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Weißer C, Netzer N, Görtz M, Schütz V, Hielscher T, Schwab C, Hohenfellner M, Schlemmer HP, Maier-Hein KH, Bonekamp D. Weakly Supervised MRI Slice-Level Deep Learning Classification of Prostate Cancer Approximates Full Voxel- and Slice-Level Annotation: Effect of Increasing Training Set Size. J Magn Reson Imaging 2024; 59:1409-1422. [PMID: 37504495 DOI: 10.1002/jmri.28891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Weakly supervised learning promises reduced annotation effort while maintaining performance. PURPOSE To compare weakly supervised training with full slice-wise annotated training of a deep convolutional classification network (CNN) for prostate cancer (PC). STUDY TYPE Retrospective. SUBJECTS One thousand four hundred eighty-nine consecutive institutional prostate MRI examinations from men with suspicion for PC (65 ± 8 years) between January 2015 and November 2020 were split into training (N = 794, enriched with 204 PROSTATEx examinations) and test set (N = 695). FIELD STRENGTH/SEQUENCE 1.5 and 3T, T2-weighted turbo-spin-echo and diffusion-weighted echo-planar imaging. ASSESSMENT Histopathological ground truth was provided by targeted and extended systematic biopsy. Reference training was performed using slice-level annotation (SLA) and compared to iterative training utilizing patient-level annotations (PLAs) with supervised feedback of CNN estimates into the next training iteration at three incremental training set sizes (N = 200, 500, 998). Model performance was assessed by comparing specificity at fixed sensitivity of 0.97 [254/262] emulating PI-RADS ≥ 3, and 0.88-0.90 [231-236/262] emulating PI-RADS ≥ 4 decisions. STATISTICAL TESTS Receiver operating characteristic (ROC) and area under the curve (AUC) was compared using DeLong and Obuchowski test. Sensitivity and specificity were compared using McNemar test. Statistical significance threshold was P = 0.05. RESULTS Test set (N = 695) ROC-AUC performance of SLA (trained with 200/500/998 exams) was 0.75/0.80/0.83, respectively. PLA achieved lower ROC-AUC of 0.64/0.72/0.78. Both increased performance significantly with increasing training set size. ROC-AUC for SLA at 500 exams was comparable to PLA at 998 exams (P = 0.28). ROC-AUC was significantly different between SLA and PLA at same training set sizes, however the ROC-AUC difference decreased significantly from 200 to 998 training exams. Emulating PI-RADS ≥ 3 decisions, difference between PLA specificity of 0.12 [51/433] and SLA specificity of 0.13 [55/433] became undetectable (P = 1.0) at 998 exams. Emulating PI-RADS ≥ 4 decisions, at 998 exams, SLA specificity of 0.51 [221/433] remained higher than PLA specificity at 0.39 [170/433]. However, PLA specificity at 998 exams became comparable to SLA specificity of 0.37 [159/433] at 200 exams (P = 0.70). DATA CONCLUSION Weakly supervised training of a classification CNN using patient-level-only annotation had lower performance compared to training with slice-wise annotations, but improved significantly faster with additional training data. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Cedric Weißer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg University Medical School, Heidelberg, Germany
| | - Nils Netzer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg University Medical School, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
- Junior Clinical Cooperation Unit, Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), Germany
| | - Klaus H Maier-Hein
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
- Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg University Medical School, Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), Germany
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Reimold P, Tosev G, Kaczorowski A, Friedhoff J, Schwab C, Schütz V, Görtz M, Panzer N, Heller M, Aksoy C, Himmelsbach R, Walle T, Zschäbitz S, Jäger D, Duensing A, Stenzinger A, Hohenfellner M, Duensing S. PD-L1 as a Urine Biomarker in Renal Cell Carcinoma-A Case Series and Proof-of-Concept Study. Diagnostics (Basel) 2024; 14:741. [PMID: 38611655 PMCID: PMC11011373 DOI: 10.3390/diagnostics14070741] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is among the most lethal urologic malignancies once metastatic. Current treatment approaches for metastatic RCC (mRCC) involve immune checkpoint inhibitors (ICIs) that target the PD-L1/PD-1 axis. High PD-L1 expression in tumor tissue has been identified as a negative prognostic factor in RCC. However, the role of PD-L1 as a liquid biomarker has not yet been fully explored. Herein, we analyze urine levels of PD-L1 in mRCC patients before and after either ICI therapy or surgical intervention, as well as in a series of patients with treatment-naïve RCC. PATIENTS AND METHODS The mid-stream urine of patients with mRCC (n = 4) or treatment-naïve RCC, i.e., prior to surgery from two centers (cohort I, n = 49: cohort II, n = 29) was analyzed for PD-L1 by ELISA. The results from cohort I were compared to a control group consisting of patients treated for non-malignant urologic diseases (n = 31). In the mRCC group, urine PD-L1 levels were measured before and after tumor nephrectomy (n = 1) or before and after ICI therapy (n = 3). Exosomal PD-L1 in the urine was analyzed in selected patients by immunoblotting. RESULTS A strong decrease in urine PD-L1 levels was found after tumor nephrectomy or following systemic treatment with ICIs. In patients with treatment-naïve RCC (cohort I), urine PD-L1 levels were significantly elevated in the RCC group in comparison to the control group (median 59 pg/mL vs. 25.7 pg/mL, p = 0.011). PD-L1 urine levels were found to be elevated, in particular, in low-grade RCCs in cohorts I and II. Exosomal PD-L1 was detected in the urine of a subset of patients. CONCLUSION In this proof-of-concept study, we show that PD-L1 can be detected in the urine of RCC patients. Urine PD-L1 levels were found to correlate with the treatment response in mRCC patients and were significantly elevated in treatment-naïve RCC patients.
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Affiliation(s)
- Philipp Reimold
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Georgi Tosev
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Adam Kaczorowski
- Molecular Urooncology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Jana Friedhoff
- Molecular Urooncology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Niklas Panzer
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Martina Heller
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Cem Aksoy
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Ruth Himmelsbach
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Thomas Walle
- Department of Medical Oncology, University Hospital Heidelberg and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, University Hospital Heidelberg and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, University Hospital Heidelberg and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Anette Duensing
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
- Precision Oncology of Urological Malignancies, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
- Molecular Urooncology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
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3
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Kovacs B, Netzer N, Baumgartner M, Schrader A, Isensee F, Weißer C, Wolf I, Görtz M, Jaeger PF, Schütz V, Floca R, Gnirs R, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D, Maier-Hein KH. Addressing image misalignments in multi-parametric prostate MRI for enhanced computer-aided diagnosis of prostate cancer. Sci Rep 2023; 13:19805. [PMID: 37957250 PMCID: PMC10643562 DOI: 10.1038/s41598-023-46747-z] [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: 10/18/2022] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
Prostate cancer (PCa) diagnosis on multi-parametric magnetic resonance images (MRI) requires radiologists with a high level of expertise. Misalignments between the MRI sequences can be caused by patient movement, elastic soft-tissue deformations, and imaging artifacts. They further increase the complexity of the task prompting radiologists to interpret the images. Recently, computer-aided diagnosis (CAD) tools have demonstrated potential for PCa diagnosis typically relying on complex co-registration of the input modalities. However, there is no consensus among research groups on whether CAD systems profit from using registration. Furthermore, alternative strategies to handle multi-modal misalignments have not been explored so far. Our study introduces and compares different strategies to cope with image misalignments and evaluates them regarding to their direct effect on diagnostic accuracy of PCa. In addition to established registration algorithms, we propose 'misalignment augmentation' as a concept to increase CAD robustness. As the results demonstrate, misalignment augmentations can not only compensate for a complete lack of registration, but if used in conjunction with registration, also improve the overall performance on an independent test set.
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Affiliation(s)
- Balint Kovacs
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany.
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany.
