tumor size. Minerva Urol Nefrol 2020. [PMID: 33256358 DOI: 10.23736/s0393-2249.20.03983-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To investigate recurrence rates in patients with T1 renal cell carcinoma (RCC) undergone partial nephrectomy (PN), radiofrequency ablation (RFA) or cryoablation (Cryo). METHODS We retrospectively evaluated data from 665 (81.4%), 68 (8.3%) and 83 (10.3%) patients who underwent PN, RFA and Cryo, respectively. Kaplan-Meier curves depict recurrence-free survival (RFS) rates in the overall population and after stratifying according to tumor's histology (namely, clear cell RCC and non-clear RCC) and size (namely < 2 cm and 2-4 cm). Multivariable Cox regression model was used to identify predictors of recurrence. Cumulative-incidence plots evaluated disease recurrence and other causes of mortality (OCM). RESULTS Patients referred to PN experienced higher RFS rate compared to those treated with RFA and Cryo at 60-month in the overall population (96.4% vs. 79.4 % vs. 87.8%), in patients with clear cell RCC (93.3% vs 75% vs. 80.4%) and in those with tumor of 2-4 cm (97.3% vs 78% and 84.4%; all p≤0.01). In patients with non-clear cell RCC and with tumor <2cm, PN showed higher RFS rate at 60-month as compared to RFA (97.9% vs 84.4% and 95.1% vs 78.1%, respectively; all p≤0.02). At multi-variate analysis, ablative techniques (RFA [HR=4.03] and Cryo [HR=3.86]) were independent predictors of recurrence (all p<0.03). At competing risks analysis, recurrence rate and OCM were 7.3% and 1.3% vs 25% and 7.2% vs 19.9% and 19.9% for PN, RFA and Cryo, respectively. CONCLUSIONS PN and Cryo showed similar RFS rates in patients with non-clear cell RCC and with renal mass < 2cm.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy - .,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy -
| | - Federico Mineo Bianchi
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pietro Piazza
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Angelo Mottaran
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Matteo Droghetti
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Roveroni
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giorgio Gentile
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Alessandro Bertaccini
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Padova, Italy
| | | | - Carla Serra
- Interventional Ultrasound Unit, Department of Organ Failure and Transplantations, Sant' Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Eugenio Brunocilla
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
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8
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Ercolino A, Droghetti M, Schiavina R, Bianchi L, Chessa F, Mineo Bianchi F, Barbaresi U, Angiolini A, Casablanca C, Mottaran A, Molinaroli E, Pultrone C, Dababneh H, Bertaccini A, Brunocilla E. Postoperative outcomes of Fast-Track-enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal. Minerva Urol Nephrol 2020; 73:763-772. [PMID: 33200895 DOI: 10.23736/s2724-6051.20.03843-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC. METHODS We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: in-hospital stay (HS) ≤ 10 days, time to defecation (TtD) below the overall mean and no major (≥ Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups. RESULTS Seventy-five patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days P=0.006), HS (12 vs. 14 days P=0.008) and lower readmission rate (8% vs. 19% P=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% P=0.006). Trifecta achievement rate was higher for FT group (31% vs. 8% P<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups. CONCLUSIONS FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC.
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Affiliation(s)
- Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy - .,University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Umberto Barbaresi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Angiolini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Molinaroli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristian Pultrone
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Hussam Dababneh
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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9
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Schiavina R, Droghetti M, Novara G, Bianchi L, Gaudiano C, Panebianco V, Borghesi M, Piazza P, Mineo Bianchi F, Guerra M, Corcioni B, Fiorentino M, Giunchi F, Verze P, Pultrone C, Golfieri R, Porreca A, Mirone V, Brunocilla E. The role of multiparametric MRI in active surveillance for low-risk prostate cancer: The ROMAS randomized controlled trial. Urol Oncol 2020; 39:433.e1-433.e7. [PMID: 33191117 DOI: 10.1016/j.urolonc.2020.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aim to evaluate the impact of multiparametric magnetic resonance imaging and fusion-target biopsy for early reclassification of patients with low-risk Prostate Cancer in a randomized trial. MATERIALS AND METHODS Between 2015 and 2018, patients diagnosed with Prostate Cancer after random biopsy fulfilling PRIAS criteria were enrolled and centrally randomized (1:1 ratio) to study group or control group. Patients randomized to study group underwent multiparametric magnetic resonance imaging at 3 months from enrollment: patients with positive findings (PIRADS-v2>2) underwent fusion-target biopsy; patients with negative multiparametric magnetic resonance imaging or confirmed ISUP - Grade Group 1 at fusion-target biopsy were managed according to PRIAS schedule and 12-core random biopsy was performed at 12 months. Patients in control group underwent PRIAS protocol, including a confirmatory 12-core random biopsy at 12 months. Primary endpoint was a reduction of reclassification rate at 12-month random biopsy in study group at least 20% less than controls. Reclassification was defined as biopsy ISUP Grade Group 1 in >2 biopsy cores or disease upgrading. RESULTS A total of 124 patients were randomized to study group (n = 62) or control group (n = 62). Around 21 of 62 patients (34%) in study group had a positive multiparametric magnetic resonance imaging, and underwent fusion-target biopsy, with 11 (17.7%) reclassifications. Considering the intention-to-treat population, reclassification rate at 12-month random biopsy was 6.5% for study group and 29% for control group, respectively (P < 0.001). CONCLUSIONS The early employment of multiparametric magnetic resonance imaging for active surveillance patients enrolled after random biopsy consents to significantly reduce reclassifications at 12-month random biopsy.
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Affiliation(s)
- Riccardo Schiavina
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Matteo Droghetti
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic University of Padua, Padua, Italy
| | - Lorenzo Bianchi
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | | - Marco Borghesi
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Pietro Piazza
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Mineo Bianchi
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Marco Guerra
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Beniamino Corcioni
- Department of Radiology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Pathology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesca Giunchi
- Department of Pathology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Paolo Verze
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Cristian Pultrone
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples, Federico II, Naples, Italy
| | - Eugenio Brunocilla
- Department of Urology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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10
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Schiavina R, Bianchi L, Chessa F, Barbaresi U, Cercenelli L, Lodi S, Gaudiano C, Bortolani B, Angiolini A, Bianchi FM, Ercolino A, Casablanca C, Molinaroli E, Porreca A, Golfieri R, Diciotti S, Marcelli E, Brunocilla E. Augmented Reality to Guide Selective Clamping and Tumor Dissection During Robot-assisted Partial Nephrectomy: A Preliminary Experience. Clin Genitourin Cancer 2020; 19:e149-e155. [PMID: 33060033 DOI: 10.1016/j.clgc.2020.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Riccardo Schiavina
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy.
| | - Francesco Chessa
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Laura Cercenelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Simone Lodi
- Department of Electrical, Electronic, and Information Engineering, "Guglielmo Marconi," University of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Radiology Unit, Department of Diagnostic Medicine and Prevention, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Barbara Bortolani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Andrea Angiolini
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Federico Mineo Bianchi
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Amelio Ercolino
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Carlo Casablanca
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Enrico Molinaroli
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Padua, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Diagnostic Medicine and Prevention, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering, "Guglielmo Marconi," University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
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11
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Porreca A, Bianchi FM, Salvaggio A, D'Agostino D, Del Rosso A, Romagnoli D, Corsi P, Colicchia M, Barbaresi U, Bianchi L, Giampaoli M, Schiavina R, Palmer K, Del Giudice F, Maggi M, Ferro M, Sciarra A, De Berardinis E, Busetto GM. Prognostic performance of magnetic resonance imaging-guided biopsy in defining prostate cancer anterior lesions. World J Urol 2020; 39:1473-1479. [PMID: 32621027 DOI: 10.1007/s00345-020-03335-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Diagnosis of anterior prostate cancer (PCa) can be quite challenging, often leading to delay in treatment. mpMRI-guided biopsy (GB) has been introduced aiming to increase the number of diagnoses of clinically significant PCa with fewer cores. The aim of our study is to compare pathological findings of prostate biopsy, In-bore or Fusion technique, with histopathological evaluation of radical prostatectomy. METHODS We prospectively collected data from 90 consecutive patients who underwent either In-bore or Fusion biopsy following the detection of an index suspicious lesion at mpMRI in the anterior part of the prostatic gland. Bioptical pathological findings were compared with pathological findings reported after robot-assisted radical prostatectomy. RESULTS Patients who underwent In-bore GB had a higher rate of previous negative prostate biopsies (19% vs 44%, p = 0.02). Median number of bioptic cores taken (13 vs 2) and number of positive cores (3 vs 2) were significantly superior in the Fusion group compared to the In-bore group (p < 0.001 and p = 0.002, respectively), whilst clinical International Society of Urological Pathology (ISUP) grade was homogeneous within groups. The concordance between anterior lesions detected at biopsy and those reported in the histopathological finding of radical prostatectomy was very high, without statistically significant difference between groups. CONCLUSION Both Fusion and In-bore GB are accurate in detecting anterior PCa, with enhanced precision detecting clinically significant tumours, as evidenced by pathologic examinations which confirmed the presence of index anterior PCa in > 50% of patients overall. Additional sextant biopsy is still required, especially among biopsy-näive patients, to avoid missing clinically significant PCa.