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
| | - Nils Netzer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Baumgartner
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
| | - Adrian Schrader
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Fabian Isensee
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Cedric Weißer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Ivo Wolf
- Mannheim University of Applied Sciences, Mannheim, Germany
| | - Magdalena Görtz
- Junior Clinical Cooperation Unit 'Multiparametric Methods for Early Detection of Prostate Cancer', German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Paul F Jaeger
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Interactive Machine Learning Group, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Victoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Ralf Floca
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Regula Gnirs
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
| | - Klaus H Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Core Center Heidelberg, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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4
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Schneider F, Kaczorowski A, Jurcic C, Kirchner M, Schwab C, Schütz V, Görtz M, Zschäbitz S, Jäger D, Stenzinger A, Hohenfellner M, Duensing S, Duensing A. Digital Spatial Profiling Identifies the Tumor Periphery as a Highly Active Biological Niche in Clear Cell Renal Cell Carcinoma. Cancers (Basel) 2023; 15:5050. [PMID: 37894418 PMCID: PMC10605891 DOI: 10.3390/cancers15205050] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is characterized by a high degree of intratumoral heterogeneity (ITH). Besides genomic ITH, there is considerable functional ITH, which encompasses spatial niches with distinct proliferative and signaling activities. The full extent of functional spatial heterogeneity in ccRCC is incompletely understood. In the present study, a total of 17 ccRCC tissue specimens from different sites (primary tumor, n = 11; local recurrence, n = 1; distant metastasis, n = 5) were analyzed using digital spatial profiling (DSP) of protein expression. A total of 128 regions of interest from the tumor periphery and tumor center were analyzed for the expression of 46 proteins, comprising three major signaling pathways as well as immune cell markers. Results were correlated to clinico-pathological variables. The differential expression of granzyme B was validated using conventional immunohistochemistry and was correlated to the cancer-specific patient survival. We found that a total of 37 proteins were differentially expressed between the tumor periphery and tumor center. Thirty-five of the proteins were upregulated in the tumor periphery compared to the center. These included proteins involved in cell proliferation, MAPK and PI3K/AKT signaling, apoptosis regulation, epithelial-to-mesenchymal transition, as well as immune cell markers. Among the most significantly upregulated proteins in the tumor periphery was granzyme B. Granzyme B upregulation in the tumor periphery correlated with a significantly reduced cancer-specific patient survival. In conclusion, this study highlights the unique cellular contexture of the tumor periphery in ccRCC. The correlation between granzyme B upregulation in the tumor periphery and patient survival suggests local selection pressure for aggressive tumor growth and disease progression. Our results underscore the potential of spatial biology for biomarker discovery in ccRCC and cancer in general.
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Affiliation(s)
- Felix Schneider
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Adam Kaczorowski
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Christina Jurcic
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, University Hospital Heidelberg, and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, University Hospital Heidelberg, and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, D-69120 Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
- Department of Urology, University Hospital Heidelberg, and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
| | - Anette Duensing
- Department of Urology, University Hospital Heidelberg, and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, 5117 Centre Avenue, Pittsburgh, PA 15213, USA
- Department of Pathology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Precision Oncology of Urological Malignancies, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, D-69120 Heidelberg, Germany
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5
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Zhang KS, Mayer P, Glemser PA, Tavakoli AA, Keymling M, Rotkopf LT, Meinzer C, Görtz M, Kauczor HU, Hielscher T, Stenzinger A, Bonekamp D, Hohenfellner M, Schlemmer HP. Are T2WI PI-RADS sub-scores of transition zone prostate lesions biased by DWI information? A multi-reader, single-center study. Eur J Radiol 2023; 167:111026. [PMID: 37639843 DOI: 10.1016/j.ejrad.2023.111026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE According to PI-RADS v2.1, T2-weighted imaging (T2WI) is the dominant sequence for transition zone (TZ) lesions. This study aimed to assess, whether diffusion-weighted imaging (DWI) information influences the assignment of T2WI scores. METHOD Out of 283 prostate MRI examinations with correlated biopsy results, fourty-four patients were selected retrospectively: first, 22 patients with a TZ lesion with T2WI and DWI scores ≥ 4, to represent lesions with unequivocal suspicion on T2WI and DWI. Second, 22 additional patients with TZ lesions of similar T2WI appearance but with corresponding DWI score ≤ 3 were added as control. Four residents and one board-certified radiologist each performed two assessments of the included patients: First, only T2WI was available (T2-only read); second, both T2WI and DWI sequences were available (biparametric read). Lesion scores were assessed using Wilcoxon signed-rank test, inter-reader agreement using weighted kappa and Kendall's W statistics, and sensitivity/specificity using McNemar test. RESULTS The T2WI scores were significantly different between the T2-only and biparametric read for 3 out of 4 residents (p ≤ 0.049) but not for the radiologist. The overall PI-RADS scores derived from the two reading sessions differed considerably for 35/220 cases (all readers pooled). Inter-reader agreement was fair for the T2WI and overall PI-RADS scores (mean kappa 0.27-0.30) and moderate for the DWI scores (mean kappa 0.43). CONCLUSIONS For inexperienced readers, assessment of T2WI is variable and potentially biased by availability of DWI information, which can lead to changes of overall PI-RADS score and consequently clinical management. Assessment of T2WI should be performed before reviewing DWI to ensure non-biased interpretation of TZ lesions in the dominant sequence.
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Affiliation(s)
- Kevin Sun Zhang
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Mayer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anoshirwan Andrej Tavakoli
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Myriam Keymling
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lukas Thomas Rotkopf
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Clara Meinzer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany; Junior Clinical Cooperation Unit 'Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany; Heidelberg University Medical School, Heidelberg, Germany.
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
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6
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Zhang KS, Neelsen CJO, Wennmann M, Glemser PA, Hielscher T, Weru V, Görtz M, Schütz V, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D. Same-day repeatability and Between-Sequence reproducibility of Mean ADC in PI-RADS lesions. Eur J Radiol 2023; 165:110898. [PMID: 37331287 DOI: 10.1016/j.ejrad.2023.110898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/23/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to assess repeatability after repositioning (inter-scan), intra-rater, inter-rater and inter-sequence variability of mean apparent diffusion coefficient (ADC) measurements in MRI-detected prostate lesions. METHOD Forty-three patients with suspicion for prostate cancer were included and received a clinical prostate bi-/multiparametric MRI examination with repeat scans of the T2-weighted and two DWI-weighted sequences (ssEPI and rsEPI). Two raters (R1 and R2) performed single-slice, 2D regions of interest (2D-ROIs) and 3D-segmentation-ROIs (3D-ROIs). Mean bias, corresponding limits of agreement (LoA), mean absolute difference, within-subject coefficient of variation (CoV) and repeatability/reproducibility coefficient (RC/RDC) were calculated. Bradley & Blackwood test was used for variance comparison. Linear mixed models (LMM) were used to account for multiple lesions per patient. RESULTS Inter-scan repeatability, intra-rater and inter-sequence reproducibility analysis of ADC showed no significant bias. 3D-ROIs demonstrated significantly less variability than 2D-ROIs (p < 0.01). Inter-rater comparison demonstrated small significant systematic bias of 57 × 10-6 mm2/s for 3D-ROIs (p < 0.001). Intra-rater RC, with the lowest variation, was 145 and 189 × 10-6 mm2/s for 3D- and 2D-ROIs, respectively. For 3D-ROIs of ssEPI, RCs and RDCs were 190-198 × 10-6 mm2/s for inter-scan, inter-rater and inter-sequence variation. No significant differences were found for inter-scan, inter-rater and inter-sequence variability. CONCLUSIONS In a single-scanner setting, single-slice ADC measurements showed considerable variation, which may be lowered using 3D-ROIs. For 3D-ROIs, we propose a cut-off of ∼ 200 × 10-6 mm2/s for differences introduced by repositioning, rater or sequence effects. The results suggest that follow-up measurements should be possible by different raters or sequences.
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Affiliation(s)
- Kevin Sun Zhang
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Vivienn Weru
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany; Junior clinical cooperation unit 'Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK), Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK), Germany; Heidelberg University Medical School, Heidelberg, Germany.
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Goertz L, Zopfs D, Pennig L, Jünger ST, Grunz JP, Timmer M, Görtz M, Huflage H, Luetkens KS, Kabbasch C, Zaeske C. Angiographic characteristics associated with rupture of small intracranial aneurysms. World Neurosurg 2023:S1878-8750(23)00849-5. [PMID: 37356486 DOI: 10.1016/j.wneu.2023.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Contrary to previous assumptions, there is increasing evidence that small intracranial aneurysms carry a relevant risk of rupture. The aim of this study was to identify angiographic characteristics of small ruptured aneurysms ≤7 mm and to evaluate their significance for clinical decision making. METHODS A total of 385 patients with 149 unruptured and 236 ruptured intracranial aneurysms were retrospectively compared. Two- and three-dimensional digital subtraction angiography was used to determine aneurysm location, various size parameters, angulations, and morphology, as well as parent artery diameter. RESULTS Aneurysms of the anterior communicating artery, the posterior inferior cerebellar artery and the internal carotid artery terminus had a significantly increased prevalence among ruptured aneurysms. Ruptured aneurysms were characterized by a significantly larger aneurysm height (area-under-the curve [AUC] 0.60, p<0.01) and inclination angle (AUC 0.61, p=0.02) in addition to a smaller dome (AUC 0.44, p=0.02) and neck width (AUC 0.38, p<0.01). Calculation of size ratios increases the predictive value for aneurysm rupture, with AUC-values of 0.77 for aspect ratio (p<0.01) and 0.76 for size ratio (p<0.01). Aneurysm morphology was not a significant factor after multivariable adjustment (p=0.92). Arterial hypertension was the only clinical risk factor significantly associated with rupture (p<0.01). CONCLUSIONS Of the numerous factors associated with aneurysm rupture, we propose aneurysmal location, aspect ratio (cut-off: 1.5), and inclination angle as the most important morphological factors for assessing the rupture risk of small aneurysms because these factors have high AUC values and are robust to changes after rupture.