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Affiliation(s)
- Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | - Antonio Salvaggio
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Alessandro Del Rosso
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Michele Colicchia
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | - Marco Giampaoli
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Katie Palmer
- Department of Internal Medicine and Geriatrics, University Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Del Giudice
- Department of Urology, Sapienza Rome University Policlinico Umberto I, P.le Aldo Moro, 5, Rome, Italy
| | - Martina Maggi
- Department of Urology, Sapienza Rome University Policlinico Umberto I, P.le Aldo Moro, 5, Rome, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Alessandro Sciarra
- Department of Urology, Sapienza Rome University Policlinico Umberto I, P.le Aldo Moro, 5, Rome, Italy
| | - Ettore De Berardinis
- Department of Urology, Sapienza Rome University Policlinico Umberto I, P.le Aldo Moro, 5, Rome, Italy
| | - Gian Maria Busetto
- Department of Urology, Sapienza Rome University Policlinico Umberto I, P.le Aldo Moro, 5, Rome, Italy.
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12
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D'Agostino D, Corsi P, Colicchia M, Romagnoli D, Busetto GM, Ferro M, Tafuri A, Cevenini M, Mineo Bianchi F, Giampaoli M, Porreca A. The pathological and clinical features of anterior lesions of prostate cancer: Evaluation in a single cohort of patients. ACTA ACUST UNITED AC 2020; 92. [PMID: 32597109 DOI: 10.4081/aiua.2020.2.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of our work is to evaluate the principal differences of the pathological features in prostate cancer (PCa) lesions comparing those in the anterior region of the gland (APCa) to those in the posterior zone (PPCa) among patients who underwent to robotic-assisted radical prostatectomy (RP). MATERIAL AND METHODS A total of 85 consecutive patients (mean age 66; IQR 62-71) with clinically suspected PCa were studied with multiparametric magnetic resonance of prostate before prostate biopsies. The prostate biopsies were RM-guided (60 inbore biopsy (MR-GB) and 25 Fusion-biopsy (FB). A total of 72 cases were eligible for robotic RP. An experienced genitourinary pathologist reviewed the histopathology of the tissue specimens of the patients after RP. The exclusion criteria were as follows: previous hormonotherapy, radiotherapy and chemotherapy for others cancers. RESULTS Based on the histological diagnosis, after RP, 68 anterior prostate cancer, and 107 posterior lesions were found. We further subcategorized lesions into peripheral and central zones for each the anterior and posterior lesions. The specific distribution of lesions by pathologic stage was: T2 = 74 (42.3%), T3a = 87 (49.7%), T3b = 12 (6.9%), T4 = 2 (1.1%) cases. Tumor volume of posterior neoplasms ranged from 0.04 to 20.35 cm3, with a median of 3.39 cm3. Anterior tumor volume ranged from 0.17 to 15 cm3, with a median volume of 2.54 cm3: PPCa were larger than APCa but the difference in size was not significant. The prostate cancer grade group (GG) I was distributed as 16.6% and 36% in anterior and posterior lesions cases. GG II and III was 43.8% and 31.5% in anterior and posterior cases, respectively. Comparatively, GG IV-V showed 39.6% and 32.5% for anterior and posterior lesions respectively (p < 0.001). Extraprostatic extention of neoplasm (EPE) was found more frequently in anterior cases (31.4%) than in in posterior cases (25.1%), but without significant difference. Lymphovascular invasion was similar in both the groups: 24% and 28.6% in anterior and posterior group, respectively. Anterior lesions showed a significantly higher rate of lymph node metastasis (9.3%) than posterior lesions (3.4%) (p < 0.005). CONCLUSION In our study, we have found EPE, often associated with worse prognosis, more frequently (but not significantly) present in anterior lesions among PCa patients. Although posterior lesions are often related to pT3b stage, in our findings, anterior lesions were more often associated with a more aggressive neoplasm with more frequent nodal involvements.
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13
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Droghetti M, Ercolino A, Piazza P, Bianchi L, Fabbrizio B, Giunchi F, Mineo Bianchi F, Barbaresi U, Casablanca C, Tonin E, Mottaran A, Fiorentino M, Schiavina R, Brunocilla E. Secondary bladder amyloidosis due to Crohn's disease: a case report and literature review. CEN Case Rep 2020; 9:413-417. [PMID: 32572782 DOI: 10.1007/s13730-020-00497-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 03/11/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
The presence of amyloid deposits in bladder walls is a rare histological finding. It can be linked to primary (limited to bladder) or secondary (systemic, associated with chronic inflammatory disorders) amyloidosis. Secondary bladder involvement is very uncommon; it usually presents with gross hematuria, which is challenging to manage, due to frail bladder mucosa and/or necrosis. We present a case of 54-year old man with secondary bladder amyloidosis due to Crohn's disease, that caused gross hematuria and severe anemia, which was managed conservatively by endoscopic transurethral resection, diatermocoagulation, clot evacuation and urinary drainage by bilateral percutaneous nephrostomy, with spontaneous resolution. Secondary bladder amyloidosis is a rare condition that presents with severe hematuria, difficult to control with standard management. Owing to chronic nature of the disease, treatment should be aimed to a conservative approach whenever possible. In case of failure, invasive procedures should be considered as salvage therapies.
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Affiliation(s)
- Matteo Droghetti
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy.
| | - Amelio Ercolino
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
| | - Pietro Piazza
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
| | - Lorenzo Bianchi
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Benedetta Fabbrizio
- Pathology Unit, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesca Giunchi
- Pathology Unit, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Federico Mineo Bianchi
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
| | - Carlo Casablanca
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
| | - Elena Tonin
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
| | - Angelo Mottaran
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
| | - Michelangelo Fiorentino
- Pathology Unit, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, S. Orsola-Malpighi University Hospital, Via P. Palagi 9, 40138, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
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D'Agostino D, Casablanca C, Mineo Bianchi F, Corsi P, Romagnoli D, Giampaoli M, Fiori C, Schiavina R, Brunocilla E, Artibani W, Porreca A. The role of magnetic resonance imaging-guided biopsy for diagnosis of prostate cancer; comparison between FUSION and "IN-BORE" approaches. Minerva Urol Nephrol 2020. [PMID: 32456413 DOI: 10.23736/s0393-2249.20.03550-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate the difference in terms of feasibility and detection rate of two magnetic resonance imaging (MRI) guided biopsy approaches (MRI fusion versus "in-bore" MRI) in a single tertiary center. METHODS We retrospectively identified 297 patients with suspected prostate cancer who underwent MRI based target prostate biopsy (FUSION or "in-bore" approaches) between January 2016 and January 2018 in a single tertiary center. RESULTS Lesion site (peripheral vs. central) and localization (anterior vs. posterior) were equally comparable among two groups, but maximum diameter of multiparametric-MRI Index lesion was slightly superior in the in-bore MRI-GB group (14 vs. 12 mm, P=0.002). Mean random biopsy cores taken were 11.2±2.1, with 1.3±2 positive cores in FUSION-GB group. Mean number of targeted biopsy cores taken was significantly superior in the FUSION-GB group as compared to the in-bore MRI-GB group (2.6±0.7 vs.1.7±1, P<0.001), whereas mean number of positive targeted biopsy cores was comparable between two groups (1±1.3 vs.1±0.9, P=0.1). 70 (45.5%) and 75 (52.8%) patients had positive targeted bioptic cores at pathologic examination among FUSION-GB and in-bore MRI-GB groups, respectively (P=0.2). Bioptical ISUP grade was also comparable among two groups (P=0.2) in multivariate analysis PI-RADS Score (OR=3.04 and OR=8.32 for PI-RADS 4 and 5, respectively) and PSA density (OR=2.69) were identified as independent predictors of positive targeted cores at histological examination (P<0.001 and P=0.01, respectively). CONCLUSIONS In-bore MRI-GB approaches represent a promising technique that may offer some advantages compared to standard systematic FUSION-GB despite higher costs of in bore-procedure. Our experience, although not showing a clear advantage between the FUSION technique and the "in-bore" technique, resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of prostate especially in a subgroup of patient with clinically significant disease. Further investigations are needed in order to identify the best approach for MRI-GB.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy -
| | | | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