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Affiliation(s)
- Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie T Jünger
- Center for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Marco Timmer
- Center for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Magdalena Görtz
- Urology Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | | | - Christoph Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Zaeske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Görtz M, Huber AK, Linz T, Schwab C, Stenzinger A, Goertz L, Bonekamp D, Schlemmer HP, Hohenfellner M. Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy. Diagnostics (Basel) 2023; 13:diagnostics13101761. [PMID: 37238245 DOI: 10.3390/diagnostics13101761] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
A negative multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy in patients with suspected prostate cancer (PC) results in clinical uncertainty, as the biopsy can be false negative. The clinical challenge is to determine the optimal follow-up and to select patients who will benefit from repeat biopsy. In this study, we evaluated the rate of significant PC (sPC, Gleason score ≥7) and PC detection in patients who received a follow-up mpMRI/ultrasound-guided biopsy for persistent PC suspicion after a negative mpMRI/ultrasound-guided biopsy. We identified 58 patients at our institution that underwent repeat targeted biopsy in case of PI-RADS lesions and systematic saturation biopsy between 2014 and 2022. At the initial biopsy, the median age was 59 years, and the median prostate specific antigen level was 6.7 ng/mL. Repeat biopsy after a median of 18 months detected sPC in 3/58 (5%) patients and Gleason score 6 PC in 11/58 (19%). Among 19 patients with a downgraded PI-RADS score at the follow-up mpMRI, none had sPC. In conclusion, men with an initial negative mpMRI/ultrasound-guided biopsy had a high likelihood of not harboring sPC at repeat biopsy (95%). Due to the small size of the study, further research is recommended.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Junior Clinical Cooperation Unit 'Multiparametric Methods for Early Detection of Prostate Cancer', German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ann-Kathrin Huber
- Medical Faculty, Ruprecht-Karls University of Heidelberg, 69117 Heidelberg, Germany
| | - Tim Linz
- Medical Faculty, Ruprecht-Karls University of Heidelberg, 69117 Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University of Heidelberg, 69120 Heidelberg, Germany
| | | | - Lukas Goertz
- Department of Radiology, Medical Faculty and University Hospital, University of Cologne, 50939 Cologne, Germany
| | - David Bonekamp
- Divison of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Divison of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
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9
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Görtz M, Baumgärtner K, Schmid T, Muschko M, Woessner P, Gerlach A, Byczkowski M, Sültmann H, Duensing S, Hohenfellner M. An artificial intelligence-based chatbot for prostate cancer education: Design and patient evaluation study. Digit Health 2023; 9:20552076231173304. [PMID: 37152238 PMCID: PMC10159259 DOI: 10.1177/20552076231173304] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Artificial intelligence (AI) is increasingly used in healthcare. AI-based chatbots can act as automated conversational agents, capable of promoting health and providing education at any time. The objective of this study was to develop and evaluate a user-friendly medical chatbot (prostate cancer communication assistant (PROSCA)) for provisioning patient information about early detection of prostate cancer (PC). Methods The chatbot was developed to provide information on prostate diseases, diagnostic tests for PC detection, stages, and treatment options. Ten men aged 49 to 81 years with suspicion of PC were enrolled in this study. Nine of ten patients used the chatbot during the evaluation period and filled out the questionnaires on usage and usability, perceived benefits, and potential for improvement. Results The chatbot was straightforward to use, with 78% of users not needing any assistance during usage. In total, 89% of the chatbot users in the study experienced a clear to moderate increase in knowledge about PC through the chatbot. All study participants who tested the chatbot would like to re-use a medical chatbot in the future and support the use of chatbots in the clinical routine. Conclusions Through the introduction of the chatbot PROSCA, we created and evaluated an innovative evidence-based health information tool in the field of PC, allowing targeted support for doctor-patient communication and offering great potential in raising awareness, patient education, and support. Our study revealed that a medical chatbot in the field of early PC detection is readily accepted and benefits patients as an additional informative tool.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital
Heidelberg, Heidelberg, Germany
- Junior Clinical Cooperation Unit,
Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center
(DKFZ), Heidelberg, Germany
| | - Kilian Baumgärtner
- Ruprecht-Karls University of
Heidelberg, Medical Faculty, Heidelberg, Germany
| | | | | | | | | | | | - Holger Sültmann
- Division of Cancer Genome Research, German Cancer Research Center
(DKFZ), Heidelberg, Germany
| | - Stefan Duensing
- Section of Molecular Urooncology,
Department of Urology, University of Heidelberg School of Medicine, Heidelberg,
Germany
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10
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Tavakoli AA, Hielscher T, Badura P, Görtz M, Kuder TA, Gnirs R, Schwab C, Hohenfellner M, Schlemmer HP, Bonekamp D. Contribution of Dynamic Contrast-enhanced and Diffusion MRI to PI-RADS for Detecting Clinically Significant Prostate Cancer. Radiology 2023; 306:186-199. [PMID: 35972360 DOI: 10.1148/radiol.212692] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Prostate Imaging Reporting and Data System (PI-RADS) version 2.0 requires multiparametric MRI of the prostate, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging sequences; however, the contribution of DCE imaging remains unclear. Purpose To assess whether DCE imaging in addition to apparent diffusion coefficient (ADC) and normalized T2 values improves PI-RADS version 2.0 for prediction of clinically significant prostate cancer (csPCa). Materials and Methods In this retrospective study, clinically reported PI-RADS lesions in consecutive men who underwent 3-T multiparametric MRI (T2-weighted, DWI, and DCE MRI) from May 2015 to September 2016 were analyzed quantitatively and compared with systematic and targeted MRI-transrectal US fusion biopsy. The normalized T2 signal (nT2), ADC measurement, mean early-phase DCE signal (mDCE), and heuristic DCE parameters were calculated. Logistic regression analysis indicated the most predictive DCE parameters for csPCa (Gleason grade group ≥2). Receiver operating characteristic parameter models were compared using the Obuchowski test. Recursive partitioning analysis determined ADC and mDCE value ranges for combined use with PI-RADS. Results Overall, 260 men (median age, 64 years [IQR, 58-69 years]) with 432 lesions (csPCa [n = 152] and no csPCa [n = 280]) were included. The mDCE parameter was predictive of csPCa when accounting for the ADC and nT2 parameter in the peripheral zone (odds ratio [OR], 1.76; 95% CI: 1.30, 2.44; P = .001) but not the transition zone (OR, 1.17; 95% CI: 0.81, 1.69; P = .41). Recursive partitioning analysis selected an ADC cutoff of 0.897 × 10-3 mm2/sec (P = .04) as a classifier for peripheral zone lesions with a PI-RADS score assessed on the ADC map (hereafter, ADC PI-RADS) of 3. The mDCE parameter did not differentiate ADC PI-RADS 3 lesions (P = .11), but classified lesions with ADC PI-RADS scores greater than 3 with low ADC values (less than 0.903 × 10-3 mm2/sec, P < .001) into groups with csPCa rates of 70% and 97% (P = .008). A lesion size cutoff of 1.5 cm and qualitative DCE parameters were not defined as classifiers according to recursive partitioning (P > .05). Conclusion Quantitative or qualitative dynamic contrast-enhanced MRI was not relevant for Prostate Imaging Reporting and Data System (PI-RADS) 3 lesion risk stratification, while quantitative apparent diffusion coefficient (ADC) values were helpful in upgrading PI-RADS 3 and PI-RADS 4 lesions. Quantitative ADC measurement may be more important for risk stratification than current methods in future versions of PI-RADS. © RSNA, 2022 Online supplemental material is available for this article See also the editorial by Goh in this issue.