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D'Agostino D, Casablanca C, Mineo Bianchi F, Corsi P, Romagnoli D, Giampaoli M, Fiori C, Schiavina R, Brunocilla E, Artibani W, Porreca A. The role of magnetic resonance imaging-guided biopsy for diagnosis of prostate cancer; comparison between FUSION and "IN-BORE" approaches. Minerva Urol Nephrol 2020; 73:90-97. [PMID: 32456413 DOI: 10.23736/s2724-6051.20.03550-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate the difference in terms of feasibility and detection rate of two magnetic resonance imaging (MRI) guided biopsy approaches (MRI fusion versus "in-bore" MRI) in a single tertiary center. METHODS We retrospectively identified 297 patients with suspected prostate cancer who underwent MRI based target prostate biopsy (FUSION or "in-bore" approaches) between January 2016 and January 2018 in a single tertiary center. RESULTS Lesion site (peripheral vs. central) and localization (anterior vs. posterior) were equally comparable among two groups, but maximum diameter of multiparametric-MRI Index lesion was slightly superior in the in-bore MRI-GB group (14 vs. 12 mm, P=0.002). Mean random biopsy cores taken were 11.2±2.1, with 1.3±2 positive cores in FUSION-GB group. Mean number of targeted biopsy cores taken was significantly superior in the FUSION-GB group as compared to the in-bore MRI-GB group (2.6±0.7 vs.1.7±1, P<0.001), whereas mean number of positive targeted biopsy cores was comparable between two groups (1±1.3 vs.1±0.9, P=0.1). 70 (45.5%) and 75 (52.8%) patients had positive targeted bioptic cores at pathologic examination among FUSION-GB and in-bore MRI-GB groups, respectively (P=0.2). Bioptical ISUP grade was also comparable among two groups (P=0.2) in multivariate analysis PI-RADS Score (OR=3.04 and OR=8.32 for PI-RADS 4 and 5, respectively) and PSA density (OR=2.69) were identified as independent predictors of positive targeted cores at histological examination (P<0.001 and P=0.01, respectively). CONCLUSIONS In-bore MRI-GB approaches represent a promising technique that may offer some advantages compared to standard systematic FUSION-GB despite higher costs of in bore-procedure. Our experience, although not showing a clear advantage between the FUSION technique and the "in-bore" technique, resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of prostate especially in a subgroup of patient with clinically significant disease. Further investigations are needed in order to identify the best approach for MRI-GB.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy -
| | | | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
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D'Agostino D, Romagnoli D, Giampaoli M, Bianchi FM, Corsi P, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. "In-Bore" MRI-Guided Prostate Biopsy for Prostate Cancer Diagnosis: Results from 140 Consecutive Patients. Curr Urol 2020; 14:22-31. [PMID: 32398993 DOI: 10.1159/000499264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022] Open
Abstract
Objectives Transrectal ultrasound-guided biopsy (TRUS-GB) is the current reference standard procedure for diagnosis of prostate cancer (PCa) but this procedure has limitations related to the low detection rate (DR) described in the literature. The aim of the study was to evaluate the DR efficiency, and complication rate in a pure "in-bore" magnetic resonance imaging-guided biopsy (MRI-GB) series according to the Prostate Imaging Reporting and Data System, version 2 (PI-RADS v2). Materials and Methods From July 2015 to April 2018, a series of 142 consecutive patients undergoing MRI-GB were prospectively enrolled. According to the European Society of Urogenital Radiology guidelines, the presence of clinically significant PCa (csPCa) on multiparametric magnetic resonance imaging was defined as equivocal, likely, or highly likely according to a PI-RADS v2, score of 3, 4, or 5, respectively. Results Of 142 patients, 76 (53.5%) were biopsy naive and 66 (46.5%) had ≤ 1 previous negative set of random TRUS-GB findings. The MRI-GB findings were positive in 75 of 142 patients with a DR of 52.8%. Of the 76 patients with ≤ 1 previous set of TRUS-GB, 43 had PCa found by MRI-GB, with a DR of 57.3%. The DR in the 66 biopsy-naive patients was 48% (32/66). Of the 75 patients with positive biopsy findings, 54 (80.5%) were found to have csPCa on histological examination. Of these 54 patients, 28 had an International Society of Urological Pathology grade 2; 5 had grade 3, 19 had grade 4, and 2 had grade 5. Considering the anatomic distribution of the index lesions using the PI-RADS v2 scheme, the probability of PCa was greater for lesions located in the peripheral zone (55 of 75, 73.3%) than for those in the central zone (20 of 75, 26.7%). Conclusions Our study conducted on 142 patients confirmed the greater DR of csPCa by MRI-GB, with a very low number of cores needed and a negligible incidence of complications, especially in patients with a previous negative biopsy. MRI-GB is optimal for the diagnosis of anterior and central lesions.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | | | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme
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Bianchi L, Borghesi M, Schiavina R, Castellucci P, Ercolino A, Bianchi FM, Barbaresi U, Polverari G, Brunocilla E, Fanti S, Ceci F. Predictive accuracy and clinical benefit of a nomogram aimed to predict 68Ga-PSMA PET/CT positivity in patients with prostate cancer recurrence and PSA < 1 ng/ml external validation on a single institution database. Eur J Nucl Med Mol Imaging 2020; 47:2100-2105. [PMID: 32006061 DOI: 10.1007/s00259-020-04696-z] [Citation(s) in RCA: 16] [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] [Received: 10/24/2019] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To perform an external validation of a recently published nomogram aimed to predict positive 68Ga-PSMA-11 PET/CT in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) by Rauscher et al. (Eur Urol 73(5):656-661, 2018). METHODS Overall, 413 PCa patients with BCR after RP (two consecutive PSA ≥ 0.2 ng/ml) and PSA value between 0.2 and 1 ng/ml were included. A multivariable logistic regression model was produced to assess the predictors of positive 68Ga-PSMA-11 PET/CT results. The performance characteristics of the model were assessed by quantifying the predictive accuracy, according to model calibration. Yuden's index was used to find the best nomogram's cut-off. Finally, decision curve analysis (DCA) was implemented to quantify the nomogram's clinical value. RESULTS In the external cohort, the overall detection rate of 68Ga-PSMA-11 PET/CT was 44% vs. 64.7% in the original population. At multivariate analysis, PSA at 68Ga-PSMA-11 PET/CT (OR: 7.06, p < 0.001) and ongoing ADT at time of 68Ga-PSMA-11 PET/CT (OR: 2.07, p = 0.03) were the only independent predictors of PET/CT positivity. The predictive accuracy of nomogram was suboptimal and comparable to that reported in the original model (64% vs. 67%, respectively). The calibration plot indicated suboptimal concordance. The best nomogram's cut-off to predict positive 68Ga-PSMA-11 PET/CT was 35% (AUC = 0.61). In DCA, the nomogram revealed clinical net benefit when the threshold probabilities of positive 68Ga-PSMA-11 PET/CT is > 35%. CONCLUSION We assessed similar suboptimal predictive accuracies in the external cohort compared to the original one. PSA and ongoing ADT were confirmed as positive predictors, and the most informative nomogram cut-off resulted 35%.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy. .,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy.
| | - Marco Borghesi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Paolo Castellucci
- Metropolitan Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Amelio Ercolino
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy
| | - Federico Mineo Bianchi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy
| | - Giulia Polverari
- Metropolitan Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Via Palagi 9, 40138, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy.,Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
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Romagnoli D, Schiavina R, Bianchi L, Borghesi M, Chessa F, Mineo Bianchi F, Angiolini A, Casablanca C, Giampaoli M, Corsi P, D'Agostino D, Brunocilla E, Porreca A. Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion? Initial results from a single high-volume centre. ACTA ACUST UNITED AC 2020; 91:230-236. [PMID: 31937087 DOI: 10.4081/aiua.2019.4.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/26/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND AIM Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre. MATERIALS AND METHODS The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion. To validate its feasibility, we compared its results with data collected from a 1:1 matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol. RESULTS We enrolled in the FT group 11 (55%) patients scheduled to RC with ileal conduit diversion, and 9 patients (45%) scheduled to orthotopic neobladder (Studer) substitution, while a numerically equivalent population was enrolled in the control group, matched according to age at surgery, BMI, gender, ASA score, CCI, preoperative stage and type of urinary diversion. No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Median overall age was 71 years (Inter Quartile Range - IQR: 63-76) and mean operatory time was 276 ± 57 minutes. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain. We found no difference, in terms of both early and late complications ratio, among the two populations. Complications graded Clavien ≥ 3 were found in 4 patients of the control group (20%), while in only one patient (5%) in the Fast Track group, though this difference was not statistically significant. CONCLUSIONS The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio.
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D'Agostino D, Mineo Bianchi F, Romagnoli D, Giampaoli M, Corsi P, Del Rosso A, Schiavina R, Brunocilla E, Porreca A. MRI/TRUS FUSION guided biopsy as first approach in ambulatory setting: Feasibility and performance of a new fusion device. ACTA ACUST UNITED AC 2020; 91:211-217. [PMID: 31937083 DOI: 10.4081/aiua.2019.4.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/02/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the detection rate of Magnetic Resonance Imaging/Transrectal Ultrasound (MRI/TRUS) Fusion Biopsy performed in a series of patients with suspicious prostate cancer in an ambulatory setting. MATERIALS AND METHODS Between March 2018 and January 2019 a series of 155 patients undergoing MRI/TRUS fusionguided biopsy were prospectively enrolled. All patients presented a suspected diagnosis for prostate cancer because of raised Prostate Specific Antigen (PSA) serum level and/or abnormal physical examination (digital rectal examination), and showed at least one suspicious area at the multiparametric Magnetic Resonance Imaging (mpMRI). RESULTS Of 155 patients, 58 (37.4%) were biopsy-naïve, 97 (62.6%) had at least 1 previous negative TRUS-guided biopsy. The median age of the patient cohort was 66 years (IQR, 61- 69); the median prebiopsy PSA value was 7.1 ng/ml (IQR, 5- 8.9). Overall, the Fusion-TB findings were positive in 94 of 155 patients with a detection rate (DR) of 60%; a significantly high DR was obtained in terms of clinically significant prostate cancer (csPCa) by Fusion-TB (61 pts; 41.9%). The overall DR in the 121 biopsy-naive patients was 60.6%. In the subgroup of the 34 patients with at least 1 previous set of TRUS-GB, overall DR was 39.3% (35/50). CONCLUSIONS The targeted MRI/TRUS fusion-guided biopsy represents a safe and accurate approach for diagnosis of csPCa, especially in patient with previous TRUS guided biopsy negative and suspicious prostate cancer.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme.
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Bianchi L, Schiavina R, Borghesi M, Chessa F, Casablanca C, Angiolini A, Ercolino A, Pultrone CV, Mineo Bianchi F, Barbaresi U, Piazza P, Manferrari F, Bertaccini A, Fiorentino M, Ferro M, Porreca A, Marcelli E, Brunocilla E. Which patients with clinical localized renal mass would achieve the trifecta after partial nephrectomy? The impact of surgical technique. MINERVA UROL NEFROL 2019; 72:339-349. [PMID: 31619030 DOI: 10.23736/s0393-2249.19.03485-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To develop a clinical nomogram aimed to predict the achievement of trifecta in patients treated with open, laparoscopic and robotic partial nephrectomy (PN) for localized renal masses (<cT2). METHODS We retrospectively evaluated 482 consecutive patients who underwent PN with open (OPN: 243), laparoscopic (LPN: 156) and robotic (RAPN: 83) approach for T1 renal mass at single tertiary center. Trifecta was defined as follows: warm ischemia time (WIT) <20 min and no positive surgical margins (PSM) and no postoperative complications. First, we compared clinical, pathologic and perioperative outcomes within the three surgical approaches. Second, multivariable logistic regression was performed to identify the independent predictors of the trifecta's achievement. Finally, regression-based coefficients were used to develop a nomogram predicting the likelihood to achieve the trifecta and 200 bootstrap resamples were used for internal validation. RESULTS The three cohorts were comparable in terms of demographics and clinical characteristics. Trifecta has been achieved in 49%, 50.6% and 69.9% of patients undergoing OPN, LPN and RAPN, respectively (P=0.003). At multivariable analyses, American Anesthesiologists Score (ASA) score 3-4 (Odd Ratio [OR]: 0.63; P=0.02), urinary collecting system (UCS) involvement (OR 0.56; P=0.02) and surgical approach (LPN and OPN vs. RAPN: OR: 0.39 and 0.38, respectively; P=0.001) were independent predictors of trifecta's achievement. A nomogram based on covariates included in the multivariable model demonstrated bootstrap-corrected predictive accuracy of 63%. CONCLUSIONS ASA Score, UCS involvement and the surgical technique were independent predictors of trifecta outcome. Our nomogram could facilitate the preoperative counselling and to choose the best surgical approach for PN.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy - .,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy -
| | - Riccardo Schiavina
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Marco Borghesi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Andrea Angiolini
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Amelio Ercolino
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Cristian V Pultrone
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Federico Mineo Bianchi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Pietro Piazza
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fabio Manferrari
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Laboratory of Oncologic Molecular Pathology, Sant'Orsola-Malpighi Teaching Hospital, University of Bologna, Bologna, Italy
| | | | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Padua, Italy
| | - Emanuela Marcelli
- Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy.,Laboratory of Oncologic Molecular Pathology, Sant'Orsola-Malpighi Teaching Hospital, University of Bologna, Bologna, Italy.,Istituto Europeo di Urologia, Milan, Italy.,Department of Urology, Abano Terme Hospital, Padua, Italy.,Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
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D'Agostino D, Mineo Bianchi F, Romagnoli D, Corsi P, Giampaoli M, Schiavina R, Brunocilla E, Artibani W, Porreca A. Comparison between "In-bore" MRI guided prostate biopsy and standard ultrasound guided biopsy in the patient with suspicious prostate cancer: Preliminary results. ACTA ACUST UNITED AC 2019; 91. [PMID: 31266272 DOI: 10.4081/aiua.2019.2.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/29/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the detection rate of prostate cancer (PCa) in patients who underwent to "in bore" Magnetic Resonance Imaging -guided prostate (MRI-GB) biopsy compared to the standard transrectal ultrasound guided prostate biopsy (TRUS-GB). MATERIALS AND METHODS Between January 2017 and March 2015 a cohort of 39 consecutive patients was prospectively enrolled. All the patients underwent an "in-bore" guided MRI prostatic biopsy and subsequently ultrasound-guided standard prostate biopsy. RESULTS Median age of patients was 65.5 years (SD ± 6.6), median total PSA serum level was 6.6 ng/ml (SD ± 4.1), median prostate total volume was 51.1 cc (SD ± 26.7). Thirty of 39 (76.9%) were biopsy-naïve patients while 7/39 (17.9%) had at least one previous negative random TRUS-GB; 2/39 (5.1%) patients were already diagnosed as PCa and were on active surveillance. In 18/39 (53.8%) men Pca was diagnosed; as regards the MRI-GB results related to the PI-RADS score, biopsies of PIRADS 3 lesions were positive in 5/18 cases (27.8%), while the number of positive cases of PI-RADS 4 and 5 lesions was 7/11 (63.6%) and 6/10 (60%)respectively. At the histological examination, 4/39 (10.3%) had a PCa ISUP grade group 1, 11/39 (28.2%) had a ISUP 2, 6/39(15.4%) had a ISUP grade group 3 and 2/39 (5.1%) had a ISUP 4-5. CONCLUSIONS MRI-GB represents a promising technique that may offer some of advantages compared to standard systematic TRUSGB. Our preliminary experience in MRI-GB resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of PCa.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme.
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22
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D'Agostino D, Corsi P, Giampaoli M, Mineo Bianchi F, Romagnoli D, Crivellaro S, Saraceni G, Garofalo M, Schiavina R, Brunocilla E, Artibani W, Porreca A. Mini-invasive robotic assisted pyelolithotomy: Comparison between the transperitoneal and retroperitoneal approach. Arch Ital Urol Androl 2019; 91. [PMID: 31266278 DOI: 10.4081/aiua.2019.2.107] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/21/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the retroperitoneal with the transperitoneal approach in a series of patients underwent to robotic-assisted pyelolithotomy (RP). MATERIALS AND METHODS From January 2015 to December 2018 we evaluated 20 patients subjected to robotic pyelolithotomy; 11 patients were treated with retroperitoneal approach (RRP) and 9 with transperitoneal approach (TRP). For each patient intra and perioperative data were recorded: operative time (OT), blood loss (BL), length of hospital stay (LOS), stone clearance, post-operative complications and time to remove the drain. The presence of stone fragments < 4 mm was considered as stone free rate. RESULTS The principal stone burden was greater in the TRP group than in the RRP group (48 ± 10 mm vs 32 ± 14 mm, p = 0.12). Preoperative hydronephrosis was present in 7 (64%) patients in RRP group and a mild hydronephrosis in 3 of TRP group (p = 0.04). The average operative time was higher in the RRP group than in the TRP group (203 ± 45 min vs 137 ± 31 min, p = 0.002). The average blood loss was 305 ± 175 ml in the RRP group versus 94 ± 104 ml in the TRP group (p = 0.005). The stone free rate was similar between the two groups, 36% (4 patients) in the RRP group and 44% (4 patients) in the TRP (p = 0.966). CONCLUSIONS RP appears to be a safe and effective minimally invasive treatment for some patients with renal staghorn calculi or urinary tract malformations. The TRP may give lower operative time and better results in terms of blood loss and length of hospital stay.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme.