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Affiliation(s)
- Anoshirwan Andrej Tavakoli
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Thomas Hielscher
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Patrick Badura
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Magdalena Görtz
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Tristan Anselm Kuder
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Regula Gnirs
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Constantin Schwab
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - David Bonekamp
- From the Department of Radiology (E010) (A.A.T., P.B., R.G., H.P.S., D.B.), Division of Biostatistics (T.H.), and Department of Medical Physics (T.A.K.), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; and Department of Urology (M.G., M.H.) and Institute of Pathology (C.S.), University of Heidelberg Medical Center, Heidelberg, Germany
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11
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Eickelschulte S, Riediger AL, Angeles AK, Janke F, Duensing S, Sültmann H, Görtz M. Biomarkers for the Detection and Risk Stratification of Aggressive Prostate Cancer. Cancers (Basel) 2022; 14:cancers14246094. [PMID: 36551580 PMCID: PMC9777028 DOI: 10.3390/cancers14246094] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Current strategies for the clinical management of prostate cancer are inadequate for a precise risk stratification between indolent and aggressive tumors. Recently developed tissue-based molecular biomarkers have refined the risk assessment of the disease. The characterization of tissue biopsy components and subsequent identification of relevant tissue-based molecular alterations have the potential to improve the clinical decision making and patient outcomes. However, tissue biopsies are invasive and spatially restricted due to tumor heterogeneity. Therefore, there is an urgent need for complementary diagnostic and prognostic options. Liquid biopsy approaches are minimally invasive with potential utility for the early detection, risk stratification, and monitoring of tumors. In this review, we focus on tissue and liquid biopsy biomarkers for early diagnosis and risk stratification of prostate cancer, including modifications on the genomic, epigenomic, transcriptomic, and proteomic levels. High-risk molecular alterations combined with orthogonal clinical parameters can improve the identification of aggressive tumors and increase patient survival.
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Affiliation(s)
- Samaneh Eickelschulte
- Junior Clinical Cooperation Unit, Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Anja Lisa Riediger
- Junior Clinical Cooperation Unit, Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, 69120 Heidelberg, Germany
| | - Arlou Kristina Angeles
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Florian Janke
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Holger Sültmann
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Magdalena Görtz
- Junior Clinical Cooperation Unit, Multiparametric Methods for Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-42-2603
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12
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Zhang KS, Schelb P, Netzer N, Tavakoli AA, Keymling M, Wehrse E, Hog R, Rotkopf LT, Wennmann M, Glemser PA, Thierjung H, von Knebel Doeberitz N, Kleesiek J, Görtz M, Schütz V, Hielscher T, Stenzinger A, Hohenfellner M, Schlemmer HP, Maier-Hein K, Bonekamp D. Pseudoprospective Paraclinical Interaction of Radiology Residents With a Deep Learning System for Prostate Cancer Detection: Experience, Performance, and Identification of the Need for Intermittent Recalibration. Invest Radiol 2022; 57:601-612. [PMID: 35467572 DOI: 10.1097/rli.0000000000000878] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the prospective utility of a previously retrospectively validated convolutional neural network (CNN) for prostate cancer (PC) detection on prostate magnetic resonance imaging (MRI). MATERIALS AND METHODS The biparametric (T2-weighted and diffusion-weighted) portion of clinical multiparametric prostate MRI from consecutive men included between November 2019 and September 2020 was fully automatically and individually analyzed by a CNN briefly after image acquisition (pseudoprospective design). Radiology residents performed 2 research Prostate Imaging Reporting and Data System (PI-RADS) assessments of the multiparametric dataset independent from clinical reporting (paraclinical design) before and after review of the CNN results and completed a survey. Presence of clinically significant PC was determined by the presence of an International Society of Urological Pathology grade 2 or higher PC on combined targeted and extended systematic transperineal MRI/transrectal ultrasound fusion biopsy. Sensitivities and specificities on a patient and prostate sextant basis were compared using the McNemar test and compared with the receiver operating characteristic (ROC) curve of CNN. Survey results were summarized as absolute counts and percentages. RESULTS A total of 201 men were included. The CNN achieved an ROC area under the curve of 0.77 on a patient basis. Using PI-RADS ≥3-emulating probability threshold (c3), CNN had a patient-based sensitivity of 81.8% and specificity of 54.8%, not statistically different from the current clinical routine PI-RADS ≥4 assessment at 90.9% and 54.8%, respectively ( P = 0.30/ P = 1.0). In general, residents achieved similar sensitivity and specificity before and after CNN review. On a prostate sextant basis, clinical assessment possessed the highest ROC area under the curve of 0.82, higher than CNN (AUC = 0.76, P = 0.21) and significantly higher than resident performance before and after CNN review (AUC = 0.76 / 0.76, P ≤ 0.03). The resident survey indicated CNN to be helpful and clinically useful. CONCLUSIONS Pseudoprospective paraclinical integration of fully automated CNN-based detection of suspicious lesions on prostate multiparametric MRI was demonstrated and showed good acceptance among residents, whereas no significant improvement in resident performance was found. General CNN performance was preserved despite an observed shift in CNN calibration, identifying the requirement for continuous quality control and recalibration.
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Affiliation(s)
- Kevin Sun Zhang
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | | | | | | | - Myriam Keymling
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | - Eckhard Wehrse
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | - Robert Hog
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | | | - Markus Wennmann
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | | | - Heidi Thierjung
- From the Division of Radiology, German Cancer Research Center (DKFZ)
| | | | | | | | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center
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13
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Görtz M, Nyarangi-Dix JN, Pursche L, Schütz V, Reimold P, Schwab C, Stenzinger A, Sültmann H, Duensing S, Schlemmer HP, Bonekamp D, Hohenfellner M, Radtke JP. Impact of Surgeon's Experience in Rigid versus Elastic MRI/TRUS-Fusion Biopsy to Detect Significant Prostate Cancer Using Targeted and Systematic Cores. Cancers (Basel) 2022; 14:cancers14040886. [PMID: 35205634 PMCID: PMC8870088 DOI: 10.3390/cancers14040886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary For the transfer of suspicious lesions in magnetic resonance imaging (MRI) to ultrasound in prostate fusion biopsy, biopsy platforms can be distinguished by rigid or elastic image registration. This study evaluates the detection rate of these different platforms for transperineal fusion-guided prostate biopsy to detect clinically significant prostate cancer under consideration of the surgeon’s learning curve. In our cohort, rigid and elastic registration systems showed a similar prostate cancer detection rate in experienced surgeons, whereas novices seem to benefit from rigid fusion. In the total cohort, targeted fusion biopsy with a rigid registration system outperformed elastic registration target biopsy with a superior significant prostate cancer detection rate, each compared to systematic saturation biopsy. Thus, rigid target biopsy aided in reducing targeting errors that result in missing MRI-visualized significant prostate cancer. These results can provide valuable decision support in selecting a biopsy fusion platform to increase the detection rate and risk stratification of prostate cancer, especially at the beginning of the surgeon’s learning curve. Abstract Multiparametric magnetic resonance imaging (mpMRI) and MRI/ultrasound fusion-targeted prostate biopsy (FB) have excellent sensitivity in detecting significant prostate cancer (sPC). FB platforms can be distinguished by rigid (RTB) or elastic image registration (ETB). We compared RTB and ETB by analyzing sPC detection rates of both RTB and ETB at different stages of the surgeons’ learning curve. Patients undergoing RTB between 2015–2017 (n = 502) were compared to patients undergoing ETB from 2017–2019 (n = 437). SPC detection rates were compared by Chi-square-test on patient-basis. Combination of transperineal systematic biopsy and each TB served as reference and sub-analyses were performed for different grades of surgeon’s experience. In the RTB subgroup, 233 men (46%) had sPC, compared to 201 (46%) in the ETB subgroup. RTB alone detected 94% of men with sPC and ETB 87% (p = 0.02). However, for at least intermediate-experienced surgeons (>100 FB), no differences occurred between RTB and ETB. In the total cohort, at least intermediate-experienced surgeons detected significantly more sPC (10%, p = 0.008) than novices. Thus, targeted transperineal MRI/TRUS-FB with a RTB registration system showed a similar sPC detection rate to ETB in experienced surgeons but a superior sPC detection rate to ETB in the total cohort. Low-experienced surgeons seem to benefit from RTB.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Helmholtz Young Investigator Group ‘Multiparametric Methods for Early Detection of Prostate Carcinoma’, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: or ; Tel.: +49-62-2156-8820
| | - Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Lars Pursche
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Constantin Schwab
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Albrecht Stenzinger