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23
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Giampaoli M, Bianchi L, D'agostino D, Corsi P, Romagnoli D, Mineo Bianchi F, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. Can preoperative multiparametric MRI avoid unnecessary prostate biopsies before holmium laser enucleation of the prostate? Preliminary results of a multicentric cohort of patients. MINERVA UROL NEFROL 2019; 71:524-530. [PMID: 31166103 DOI: 10.23736/s0393-2249.19.03463-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is a surgical technique that allows to safely and effectively treat bladder outlet obstruction due to benign prostate enlargement and retrieve an adequate surgical specimen. We investigated the role of multiparametric magnetic resonance imaging of the prostate (mpMRI) as a tool to exclude incidental prostate cancer (iPCa) and to compare mpMRI alone with a contextual transrectal ultrasound guided biopsy (TRUS-GB). METHODS Retrospective multicentric evaluation of 244 patients underwent to HoLEP with a suspicion of prostate cancer (PCa) due to raised PSA and/or abnormal digital rectal examination (DRE) and a negative mpMRI (PI-RADS score <3), was performed. Of these, 118 patients had only a negative mpMRI (MRI group) while 126 had a negative mpMRI and a contextual preoperative negative TRUS-GB (MRI + TRUS-GB group). Comparison between the two groups, univariate and multivariate analysis were conducted in order to identify any predictive factors of iPCa. RESULTS Median age, PSA, prostate volume and PSA density were 64.0 years (IQR: 58.0-69.0), 6.10 ng/mL (IQR: 4.76-9.65), 86.0 cc (IQR: 65.0-115.0), 50.0 cc (IQR: 37.5-80.0) and 0.08 ng/mL/cc (IQR: 0.06-0.10), respectively. In surgical specimen, iPCa was detected in 21 cases (8.8%). No statistically differences between MRI and MRI + TRUS-GB group were found in terms of iPCa (7.6% and 8.5%, respectively), pathological T stage and ISUP Grade Group. A contextual TRUS-GB added to mpMRI did not correlate to iPCa either at uni- and multivariate analysis while a significant correlation of a PSA density >0.15 ng/mL/cc was found only at univariate analysis. CONCLUSIONS Including a mpMRI in clinical evaluation of patients eligible to HoLEP with a preoperative PCa suspicion leads to low the rates of iPCa and might avoid unnecessary TRUS-GB.
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Affiliation(s)
- Marco Giampaoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy -
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Paolo Corsi
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Daniele Romagnoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | | | | | | | | | - Walter Artibani
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
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Bianchi L, Schiavina R, Borghesi M, Casablanca C, Chessa F, Mineo Bianchi F, Pultrone C, Vagnoni V, Ercolino A, Dababneh H, Fiorentino M, Brunocilla E. Patterns of positive surgical margins after open radical prostatectomy and their association with clinical recurrence. MINERVA UROL NEFROL 2019; 72:464-473. [PMID: 31144486 DOI: 10.23736/s0393-2249.19.03269-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We report long-term oncologic outcomes in patients with positive surgical margins (PSMs) at radical prostatectomy (RP) and the oncologic impact of different scenarios of PSMs presentation. METHODS We selected 494 men with at least 3 years follow-up after surgery. PSMs patterns were recorded as: burden (focal vs. multifocal), site (apical-anterior vs. posterolateral vs. base-bladder neck vs. multiple) and side (unilateral vs. bilateral). Kaplan-Meier curves depicted the clinical recurrence-free survival (CR-FS) rates at 10-year in the overall population, after biochemical recurrence and according to different PSMs patterns. Multivariate Cox-regression analysis was performed to predict CR. RESULTS Overall, PSMs sites were apical-anterior, postero-lateral, base-bladder neck and multiple in 19.8%, 23.7%, 3.4% and 43.8%, respectively. Out of 494 patients, 278 (56.3%) had a focal margin, while 216 (43.7%) had a multifocal margin. In 268 (54.3%) and 87 (17.6%) men, PSMs were unilateral and bilateral, respectively. Median follow-up was 93 months. No significant differences were found in CR-FS rates after stratifying according to burden and site of PSMs. Men with unilateral PSMs experienced significant higher CR-FS rates compared to those with bilateral PSMs (87.1% vs. 71.3% at 10 years, P<0.001). At multivariate Cox regression Gleason score 8-10 (HR: 2.53, Confidence Interval [CI]: 1.01-6.33; P=0.04), pathologic stage pT3b-pT4 (HR 3.02, CI: 1.60-7.85; P=0.02) and adjuvant radiotherapy (HR: 0.30, CI: 0.11-0-86; P=0.02) were independent predictors of CR. CONCLUSIONS Men with bilateral PSMs had higher risk to experience CR, suggesting that the different patterns of PSMs, should be considered during patients counseling to guide postoperative treatments. Retrospective nature of the study and restricted number of patients included consist of main limitations.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy - .,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy -
| | - Riccardo Schiavina
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Marco Borghesi
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Chessa
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | | | - Cristian Pultrone
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Valerio Vagnoni
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Amelio Ercolino
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Hussam Dababneh
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), F. Addarii Institute of Oncology and Transplant Pathology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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25
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Corsi P, Daniele D'Agostino D, Giampaoli M, Bianchi FM, Romagnoli D, Crivellaro S, Saraceni G, Garofalo M, Schiavina R, Brunocilla E, Artibani W, Porreca A. Minimally Invasive Pyelolithotomy: Comparison of Robot-assisted and Laparoscopic Techniques. Surg Technol Int 2019; 34:296-301. [PMID: 31034578] [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: 06/09/2023]
Abstract
OBJECTIVES To compare the perioperative and short-term outcomes of robotic pyelolithotomy (RP) and laparoscopic pyelolithotomy (LP) for the treatment of renal stones. MATERIALS AND METHODS We retrospectively evaluated 39 patients who underwent robotic or laparoscopic pyelolithotomy from January 2015 to December 2018. RESULTS The preoperative characteristics of the two groups were comparable. The mean operative time was 173 ± 51 and 182 ± 62 min in the RP and LP groups, respectively (p=0.6). Blood loss and length of hospital stay with the robotic approach were lower than those with the laparoscopic approach (210 ± 180 ml vs. 639 ± 412 ml, p<0.001, and 3.8 ± 3 days vs. 7.3 ± 2.8 days, p=0.001). A complete stone-free status was achieved in 17 (85%) patients in the RP group and 8 (42%) in the LP group (p=0.01). Post-operative complications with the two approaches were also similar. CONCLUSIONS In some selected cases, laparoscopic and robotic pyelolithotomy are alternative procedures for large, multiple and complex kidney stones. The robotic approach was associated with less intraoperative blood loss and fewer days of hospitalization compared to the laparoscopic method, and also gives a better stone-free rate.
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Affiliation(s)
- Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme (PD), Italy
| | | | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme (PD), Italy
| | | | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme (PD), Italy
| | - Simone Crivellaro
- Division of Urology, Department of Surgery, University of Illinois at Chicago Chicago, IL, USA
| | | | - Marco Garofalo
- Department of Urology, University of Bologna Bologna, Italy
| | | | | | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme (PD), Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme (PD), Italy
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26
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Romagnoli D, Bianchi FM, Corsi P, D'Agostino D, Giampaoli M, Bianchi L, Chessa F, Schiavina R, Brunocilla E, Artibani W, Porreca A. Robot-Assisted Radical Cystectomy with Intracorporeal Orthotopic Ileal Neobladder: A Safe Strategy in Elderly Patients? Results of Propensity Score Matching in a Single High-Volume Center. Surg Technol Int 2019; 34:302-309. [PMID: 31037718] [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: 06/09/2023]
Abstract
AIM To compare surgical, functional and early survival outcomes for robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder (ONB) reconstruction in patients age = 75 y to those in patients age < 75 y using Propensity Score Matching. METHODS We collected data from 15 patients age = 75 y from among 60 consecutive RARC with ONB reconstruction performed at our institution from January 2015 to July 2018. All procedures were performed by a single surgeon after modular training under the supervision of a skilled surgeon. Demographic, surgical, functional and survival data were prospectively collected and compared to the corresponding data from 15 patients from the same series age < 75 y, matched according to the ASA score, body mass index, clinical stage and associated carcinoma in situ using Propensity Score Matching. RESULTS There were no significant differences between the two groups with regard to preoperative parameters, such as ASA score, BMI and preoperative stage. The same homogeneity was found for intraoperative parameters, such as operation time, number of nodes retrieved and ONB time. The only statistically significant difference noted was in the percentage of nerve-sparing procedures, which was higher in the younger patient group (p < 0.001). The percentages of early and late postoperative complications were higher in the older patients, but the differences were not statistically significant. Moreover, there were no differences among the two populations in terms of functional outcomes (daytime and nighttime continence, potency), or in either cancer-specific or overall mortality. CONCLUSIONS RARC with totally intracorporeal ONB diversion can be offered to older patients with an expectation of good surgical, functional and early survival outcomes, although further studies with a larger sample size will be needed to confirm these results.