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Holger Sültmann
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany;
| | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, 69120 Heidelberg, Germany;
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
- Department of Urology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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14
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Görtz M, Byczkowski M, Rath M, Schütz V, Reimold P, Gasch C, Simpfendörfer T, März K, Seitel A, Nolden M, Ross T, Mindroc-Filimon D, Michael D, Metzger J, Onogur S, Speidel S, Mündermann L, Fallert J, Müller M, von Knebel Doeberitz M, Teber D, Seitz P, Maier-Hein L, Duensing S, Hohenfellner M. A Platform and Multisided Market for Translational, Software-Defined Medical Procedures in the Operating Room (OP 4.1): Proof-of-Concept Study. JMIR Med Inform 2022; 10:e27743. [PMID: 35049510 PMCID: PMC8814925 DOI: 10.2196/27743] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/25/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although digital and data-based technologies are widespread in various industries in the context of Industry 4.0, the use of smart connected devices in health care is still in its infancy. Innovative solutions for the medical environment are affected by difficult access to medical device data and high barriers to market entry because of proprietary systems. Objective In the proof-of-concept project OP 4.1, we show the business viability of connecting and augmenting medical devices and data through software add-ons by giving companies a technical and commercial platform for the development, implementation, distribution, and billing of innovative software solutions. Methods The creation of a central platform prototype requires the collaboration of several independent market contenders, including medical users, software developers, medical device manufacturers, and platform providers. A dedicated consortium of clinical and scientific partners as well as industry partners was set up. Results We demonstrate the successful development of the prototype of a user-centric, open, and extensible platform for the intelligent support of processes starting with the operating room. By connecting heterogeneous data sources and medical devices from different manufacturers and making them accessible for software developers and medical users, the cloud-based platform OP 4.1 enables the augmentation of medical devices and procedures through software-based solutions. The platform also allows for the demand-oriented billing of apps and medical devices, thus permitting software-based solutions to fast-track their economic development and become commercially successful. Conclusions The technology and business platform OP 4.1 creates a multisided market for the successful development, implementation, distribution, and billing of new software solutions in the operating room and in the health care sector in general. Consequently, software-based medical innovation can be translated into clinical routine quickly, efficiently, and cost-effectively, optimizing the treatment of patients through smartly assisted procedures.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mathias Rath
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Reimold
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Claudia Gasch
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Keno März
- German Cancer Research Center, Heidelberg, Germany
| | | | - Marco Nolden
- German Cancer Research Center, Heidelberg, Germany
| | - Tobias Ross
- German Cancer Research Center, Heidelberg, Germany
| | | | | | | | - Sinan Onogur
- German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | | | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, Heidelberg, Germany
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15
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Netzer N, Weißer C, Schelb P, Wang X, Qin X, Görtz M, Schütz V, Radtke JP, Hielscher T, Schwab C, Stenzinger A, Kuder TA, Gnirs R, Hohenfellner M, Schlemmer HP, Maier-Hein KH, Bonekamp D. Fully Automatic Deep Learning in Bi-institutional Prostate Magnetic Resonance Imaging: Effects of Cohort Size and Heterogeneity. Invest Radiol 2021; 56:799-808. [PMID: 34049336 DOI: 10.1097/rli.0000000000000791] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/27/2022]
Abstract
BACKGROUND The potential of deep learning to support radiologist prostate magnetic resonance imaging (MRI) interpretation has been demonstrated. PURPOSE The aim of this study was to evaluate the effects of increased and diversified training data (TD) on deep learning performance for detection and segmentation of clinically significant prostate cancer-suspicious lesions. MATERIALS AND METHODS In this retrospective study, biparametric (T2-weighted and diffusion-weighted) prostate MRI acquired with multiple 1.5-T and 3.0-T MRI scanners in consecutive men was used for training and testing of prostate segmentation and lesion detection networks. Ground truth was the combination of targeted and extended systematic MRI-transrectal ultrasound fusion biopsies, with significant prostate cancer defined as International Society of Urological Pathology grade group greater than or equal to 2. U-Nets were internally validated on full, reduced, and PROSTATEx-enhanced training sets and subsequently externally validated on the institutional test set and the PROSTATEx test set. U-Net segmentation was calibrated to clinically desired levels in cross-validation, and test performance was subsequently compared using sensitivities, specificities, predictive values, and Dice coefficient. RESULTS One thousand four hundred eighty-eight institutional examinations (median age, 64 years; interquartile range, 58-70 years) were temporally split into training (2014-2017, 806 examinations, supplemented by 204 PROSTATEx examinations) and test (2018-2020, 682 examinations) sets. In the test set, Prostate Imaging-Reporting and Data System (PI-RADS) cutoffs greater than or equal to 3 and greater than or equal to 4 on a per-patient basis had sensitivity of 97% (241/249) and 90% (223/249) at specificity of 19% (82/433) and 56% (242/433), respectively. The full U-Net had corresponding sensitivity of 97% (241/249) and 88% (219/249) with specificity of 20% (86/433) and 59% (254/433), not statistically different from PI-RADS (P > 0.3 for all comparisons). U-Net trained using a reduced set of 171 consecutive examinations achieved inferior performance (P < 0.001). PROSTATEx training enhancement did not improve performance. Dice coefficients were 0.90 for prostate and 0.42/0.53 for MRI lesion segmentation at PI-RADS category 3/4 equivalents. CONCLUSIONS In a large institutional test set, U-Net confirms similar performance to clinical PI-RADS assessment and benefits from more TD, with neither institutional nor PROSTATEx performance improved by adding multiscanner or bi-institutional TD.
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Affiliation(s)
| | | | | | | | | | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center
| | | | | | | | | | | | - Regula Gnirs
- From the Division of Radiology, German Cancer Research Center
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16
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Nientiedt C, Budczies J, Endris V, Kirchner M, Schwab C, Jurcic C, Behnisch R, Hoveida S, Lantwin P, Kaczorowski A, Geisler C, Dieffenbacher S, Falkenbach F, Franke D, Görtz M, Heller M, Himmelsbach R, Pecqueux C, Rath M, Reimold P, Schütz V, Simunovic I, Walter E, Hofer L, Gasch C, Schönberg G, Pursche L, Hatiboglu G, Nyarangi-Dix J, Sültmann H, Zschäbitz S, Koerber SA, Jäger D, Debus J, Duensing A, Schirmacher P, Hohenfellner M, Stenzinger A, Duensing S. Mutations in TP53 or DNA damage repair genes define poor prognostic subgroups in primary prostate cancer. Urol Oncol 2021; 40:8.e11-8.e18. [PMID: 34325986 DOI: 10.1016/j.urolonc.2021.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/03/2021] [Revised: 06/11/2021] [Accepted: 06/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mutations in DNA damage repair genes, in particular genes involved in homology-directed repair, define a subgroup of men with prostate cancer with a more unfavorable prognosis but a therapeutic vulnerability to PARP inhibition. In current practice, mutational testing of prostate cancer patients is commonly done late i.e., when the tumor is castration resistant. In addition, most sequencing panels do not include TP53, one of the most crucial tumor suppressor genes in human cancer. In this proof-of-concept study, we sought to extend the clinical use of these molecular markers by exploring the early prognostic impact of mutations in TP53 and DNA damage repair genes in men with primary, nonmetastatic prostate cancer undergoing radical prostatectomy (RPX). METHODS Tumor specimens from a cohort of 68 RPX patients with intermediate (n = 11, 16.2%) or high-risk (n = 57, 83.8%) disease were analyzed by targeted next generation sequencing using a 37 DNA damage repair and checkpoint gene panel including TP53. Sequencing results were correlated to clinicopathologic variables as well as PSA persistence or time to PSA failure. In addition, the distribution of TP53 and DNA damage repair gene mutations was analyzed in three large publicly available datasets (TCGA, MSKCC and SU2C). RESULTS Of 68 primary prostate cancers analyzed, 23 (33.8%) were found to harbor a mutation in either TP53 (n = 12, 17.6%) or a DNA damage repair gene (n = 11, 16.2%). The vast majority of these mutations (22 of 23, 95.7%) were detected in primary tumors from patients with high-risk features. These mutations were mutually exclusive in our cohort and additional data mining suggests an enrichment of DNA damage repair gene mutations in TP53 wild-type tumors. Mutations in either TP53 or a DNA damage repair gene were associated with a significantly worse prognosis after RPX. Importantly, the presence of TP53/DNA damage repair gene mutations was an independent risk factor for PSA failure or PSA persistence in multivariate Cox regression models. CONCLUSION TP53 or DNA damage repair gene mutations are frequently detected in primary prostate cancer with high-risk features and define a subgroup of patients with an increased risk for PSA failure or persistence after RPX. The significant adverse impact of these alterations on patient prognosis may be exploited to identify men with prostate cancer who may benefit from a more intensified treatment.
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Affiliation(s)
- Cathleen Nientiedt
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, Germany
| | - Jan Budczies
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg, Germany
| | - Volker Endris
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg, Germany
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg, Germany
| | - Christina Jurcic
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, Heidelberg, Germany
| | - Rouven Behnisch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130, Heidelberg, Germany
| | - Shirin Hoveida
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, Heidelberg, Germany
| | - Philippa Lantwin
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, Heidelberg, Germany
| | - Adam Kaczorowski
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, Heidelberg, Germany
| | - Christine Geisler
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Svenja Dieffenbacher
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Fabian Falkenbach
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Desiree Franke
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Martina Heller
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Ruth Himmelsbach
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Carine Pecqueux
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Mathias Rath
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Iva Simunovic
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Elena Walter
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Luisa Hofer
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Claudia Gasch
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Gita Schönberg
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Lars Pursche
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Holger Sültmann
- Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Im Neuenheimer Feld 460, Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany
| | - Anette Duensing
- Cancer Therapeutics Program and Department of Pathology, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, 5117 Centre Avenue, Pittsburgh, USA; Precision Oncology of Urological Malignancies, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, Heidelberg, Germany.
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 517, Heidelberg, Germany.
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17
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Schütz V, Güttlein M, Würkner D, Hofer L, Reimold P, Kaltenecker K, Tosev G, Görtz M, Hohenfellner M, Nyarangi-Dix J. Retzius-sparing vs. conventional robotic assisted radical prostatectomy in a prospective, randomised trial – early functional outcome and quality of life. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01473-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Görtz M, Hohenfellner M. Re: Adjuvant Radiotherapy Versus Early Salvage Radiotherapy Following Radical Prostatectomy (TROG 08.03/ANZUP RAVES): A Randomised, Controlled, Phase 3, Non-inferiority Trial. Eur Urol 2021; 79:893-894. [PMID: 33608153 DOI: 10.1016/j.eururo.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
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19
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Tavakoli AA, Kuder TA, Tichy D, Radtke JP, Görtz M, Schütz V, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D. Measured Multipoint Ultra-High b-Value Diffusion MRI in the Assessment of MRI-Detected Prostate Lesions. Invest Radiol 2021; 56:94-102. [PMID: 32930560 DOI: 10.1097/rli.0000000000000712] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess quantitative ultra-high b-value (UHB) diffusion magnetic resonance imaging (MRI)-derived parameters in comparison to standard clinical apparent diffusion coefficient (SD-ADC-2b-1000, SD-ADC-2b-1500) for the prediction of clinically significant prostate cancer, defined as Gleason Grade Group greater than or equal to 2. MATERIALS AND METHODS Seventy-three patients who underwent 3-T prostate MRI with diffusion-weighted imaging acquired at b = 50/500/1000/1500s/mm2 and b = 100/500/1000/1500/2250/3000/4000 s/mm2 were included. Magnetic resonance lesions were segmented manually on individual sequences, then matched to targeted transrectal ultrasonography/MRI fusion biopsies. Monoexponential 2-point and multipoint fits of standard diffusion and of UHB diffusion were calculated with incremental b-values. Furthermore, a kurtosis fit with parameters Dapp and Kapp with incremental b-values was obtained. Each parameter was examined for prediction of clinically significant prostate cancer using bootstrapped receiver operating characteristics and decision curve analysis. Parameter models were compared using Vuong test. RESULTS Fifty of 73 men (age, 66 years [interquartile range, 61-72]; prostate-specific antigen, 6.6 ng/mL [interquartile range, 5-9.7]) had 64 MRI-detected lesions. The performance of SD-ADC-2b-1000 (area under the curve, 0.82) and SD-ADC-2b-1500 (area under the curve, 0.82) was not statistically different (P = 0.99), with SD-ADC-2b-1500 selected as reference. Compared with the reference model, none of the 19 tested logistic regression parameter models including multipoint and 2-point UHB-ADC, Dapp, and Kapp with incremental b-values of up to 4000 s/mm2 outperformed SD-ADC-2b-1500 (all P's > 0.05). Decision curve analysis confirmed these results indicating no higher net benefit for UHB parameters in comparison to SD-ADC-2b-1500 in the clinically important range from 3% to 20% of cancer threshold probability. Net reduction analysis showed no reduction of MR lesions requiring biopsy. CONCLUSIONS Despite evaluation of a large b-value range and inclusion of 2-point, multipoint, and kurtosis models, none of the parameters provided better predictive performance than standard 2-point ADC measurements using b-values 50/1000 or 50/1500. Our results suggest that most of the diagnostic benefits available in diffusion MRI are already represented in an ADC composed of one low and one 1000 to 1500 s/mm2 b-value.
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Affiliation(s)
| | | | - Diana Tichy
- Division of Biostatistics, German Cancer Research Center (DKFZ)
| | | | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center
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20
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Wang X, Hielscher T, Radtke JP, Görtz M, Schütz V, Kuder TA, Gnirs R, Schwab C, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D. Comparison of single-scanner single-protocol quantitative ADC measurements to ADC ratios to detect clinically significant prostate cancer. Eur J Radiol 2021; 136:109538. [PMID: 33482592 DOI: 10.1016/j.ejrad.2021.109538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/08/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mean ADC has high predictive value for the presence of clinically significant prostate cancer (sPC). Measurement variability is introduced by different scanners, protocols, intra-and inter-patient variation. Internal calibration by ADC ratios can address such fluctuations however can potentially lower the biological value of quantitative ADC determination by being sensitive to deviations in reference tissue signal. PURPOSE To better understand the predictive value of quantitative ADC measurements in comparison to internal reference ratios when measured in a single scanner, single protocol setup. MATERIALS AND METHODS 284 consecutive patients who underwent 3 T MRI on a single scanner followed by MRI-transrectal ultrasound fusion biopsy were included. A board-certified radiologist retrospectively reviewed all MRIs blinded to clinical information and placed regions of interest (ROI) on all focal lesions and the following reference regions: normal-appearing peripheral zone (PZNL) and transition zone (TZNL), the urinary bladder (BLA), and right and left internal obturator muscle (RIOM, LIOM). ROI-based mean ADC and ADC ratios to the reference regions were compared regarding their ability to predict the aggressiveness of prostate cancer. Spearman's rank correlation coefficient was used to estimate the correlation between ADC parameters, Gleason score (GS) and ADC ratios. The primary endpoint was presence of sPC, defined as a GS ≥ 3 + 4. Univariable and multivariable logistic regression models were constructed to predict sPC. Receiver operating characteristics curves (ROC) were used for visualization; DeLong test was used to evaluate the differences of the area under the curve (AUC). Bias-corrected AUC values and corresponding 95 %-CI were calculated using bootstrapping with 100 bootstrap samples. RESULTS After exclusion of patients who received prior treatment, 259 patients were included in the final cohort of which 220 harbored 351 MR lesions. Mean ADC and ADC ratios demonstrated a negative correlation with the GS. Mean ADC had the strongest correlation with ρ of -0.34, followed by ADCratioPZNL (ρ=-0.32). All ADC parameters except ADCratioLIOM (p = 0.07) were associated with sPC p<0.05). Mean ADC and ADCratioPZNL had the highest ROC AUC of all parameters (0.68). Multivariable models with mean ADC improve predictive performance. CONCLUSIONS A highly standardized single-scanner mean ADC measurement could not be improved upon using any of the single ADC ratio parameters or combinations of these parameters in predicting the aggressiveness of prostate cancer.
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Affiliation(s)
- Xianfeng Wang
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiology, Affiliated Hospital of Guilin Medical University, Guangxi, Guilin, PR China
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Philipp Radtke
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Tristan Anselm Kuder
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Regula Gnirs
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Germany.