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Affiliation(s)
- Daniele Romagnoli
- Robotic Urology and Mini Invasive Urologic Surgery Unit, Policlinico Abano TermeAbano Terme Padua (PD), Italy
| | | | - Paolo Corsi
- Robotic Urology and Mini Invasive Urologic Surgery Unit, Policlinico Abano TermeAbano Terme Padua (PD), Italy
| | - Daniele D'Agostino
- Robotic Urology and Mini Invasive Urologic Surgery Unit, Policlinico Abano TermeAbano Terme Padua (PD), Italy
| | - Marco Giampaoli
- Robotic Urology and Mini Invasive Urologic Surgery Unit, Policlinico Abano TermeAbano Terme Padua (PD), Italy
| | | | | | | | | | - Walter Artibani
- Robotic Urology and Mini Invasive Urologic Surgery Unit, Policlinico Abano TermeAbano Terme Padua (PD), Italy
| | - Angelo Porreca
- Robotic Urology and Mini Invasive Urologic Surgery Unit, Policlinico Abano TermeAbano Terme Padua (PD), Italy
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27
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Bianchi FM, Romagnoli D, D'Agostino D, Corsi P, Giampaoli M, Salvaggio A, Schiavina R, Brunocilla E, Artibani W, Porreca A. Is robotic approach useful to palliate advanced bladder cancer? A monocentric single surgeon experience. Cent European J Urol 2019; 72:113-120. [PMID: 31482017 PMCID: PMC6715081 DOI: 10.5173/ceju.2019.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/27/2019] [Revised: 03/20/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction The aim of this study was to assess surgical and functional outcomes of 17 consecutive patients undergoing robot- assisted radical cystectomy (RARC) with palliative intent in a monocentric single surgeon series. Material and methods We collected data from 17 consecutive patients who underwent RARC with palliative intent performed by a single surgeon at our institution. Patients undergoing palliative RARC were those with advanced bladder cancer (BC) or advanced comorbidities. Clinical, surgical and functional outcomes were prospectively collected. Patients completed a specific questionnaire (Functional Assessment of Cancer Therapy-Bladder Cancer, FACT-BL) before and after surgery to assess the role of palliative RARC in terms of quality of life improvement. Results Median age at surgery was 78 years, with median Charlson Comorbidity Index (CCI) and age-adjusted CCI of 3 and 7, respectively. Clinical stage was T2, T3 or T4 in 7, 8 and 2 patients respectively, with 52.9% and 29.4% with cN+ and cM+ disease. Median estimated blood loss was 200 ml, with 1 patient requiring intra-operative blood transfusion. Median hospital stay was 7 days. A total of 3 and 2 patients were re-hospitalized during the first 30 and 30–90 post-operative days, respectively. One major Clavien grade complication was recorded. At median follow-up of 8 months, 9 and 2 patients succumbed due to tumor progression and other causes. Pre-operative and post-operative FACT-BL scores improved significantly in each domain. Conclusions A RARC is a safe and feasible technique which could be offered as part of palliative care in patients with advanced BC or comorbidities. Precise guidelines for palliating BC patients should be better.
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Affiliation(s)
- Federico Mineo Bianchi
- Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Department of Urology, Bologna, Italy.,Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | | | - Paolo Corsi
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Marco Giampaoli
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | - Riccardo Schiavina
- Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Department of Urology, Bologna, Italy
| | - Eugenio Brunocilla
- Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Department of Urology, Bologna, Italy
| | - Walter Artibani
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Angelo Porreca
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
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Porreca A, Giampaoli M, Bianchi L, D'Agostino D, Romagnoli D, Bianchi FM, Rosso AD, Corsi P, Schiavina R, Artibani W, Brunocilla E. Preoperative multiparametric prostate magnetic resonance imaging: a safe clinical practice to reduce incidental prostate cancer in Holmium laser enucleation of the prostate. Cent European J Urol 2019; 72:106-112. [PMID: 31482016 PMCID: PMC6715077 DOI: 10.5173/ceju.2019.1943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/20/2019] [Accepted: 04/21/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Purpose of the study was to investigate the correlation of a preoperative multiparametric magnetic resonance imaging of the prostate (mpMRI) in patients with a suspicion of prostate cancer and eligible for Holmium Laser Enucleation of the Prostate (HoLEP). Material and methods Data of 228 patients who had undergone HoLEP was selected and retrospectively analyzed from a multicentric database. All patients presented with a raised serum PSA and/or an abnormal digital rectal examination (DRE). Prostate cancer (PCa) was excluded either with a negative mpMRI (group ‘NEGATIVE MRI’ n = 113) or a standard biopsy (group ‘NO MRI’ n = 115). Preoperative characteristic surgical and histological outcomes were confronted. A univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa). Results Both groups presented with no statistical differences in preoperative characteristics besides previous acute urinary retention rates and post-voided residual volume, found to be higher (27.8% vs. 14.2% and median 120cc vs. 80cc) in NO MRI and NEGATIVE MRI respectively. No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. Statistically lower rate of iPCa (p = 0.03) was detected in the NEGATIVE MRI group (6.2%) in comparison with NO MRI group (14.8%). In multivariate logistic regression only presence of a preoperative negative mpMRI correlated (p = 0.04) as an independent predictive factor (OR 2.63; 95% CI: 1.02–6.75). Conclusions A negative mpMRI might be a useful tool to be included in a novel preoperative assessment to patients eligible for HoLEP with a suspicion of PCa in order to avoid an incidental PCa.
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Affiliation(s)
- Angelo Porreca
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Marco Giampaoli
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Lorenzo Bianchi
- University of Bologna, Department of Urology, Bologna, Italy
| | | | | | | | | | - Paolo Corsi
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | - Walter Artibani
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
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29
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Porreca A, Mineo Bianchi F, D'Agostino D, Sadini P, Romagnoli D, Del Rosso A, Cindolo L, Corsi P, Schiavina R, Brunocilla E, Giampaoli M. Ejaculation Sparing Bladder Neck Incision with Holmium Laser in Patients with Urinary Symptoms and Small Prostates: Short-Term Functional Results. Urol Int 2019; 103:102-107. [PMID: 30965341 DOI: 10.1159/000499410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/07/2019] [Accepted: 03/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment options for male lower urinary tract symptoms (LUTS) widely range from self-monitoring to oral medications to surgical procedures. As far as concerns surgical treatment of obstructive LUTS, transurethral incision of the prostate is considered as the gold standard in patients with mild benign prostatic enlargement. OBJECTIVES The aim of our study is to describe this novel approach to perform ejaculation sparing Holmium laser bladder neck incision (ES-HoBNI), with particular regard to its effect on ejaculation and LUTS relief. METHODS We evaluated prospective clinical data from 143 consecutive patients who underwent ES-HoBNI at our institution from January 2012 to February 2018. Procedures were performed with a continuous flow 26 Ch resectoscope and a 550 µm holmium laser end-fire fiber. The stenotic bladder neck was deeply incised at 3 and 9'o clock down to the prostatic capsule in a retrograde direction to either side in front of the veromontanum. RESULTS Median Qmax, postvoid residual volume, International Prostate Symptom Score, and quality of life were 9 mL/s (7.4-10.2), 130 mL (100-190), 15 (13-19), and 3 (2-4), respectively. In total, 110 (76.9) reported regular anterograde ejaculation. Median operative time was 20 min (15-26). Median catheterization time and hospital stay were 3 days (3-4) and 22 h (20-24), respectively. Moreover, we have compared the frequency of anterograde ejaculation, which slightly increases after ES-HoBNI (77 vs. 81.2%) when compared to baseline data, despite not reaching statistical significancy. CONCLUSIONS ES-HoBNI is a safe, reproducible technique to relieve obstructive LUTS in men with small prostates while preserving ejaculation in younger and sexually active individuals.
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Affiliation(s)
- Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | - Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy,
| | - Paolo Sadini
- Department of Urology, University of Bologna, Bologna, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Alessandro Del Rosso
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | | | - Marco Giampaoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
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Bianchi FM, Marsaro Júnior AL, Grazia J, Pereira PRVS, Panizzi AR. Diversity of Stink Bugs (Pentatomidae) Associated with Canola: Looking for Potential Pests. Neotrop Entomol 2019; 48:219-224. [PMID: 30374737 DOI: 10.1007/s13744-018-0642-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/23/2018] [Accepted: 10/02/2018] [Indexed: 06/08/2023]
Abstract
Canola (Brassicaceae: Brassica spp.) is an important feedstock for biodiesel production and a potential ingredient for use in the food industry. In different continents, various arthropod pests damage canola plants. Stink bugs (Heteroptera: Pentatomidae) are present in all zoogeographical regions, and many species are recognized by their economic importance as crop pests. Our aim was to describe the composition, structure, and diversity of the assemblage of stink bugs sampled on canola in southern Brazil. A total of 878 pentatomids were captured, belonging to 27 species. The dominant species were Euschistus heros (F.) (n = 439), Dichelops furcatus (F.) (n = 160), and Nezara viridula L. (n = 79). The species richness estimators indicated the samples correspond from 79.7 to 93.1% of the richness estimated. Comparing canola to other monocultures, the richness of Pentatomidae was much superior. Otherwise, when compared to studies conducted in native vegetation and urban fragments, the richness is similar, and sometimes higher. This relatively high number of associations brings out the vulnerability of the canola fields according to the expansion of its cultivated area. Nine species of Pentatomidae are recorded on canola for the first time in Brazil. The most abundant species reported here are often stressed as stink bugs of economic importance in agro-ecosystems. The economic importance of each species varies greatly depending on the plant attacked. Detailed studies are needed to evaluate the damage caused to canola by stink bugs.