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21
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Schelb P, Tavakoli AA, Tubtawee T, Hielscher T, Radtke JP, Görtz M, Schütz V, Kuder TA, Schimmöller L, Stenzinger A, Hohenfellner M, Schlemmer HP, Bonekamp D. Comparison of Prostate MRI Lesion Segmentation Agreement Between Multiple Radiologists and a Fully Automatic Deep Learning System. ROFO-FORTSCHR RONTG 2020; 193:559-573. [PMID: 33212541 DOI: 10.1055/a-1290-8070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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
PURPOSE A recently developed deep learning model (U-Net) approximated the clinical performance of radiologists in the prediction of clinically significant prostate cancer (sPC) from prostate MRI. Here, we compare the agreement between lesion segmentations by U-Net with manual lesion segmentations performed by different radiologists. MATERIALS AND METHODS 165 patients with suspicion for sPC underwent targeted and systematic fusion biopsy following 3 Tesla multiparametric MRI (mpMRI). Five sets of segmentations were generated retrospectively: segmentations of clinical lesions, independent segmentations by three radiologists, and fully automated bi-parametric U-Net segmentations. Per-lesion agreement was calculated for each rater by averaging Dice coefficients with all overlapping lesions from other raters. Agreement was compared using descriptive statistics and linear mixed models. RESULTS The mean Dice coefficient for manual segmentations showed only moderate agreement at 0.48-0.52, reflecting the difficult visual task of determining the outline of otherwise jointly detected lesions. U-net segmentations were significantly smaller than manual segmentations (p < 0.0001) and exhibited a lower mean Dice coefficient of 0.22, which was significantly lower compared to manual segmentations (all p < 0.0001). These differences remained after correction for lesion size and were unaffected between sPC and non-sPC lesions and between peripheral and transition zone lesions. CONCLUSION Knowledge of the order of agreement of manual segmentations of different radiologists is important to set the expectation value for artificial intelligence (AI) systems in the task of prostate MRI lesion segmentation. Perfect agreement (Dice coefficient of one) should not be expected for AI. Lower Dice coefficients of U-Net compared to manual segmentations are only partially explained by smaller segmentation sizes and may result from a focus on the lesion core and a small relative lesion center shift. Although it is primarily important that AI detects sPC correctly, the Dice coefficient for overlapping lesions from multiple raters can be used as a secondary measure for segmentation quality in future studies. KEY POINTS · Intermediate human Dice coefficients reflect the difficulty of outlining jointly detected lesions.. · Lower Dice coefficients of deep learning motivate further research to approximate human perception.. · Comparable predictive performance of deep learning appears independent of Dice agreement.. · Dice agreement independent of significant cancer presence indicates indistinguishability of some benign imaging findings.. · Improving DWI to T2 registration may improve the observed U-Net Dice coefficients.. CITATION FORMAT · Schelb P, Tavakoli AA, Tubtawee T et al. Comparison of Prostate MRI Lesion Segmentation Agreement Between Multiple Radiologists and a Fully Automatic Deep Learning System. Fortschr Röntgenstr 2021; 193: 559 - 573.
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Affiliation(s)
- Patrick Schelb
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Teeravut Tubtawee
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan-Philipp Radtke
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Tristan Anselm Kuder
- Division of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lars Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany
| | | | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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22
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Görtz M, Radtke J, Hatiboglu G, Schütz V, Tosev G, Güttlein M, Leichsenring J, Stenzinger A, Bonekamp D, Schlemmer H, Hohenfellner M, Nyarangi-Dix J. The value of PSA density in PI-RADS 3 lesions on multiparametric MRI - a strategy to avoid unnecessary prostate biopsies. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33752-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Nientiedt C, Endris V, Jenzer M, Mansour J, Sedehi NTP, Pecqueux C, Volckmar AL, Leichsenring J, Neumann O, Kirchner M, Hoveida S, Lantwin P, Kaltenecker K, Dieffenbacher S, Gasch C, Hofer L, Franke D, Tosev G, Görtz M, Schütz V, Radtke JP, Nyarangi-Dix J, Hatiboglu G, Simpfendörfer T, Schönberg G, Isaac S, Teber D, Koerber SA, Christofi G, Czink E, Kreuter R, Apostolidis L, Kratochwil C, Giesel F, Haberkorn U, Debus J, Sültmann H, Zschäbitz S, Jäger D, Duensing A, Schirmacher P, Grüllich C, Hohenfellner M, Stenzinger A, Duensing S. High prevalence of DNA damage repair gene defects and TP53 alterations in men with treatment-naïve metastatic prostate cancer -Results from a prospective pilot study using a 37 gene panel. Urol Oncol 2020; 38:637.e17-637.e27. [PMID: 32280037 DOI: 10.1016/j.urolonc.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/24/2019] [Revised: 01/14/2020] [Accepted: 03/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Defects in DNA damage repair genes characterize a subset of men with prostate cancer and provide an attractive opportunity for precision oncology approaches. The prevalence of such perturbations in newly diagnosed, treatment-naïve patients with a high risk for lethal disease outcome, however, has not been sufficiently explored. PATIENTS AND METHODS Prostate cancer specimens from 67 men with newly diagnosed early onset, localized high-risk/locally advanced or metastatic prostate cancer were included in this prospective pilot study. Tumor samples, including 30 prostate biopsies, were analyzed by targeted next generation sequencing using a formalin-fixed, paraffin-embedded tissue-optimized 37 DNA damage repair and checkpoint gene panel. RESULTS The drop-out rate due to an insufficient quantity of DNA was 4.5% (3 of 67 patients). In the remaining 64 patients, the rate of pathogenic DNA damage repair gene mutations was 26.6%. The highest rate of pathogenic DNA damage repair and checkpoint gene mutations was found in men with treatment-naïve metastatic prostate cancer (38.9%). In addition, a high number of likely pathogenic mutations and gene deletions were detected. Altogether, one or more pathogenic mutation, likely pathogenic mutation or gene deletion affected 43 of 64 patients (67.2%) including 29 of 36 patients (80.6%) with treatment-naïve metastatic prostate cancer. Men with metastatic prostate cancer showed a high prevalence of alterations in TP53 (36.1%). CONCLUSIONS This pilot study demonstrates the feasibility, performance and clinical relevance of somatic targeted next generation sequencing using a unique 37 DNA damage repair and checkpoint gene panel under routine conditions. Our results indicate that this approach can detect actionable DNA repair gene alterations, uncommon mutations as well as mutations associated with therapy resistance in a high number of patients, in particular patients with treatment-naïve metastatic prostate cancer.
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Affiliation(s)
- Cathleen Nientiedt
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Volker Endris
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Jenzer
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Josef Mansour
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Carine Pecqueux
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna-Lena Volckmar
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Leichsenring
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Neumann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Shirin Hoveida
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philippa Lantwin
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katrin Kaltenecker
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Claudia Gasch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Luisa Hofer
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Desiree Franke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georgi Tosev
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan-Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Gita Schönberg
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sanjay Isaac
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georgia Christofi
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Elena Czink
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Rebecca Kreuter
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg; Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg; Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg; Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Sültmann
- Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Duensing
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Cancer Therapeutics Program and Department of Pathology, University of Pittsburgh School of Medicine, Hillman Cancer Center, Pittsburgh, PA; Precision Oncology of Urological Malignancies, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | | | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
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Nyarangi-Dix JN, Görtz M, Gradinarov G, Hofer L, Schütz V, Gasch C, Radtke JP, Hohenfellner M. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer. BMC Urol 2019; 19:113. [PMID: 31718600 PMCID: PMC6852736 DOI: 10.1186/s12894-019-0550-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 03/01/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background Retzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort. Methods Prospectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery. Results 3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out. Considering the 17 preoperatively potent patients who underwent bi- or unilateral nerve-sparing surgery, 41% reported their first sexual intercourse within 1 year after rsRARP. 84% of patients had ≥pT3a disease and 42% positive surgical margins. A lymphadenectomy was done in 94% of patients with a median lymph node removal of 15 and lymph node metastasis in 13%. 34% underwent adjuvant radiotherapy and 22% adjuvant androgen deprivation therapy (ADT). 1-year recurrence-free survival was 96%, including 25% of patients on adjuvant or salvage ADT. Conclusions RsRARP in high-risk PCa is feasible and results in excellent continence rates, even after postoperative radiotherapy. The potency rates are promising but need further clarification in larger cohorts. Reliable oncologic outcomes require longterm follow-up and are awaited.
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Affiliation(s)
- Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Georgi Gradinarov
- Ruprecht-Karls University of Heidelberg, Medical Faculty, Heidelberg, Germany
| | - Luisa Hofer
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Claudia Gasch
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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25
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Radtke JP, Giganti F, Wiesenfarth M, Stabile A, Marenco J, Orczyk C, Kasivisvanathan V, Nyarangi-Dix JN, Schütz V, Dieffenbacher S, Görtz M, Stenzinger A, Roth W, Freeman A, Punwani S, Bonekamp D, Schlemmer HP, Hohenfellner M, Emberton M, Moore CM. Prediction of significant prostate cancer in biopsy-naïve men: Validation of a novel risk model combining MRI and clinical parameters and comparison to an ERSPC risk calculator and PI-RADS. PLoS One 2019; 14:e0221350. [PMID: 31450235 PMCID: PMC6710031 DOI: 10.1371/journal.pone.0221350] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Risk models (RM) need external validation to assess their value beyond the setting in which they were developed. We validated a RM combining mpMRI and clinical parameters for the probability of harboring significant prostate cancer (sPC, Gleason Score ≥ 3+4) for biopsy-naïve men. MATERIAL AND METHODS The original RM was based on data of 670 biopsy-naïve men from Heidelberg University Hospital who underwent mpMRI with PI-RADS scoring prior to MRI/TRUS-fusion biopsy 2012-2015. Validity was tested by a consecutive cohort of biopsy-naïve men from Heidelberg (n = 160) and externally by a cohort of 133 men from University College London Hospital (UCLH). Assessment of validity was performed at fusion-biopsy by calibration plots, receiver operating characteristics curve and decision curve analyses. The RM`s performance was compared to ERSPC-RC3, ERSPC-RC3+PI-RADSv1.0 and PI-RADSv1.0 alone. RESULTS SPC was detected in 76 men (48%) at Heidelberg and 38 men (29%) at UCLH. The areas under the curve (AUC) were 0.86 for the RM in both cohorts. For ERSPC-RC3+PI-RADSv1.0 the AUC was 0.84 in Heidelberg and 0.82 at UCLH, for ERSPC-RC3 0.76 at Heidelberg and 0.77 at UCLH and for PI-RADSv1.0 0.79 in Heidelberg and 0.82 at UCLH. Calibration curves suggest that prevalence of sPC needs to be adjusted to local circumstances, as the RM overestimated the risk of harboring sPC in the UCLH cohort. After prevalence-adjustment with respect to the prevalence underlying ERSPC-RC3 to ensure a generalizable comparison, not only between the Heidelberg and die UCLH subgroup, the RM`s Net benefit was superior over the ERSPC`s and the mpMRI`s for threshold probabilities above 0.1 in both cohorts. CONCLUSIONS The RM discriminated well between men with and without sPC at initial MRI-targeted biopsy but overestimated the sPC-risk at UCLH. Taking prevalence into account, the model demonstrated benefit compared with clinical risk calculators and PI-RADSv1.0 in making the decision to biopsy men at suspicion of PC. However, prevalence differences must be taken into account when using or validating the presented risk model.