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Affiliation(s)
- F M Bianchi
- Depto de Zoologia, Univ Federal do Rio Grande do Sul, Avenida Bento Gonçalves 9500, Prédio 43435, Porto Alegre, RS, 91501-970, Brasil.
| | - A L Marsaro Júnior
- Lab de Entomologia, Centro Nacional de Pesquisa de Trigo - Embrapa Trigo, Caixa Postal 3081, Passo Fundo, RS, Brasil
| | - J Grazia
- Depto de Zoologia, Univ Federal do Rio Grande do Sul, Avenida Bento Gonçalves 9500, Prédio 43435, Porto Alegre, RS, 91501-970, Brasil
| | - P R V S Pereira
- Lab de Entomologia, Centro Nacional de Pesquisa de Trigo - Embrapa Trigo, Caixa Postal 3081, Passo Fundo, RS, Brasil
| | - A R Panizzi
- Lab de Entomologia, Centro Nacional de Pesquisa de Trigo - Embrapa Trigo, Caixa Postal 3081, Passo Fundo, RS, Brasil
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Mineo Bianchi F, Romagnoli D, D'Agostino D, Salvaggio A, Giampaoli M, Corsi P, Bianchi L, Borghesi M, Schiavina R, Brunocilla E, Wiklund P, Porreca A. Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence. Arch Ital Urol Androl 2019; 91:5-10. [DOI: 10.4081/aiua.2019.1.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/08/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of our study is to describe the use of posterior muscle-fascial reconstruction during urethro-ileal anastomosis in bladder cancer (BC) patients submitted to robot-assisted radical cystectomy (RC) with orthotopic neobladder (ON) and its role in facilitating day- and night-time continence recovery during a 12-month follow up. Materials and methods: We prospectively collected data from 42 consecutive patients who underwent RARC with totally intracorporeal ON and extended pelvic lymph node dissection (PLND) at our Institution from June 2014 to October 2017. Prior to the urethro-neobladder anastomosis we reconstructed the Denonvilliers Fascia (DF) as previously described for radical prostatectomy using a bidirectional barbed suture. Day and night-time recovery rates were reported at 3, 6 and 12 months after surgery, with continent patients being those using either no urinary pads or 1 safety pads. Results: Median age at surgery was 63 yrs, 41 (97.6%) patients were male. 28 (66.7%) patients presented a clinical T2 disease. Median operative time and median ON reconstruction time were 450 minutes and 180 minutes respectively. 13 (31%) individuals had non-organ confined disease, with 11 (26.2%) patients with positive lymph nodes (median 3 positive lymph nodes) and 2 (4.8%) with non-urothelial cancer at final pathologic examination. Median hospital stay and median catheterization time were 7 (IQR 7-8) and 21 (IQR 19-22). During first 30 post-operative days we recorded 7 (16.7%) low-grade Clavien and 2 (4.8%) IIIa Clavien complications, whereas between 30 and 90 postoperative days we recorded 4 (9.5%) low-grade, 4 (9.5) IIIa and 1 (2.4%) IIIb complications. Day-time and night-time continence rates were 61.9% vs 52.4%, 73.8% vs 64.3% and 90.5% vs 73.8% at three, six and twelve months follow up. Day-time continence was significantly superior in the younger group (97% vs 57%, p 0.01); night-time continence rates were also superior among < 70 yrs patients, despite not reaching statistical significance (77% vs 57%, p 0.3). Conclusions: Posterior muscle-fascial reconstruction aids continence recovery in BC patients undergoing RARC with ON, with younger and fitter patients most benefitting from ON reconstruction.
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Romagnoli D, Mineo Bianchi F, Sadini P, Angiolini A, D'Agostino D, Giampaoli M, Candiotto S, Schiavina R, Brunocilla E, Porreca A. Pubis bone osteomyelitys after robotic radical cystectomy with continent intracorporeal urinary diversion: Multidisciplinary approach to a complex situation. ACTA ACUST UNITED AC 2019; 91:63-67. [PMID: 30932436 DOI: 10.4081/aiua.2019.1.63] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/08/2019] [Indexed: 11/22/2022]
Abstract
Pubic bone osteomyelitis is a rare infectious condition which is characterized by a complex diagnostic and therapeutic workup, due to its various clinical manifestations. Among the many causes of this condition, urinary fistula is the most common in case of previous urological procedures. In order to solve this complication, it is crucial to treat both the fistula and (moreover) the infectious locus arising from it, because treating the fistula alone does not provide any control on the infectious noxa. We present the first case of pubic bone osteomyelitis arising from a urinary fistula after a robotic radical cystectomy with intra corporeal continent neobladder, which has been successfully treated through a multidisciplinary approach.
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Affiliation(s)
- Daniele Romagnoli
- Robotic Urology and Mini Invasive Urologic Surgery Unit, Abano Terme Hospital, Abano Terme (PD).
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Kube R, Bianchi FM, Brunner D, LaBombard B. Outlier classification using autoencoders: Application for fluctuation driven flows in fusion plasmas. Rev Sci Instrum 2019; 90:013505. [PMID: 30709222 DOI: 10.1063/1.5049519] [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] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
Understanding the statistics of fluctuation driven flows in the boundary layer of magnetically confined plasmas is desired to accurately model the lifetime of the vacuum vessel components. Mirror Langmuir probes (MLPs) are a novel diagnostic that uniquely allow us to sample the plasma parameters on a time scale shorter than the characteristic time scale of their fluctuations. Sudden large-amplitude fluctuations in the plasma degrade the precision and accuracy of the plasma parameters reported by MLPs for cases in which the probe bias range is of insufficient amplitude. While some data samples can readily be classified as valid and invalid, we find that such a classification may be ambiguous for up to 40% of data sampled for the plasma parameters and bias voltages considered in this study. In this contribution, we employ an autoencoder (AE) to learn a low-dimensional representation of valid data samples. By definition, the coordinates in this space are the features that mostly characterize valid data. Ambiguous data samples are classified in this space using standard classifiers for vectorial data. In this way, we avoid defining complicated threshold rules to identify outliers, which require strong assumptions and introduce biases in the analysis. By removing the outliers that are identified in the latent low-dimensional space of the AE, we find that the average conductive and convective radial heat fluxes are between approximately 5% and 15% lower as when removing outliers identified by threshold values. For contributions to the radial heat flux due to triple correlations, the difference is up to 40%.
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Affiliation(s)
- R Kube
- Department of Physics and Technology, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
| | - F M Bianchi
- Department of Physics and Technology, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
| | - D Brunner
- Commonwealth Fusion Systems, Cambridge, Massachusetts 02139, USA
| | - B LaBombard
- MIT Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
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Ballarini C, Intra M, Ceretti AP, Prestipino F, Bianchi FM, Sparacio F, Berti E, Perrone S, Silva F. Gastrointestinal Stromal Tumors: A “Benign” Tumor with Hepatic Metastasis after 11 Years. Tumori 2018; 84:78-81. [PMID: 9619721 DOI: 10.1177/030089169808400117] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gastrointestinal stromal tumors (GIST) constitue the largest category of primary non-epithelial neoplasms of the stomach and small bowel. They are characterized by a remarkable cellular variability and their malignant potential is sometimes difficult to predict. Very recent studies, using mitotic count and tumor size as the best determinants of biological behavior, divide GISTs into three groups: benign, borderline and malignant tumors. We report on a male patient who underwent a right hepatectomy for a large metastasis 11 years after the surgical treatment of an antral-pyloric gastric neoplasm, histologically defined as leiomyoblastoma and with clinical, morphological and immunohistochemical features of benignity (low mitotic count, tumor size < 5 cm, low cellular proliferation index). Histological and immunohistochemical analysis of the hepatic metastasis showed the cellular proliferation index (Ki-67) to be positive in 25% of neoplastic cells, as opposed to the primary gastric tumor in which Ki-67 was positive in only 5% of neoplastic cells. In conclusion, although modern immunohistochemical techniques are now available to obtain useful prognostic information, the malignant potential of GISTs is sometimes difficult to predict: neoplasms clinically and histologically defined as benign could metastasize a long time after oncologically correct surgical treatment. Therefore, benign GISTs also require consistent, long-term follow-up.