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Affiliation(s)
- Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Armando Stabile
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jose Marenco
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Clement Orczyk
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Dieffenbacher
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wilfried Roth
- Institute of Pathology, University of Heidelberg, Heidelberg Germany
- Institute of Pathology, University Medicine Mainz, Mainz, Germany
| | - Alex Freeman
- Department of Pathology, University College Hospital, London, United Kingdom
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Imaging, University College London Hospitals NHS Foundation Trust, University College London, London, United Kingdom
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | | | | | - Mark Emberton
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Franz C, Görtz M, Wührl M, Kulu Y, Hoffmann K, Hackert T, Morath C, Zeier M, Büchler MW, Mehrabi A. The Role of Pre-Procurement Pancreas Suitability Score (P-PASS) and Pancreas Donor Risk Index (PDRI) in the Outcome of Simultaneous Pancreas and Kidney or Pancreas After Kidney Transplantation. Ann Transplant 2019; 24:439-445. [PMID: 31346153 PMCID: PMC6681688 DOI: 10.12659/aot.915852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The pre-procurement pancreas suitability score (P-PASS) and the pancreas donor risk index (pDRI) are established predictive scores for graft survival and patient outcome following pancreatic transplantation. This retrospective study aimed to evaluate the predictive value of P-PASS and pDRI following simultaneous pancreas and kidney (SPK) transplantation, or pancreas after kidney (PAK) transplantation, and the clinical impact of donor-specific factors on the postoperative graft and recipient outcome at a single transplant center. Material/Methods The study included 105 patients who underwent SPK (n=104) or PAK (n=4) between 2000 and 2017. Donor-specific and recipient-specific parameters were recorded. Kaplan-Meier analysis and Cox regression analysis were used to assess the outcome after transplantation. Results Overall, the mean 1-year and 5-year pancreas graft survival and patient survival rates were 78.7% and 93.2%, and 76.9% and 90.0%, respectively. The postoperative outcome in patients with a P-PASS score of <17 was not significantly different when compared with patients with a score of ≥17. A P-PASS score of ≥17 was significantly associated with early pancreas graft loss (p=0.04). There was no significant difference in postoperative outcome between patients with high pDRI and low pDRI. Smoking of donor (p=0.046) was a risk factor and coronary heart disease of recipient (p=0.003) had a significant effect on survival of pancreas graft. Conclusions This study showed that P-PASS and pDRI were not reliable predictors of outcome after pancreas transplantation and that specific characteristics of the donor and recipient must be evaluated when predicting the outcome of pancreas transplantation.
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Affiliation(s)
- Clemens Franz
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Magdalena Görtz
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.,Department of Urology, Ruprecht-Karls-University Heidelberg, Heidelberg, China (mainland)
| | - Michael Wührl
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Görtz M, Galli U, Longerich T, Zöller M, Erb U, Schemmer P. De novo synthesis of C4.4A in hepatocellular carcinoma promotes migration and invasion of tumor cells. Oncol Rep 2017; 38:2697-2704. [PMID: 29048672 PMCID: PMC5780022 DOI: 10.3892/or.2017.5980] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/31/2017] [Indexed: 01/12/2023] Open
Abstract
C4.4A is a glycoprotein that is upregulated in several human malignancies, including colorectal, breast and renal cell carcinomas. Due to its highly restricted expression in healthy tissue, C4.4A was proposed as a potential diagnostic marker. Thus, the present study was designed to evaluate C4.4A expression and function in hepatocellular carcinoma (HCC) for the first time. Immunohistochemistry was performed to detect expression of C4.4A in human sections of healthy liver, primary HCC in the liver and metastatic HCC in the lung. To assess the contribution of C4.4A to HCC progression proliferation, apoptosis, migration and invasion assays were performed with C4.4A knockdown Huh7 and HepG2 cells. C4.4A is absent in healthy liver tissue. However, intense expression was seen in 59% of primary HCCs and strong expression in 80% of HCC lung metastases. C4.4A expression was also observed in human HCC cell lines, which strongly increased under hypoxic conditions. A C4.4A knock-down revealed that C4.4A is involved in both migration and invasion of HCC cells. Taken together, C4.4A expression in both primary and metastatic HCC suggests its potential value as a diagnostic marker for HCC. Due to its absence in healthy liver tissue, C4.4A might even serve as a possible therapeutic target, particularly for metastatic HCC.
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Affiliation(s)
- Magdalena Görtz
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Galli
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Longerich
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Margot Zöller
- Tumor Cell Biology, Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Erb
- Tumor Cell Biology, Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schemmer
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
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28
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Mokwa W, Görtz M. [Technological Set-up of Epiretinal Implants]. Klin Monbl Augenheilkd 2016; 233:1222-1226. [PMID: 27855446 DOI: 10.1055/s-0042-118708] [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: 10/20/2022]
Abstract
In blinded patients, visual prostheses can restore visual perception by appropriate electrical stimulation of retinal nerve cells. This article presents the basic technological principles of retinal prostheses, using an epiretinal implantable visual prosthesis as example. An implantable visual prosthesis typically consists of extraocular and intraocular sections. The extraocular section is responsible for detecting the image. The information is derived from this image that is needed for appropriate electrical stimulation of the retinal nerve cells. Together with the necessary energy, these data are transmitted through a magnetic connection to the intraocular section. To ensure reliable transmission, the data are encoded. After transmission, energy and data are separated in the intraocular section, and the data are decoded. In accordance with the transmitted information, biphasic pulses of defined intensity and duration are produced on the simulation electrodes. In this way, ganglia cells are electrically stimulated and react with action potentials, which are transmitted to the visual cortex, where they lead to visual perception.
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Affiliation(s)
- W Mokwa
- Institut für Werkstoffe der Elektrotechnik I, Rheinisch-Westfälische Technische Hochschule Aachen
| | - M Görtz
- Mikro- und Nanosysteme, Fraunhofer-Institut für Mikroelektronische Schaltungen und Systeme, Duisburg
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Häfner J, Betz W, Görtz M, Mokwa W. Thinned CMOS Pressure Sensors for Tactile Sensing in Prosthetics. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4031] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cleven NJ, Woitok A, Penzkofer T, Isfort P, Görtz M, Goettsche T, Steinseifer U, Schmitz-Rode T. Results from long-term In-vivo Tests of a Wireless, Intravascular Blood-Pressure Monitoring System for Hypertension Patients. BIOMED ENG-BIOMED TE 2012; 57. [DOI: 10.1515/bmt-2012-4446] [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] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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31
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Abstract
Massive localized lymphedema is a rare disease. Only a few cases have been described in the literature. These monstrous pseudotumors of the subcutis are mostly localized in the inguinal region or at the lower extremity. These tumors often show a slow growth for many years. Besides hernias, lipomatous tumors must be distinguished. The therapy of choice is the excision of the tumor. Relapse is not uncommon in the few cases described in the literature so far. The diagnostic procedure and therapy of an 48-year-old women with a massive localized lymphedema weighing about 22 kg are demonstrated and discussed.
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Affiliation(s)
- P Decker
- Chirurgische Klinik I der Krankenanstalten Mutterhaus der Borromäerinnen Trier.
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