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Affiliation(s)
- C Ballarini
- Seconda Divisione di Chirurgia, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
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Bianchi L, Schiavina R, Borghesi M, Bianchi FM, Briganti A, Carini M, Terrone C, Mottrie A, Gacci M, Gontero P, Imbimbo C, Marchioro G, Milanese G, Mirone V, Montorsi F, Morgia G, Novara G, Porreca A, Volpe A, Brunocilla E. Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node-positive prostate cancer patients: External validation on a multi-institutional database. Int J Urol 2018; 25:574-581. [DOI: 10.1111/iju.13565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Marco Borghesi
- Department of Urology; University of Bologna; Bologna Italy
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology; URI; IRCCS San Raffaele Hospital; Milan Italy
| | - Marco Carini
- Department of Urology; University of Florence; Florence Italy
| | - Carlo Terrone
- Department of Urology; University of Genoa; Genoa Italy
| | - Alex Mottrie
- Department of Urology; OLV Hospital; Aalst Belgium
| | - Mauro Gacci
- Department of Urology; University of Florence; Florence Italy
| | - Paolo Gontero
- Department of Urology; University of Turin; Turin Italy
| | - Ciro Imbimbo
- Department of Urology; University of Naples; Naples Italy
| | | | | | | | - Francesco Montorsi
- Unit of Urology/Division of Oncology; URI; IRCCS San Raffaele Hospital; Milan Italy
| | | | | | - Angelo Porreca
- Department of Urology; Abano Hospital; Abano Terme Italy
| | - Alessandro Volpe
- Department of Urology; University of Eastern Piedmont; Novara Italy
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Bianchi FM, Mendonça MS, Campos LA. Comparing vegetation types and anthropic disturbance levels in the Atlantic forest: how do Pentatomoidea (Hemiptera: Heteroptera) assemblages respond? Environ Entomol 2014; 43:1507-1513. [PMID: 25369568 DOI: 10.1603/en13283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Atlantic Forest (AF) is considered the most fragmented and endangered Brazilian biome. The diversity of phytophagous insects increases after disturbances in forests, and it was hypothesized the Pentatomidae can furnish ecologically reliable information in terms of diversity in response to the changes occurring in AF. Our aim was to quantify the response of assemblages of Pentatomoidea to gradient of human disturbance in two vegetation types of the AF-dense ombrophilous forest (DOF) and mixed ombrophilous forest (MOF). Twelve transects were grouped into environmental classes, namely open, intermediate, and closed. Overall, 1,017 pentatomoids were sampled, representing 64 species. The open environment was more abundant than closed environment, though it is expected that Pentatomoidea respond with increasing abundance when under light or moderate disturbance. The MOF was more abundant than DOF, and the composition differed between both of them. Given the differences in composition between MOF and DOF, abiotic variables are important factors acting as environmental filters for Pentatomoidea, not just directly on the insects, but probably also on the nutritional support of their host plants.
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Affiliation(s)
- F M Bianchi
- Departamento de Zoologia, Programa de Pós-Graduação em Biologia Animal, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Bloco IV, Prédio 43435, 91501-970, Porto Alegre, RS, Brazil
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Gilio-Dias SMC, Campos LA, Bianchi FM. Morphology of immatures of Caonabo pseudoscylax (Bergroth) (Hemiptera: Pentatomidae). Neotrop Entomol 2013; 42:178-184. [PMID: 23949752 DOI: 10.1007/s13744-013-0110-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/12/2013] [Indexed: 06/02/2023]
Abstract
Characters of immatures are potentially useful in identifying taxa, but few immatures of Pentatomidae were described. The objectives here are to describe the egg and five nymphal instars of Caonabo pseudoscylax (Bergroth) under light and scanning electron microscopy. Adults, eggs, and nymphs were collected on Homolepsis glutinosa during 2008, in Criciúma (Santa Catarina, Brazil). The egg of C. pseudoscylax is subcylindrical, chorion reddish brown, slightly translucent, and with granulate surface. Aero-micropylar processes translucent, spongy, and strongly clavate. Nymphs without punctures, spiracles placed near the lateral abdominal margin. The dorsal abdominal gland has rounded ostioles bearing cuticular valve; spout peritreme smooth, directed anteriorly; evaporatorium network-shaped; and microsculpture poorly ornamented. Humeral angles of the pronotum were produced from fourth instar. The almost marginal placement of abdominal spiracles may diagnose the nymphs of C. pseudoscylax from first instar to adulthood.
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Affiliation(s)
- S M C Gilio-Dias
- Depto de Zoologia, Instituto de Biociências, Univ Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Campos LA, Bianchi FM, Garbelotto TA. On the genus Chinavia orian: additions to the descriptions of three species (Hemiptera: Pentatomidae). Neotrop Entomol 2012; 41:163-167. [PMID: 23950028 DOI: 10.1007/s13744-012-0027-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 03/06/2012] [Indexed: 06/02/2023]
Abstract
Chinavia Orian has 79 nominal species, 32 of them occur in Brazil, and intraspecific chromatic or morphological variations are known for both immatures and adults of some species. Additions to the descriptions of Chinavia difficilis (Stål), Chinavia geniculata (Dallas), and Chinavia obstinata (Stål) are provided in here, and corrections are proposed for the pictorial key by Schwertner & Grazia for the Brazilian species of Chinavia. New distribution records are also given for the first two species.
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Affiliation(s)
- L A Campos
- Depto Zoologia, Univ Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
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Bianchi FM, Bianchi C, Ferrari AR. [Lymph-node inflammatory pseudotumor with granulomatous component. Report of a case and review of the literature]. Pathologica 1994; 86:536-40. [PMID: 7739881] [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: 01/26/2023] Open
Abstract
A case of inflammatory pseudotumor of lymph node in a 65 year-old man is described. The case is striking because of a granulomatous component within the lesion, a finding unpreviously described. This lesion, benign by nature, should not be misinterpreted as a neoplastic process, especially lymphomas or soft tissue tumors; problems related to the differential diagnosis are also discussed.
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Affiliation(s)
- F M Bianchi
- Servizio di Anatomia ed Istologia Patologica, Ospedale Fatebenefratelli, Oftalmico Milano
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40
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Ferrari AR, Bianchi FM, Migliorini L. [Proposal for a semiqualitative evaluation method for AgNORs (rap score)]. Pathologica 1993; 85:661-5. [PMID: 8170715] [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: 01/29/2023] Open
Abstract
Nucleolar Organiser Regions (NORs) can be stained in paraffin embedded specimens by a simple silver technique: the black dots formed, called AgNORs, have usually been counted only by eye with "careful focusing", a time-consuming and subjective method. Therefore we propose a new semiquantitative approach based on three patterns of AgNORs configuration of increasing malignancy as previously described by Crocker et al: 1) AgNORs fully aggregated to form a solitary argyrophil structure (pattern RESTING: -R-); 2) AgNORs lying within nucleolus and nucleoplasm (Pattern ACTIVATED: -A-); 3) Numerous small AgNORs distributed through the nucleoplasm, without nucleolar structures (Pattern PROLIFERATING: -P-). We assigned a numerical value to each pattern: R = 1; A = 2; P = 3. These values are multiplied by the relative rate in 100 cells. Eventually we obtain a score (range 100-300): this method shows significant correlation (r = 0.8363: regression equation) compared to the usual count obtained "by eye", tested on a sample of 150 breast cancer. Further studies are under way to validate this method which may represent a cheap and useful tool in AgNORs evaluation.
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Affiliation(s)
- A R Ferrari
- Servizio di Anatomia e Istologia patologica, Ospedale Fatebenefratelli e Oftalmico di Milano
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Bianchi FM, Cavassini GB, Leo P. Iron protein succynilate in the treatment of iron deficiency: potential interaction with H2-receptor antagonists. Int J Clin Pharmacol Ther Toxicol 1993; 31:209-17. [PMID: 8100220] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A prospective, open, multicenter clinical trial was set up to evaluate the potential interaction of ITF 282 with H2-receptor antagonists in patients affected with iron deficiency. Patients treated with H2 blockers and affected with iron deficiency or iron deficient anemia were given one tablet of ITF 282 (60 mg iron) twice daily for 60 days. A second group of iron deficient patients with no anti H2 concurrent treatment were admitted to the same iron treatment, lasting 60 days. To evaluate the outcome of the iron treatment, a comprehensive assessment of laboratory and clinical determinations was adopted in all the patients: special hematology, symptomatology, safety hematology and hematochemistry, urinalysis. Fifty-three patients with iron deficiency and 47 patients affected with overt iron deficient anemia entered the study. After treatment, a significant trend toward the normalization of the main hematologic parameters in both groups was detected. The general tolerability was apparently more favorable in the patients who had also the antiulcer (1 event of diarrhoea) than in those who had ITF 282 alone (2 heartburn, 3 constipation, 2 abdominal pain). There were no indications of subgroups of patients particularly at risk of adverse events, all of which resulted reversible without the need to reduce the dose of medication or to take other medical action. ITF 282 resulted, also when administered together with H2-receptor antagonists, in the expected therapeutic efficacy, with the expected clinical tolerability and biological safety, without signs of possible interaction, negative or positive.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F M Bianchi
- Department of Internal Medicine, Polyclinic Hospital S. Orsola-Malpighi, Bologna, Italy
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Ferrari AR, Terreni MR, Bianchi FM, Gambacorta M. [Gastric lymphoma. Anatomo-clinical and prognostic correlations]. Pathologica 1990; 82:381-9. [PMID: 2284140] [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: 12/31/2022] Open
Abstract
In order to assess the prognostic value of some clinicopathological factors of Gastric Lymphoma the authors reviewed 37 consecutive cases observed between 1973 and 1985 with 48 months follow up at least. Age, sex, gross features, site, histological subtype, depth of gastric wall invasion, regional lymph nodes involvement weren't useful parameters. Notable difference exists in survival according to the treatment carried out (surgery and chemoradiotherapy 100% alive & well, surgery and chemotherapy 29% a&w, surgery 17% a&w). The authors compared inflammatory cell population reactive to neoplasm to survival as possible meaningful parameter.
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Affiliation(s)
- A R Ferrari
- Servizio di anatomia e istologia patologica, Ospedale Fatebenefratelli-Oftalmico di Milano
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