Significant prostate cancer risk after MRI-guided biopsy showing benign findings: Results from a cohort of 381 men

BACKGROUND

MRI-guided biopsy (MGB) contributes to the diagnosis of clinically significant Prostate Cancer (csPCa). However, there are no clear recommendations for the management of men after a negative MGB. The aim of this study was to assess the risk of csPCa after a first negative MGB.

METHODS

Between 2014 and 2020, we selected men with a PI-RADS score ≥ 3 on MRI and a negative MGB (showing benign findings) performed for suspected prostate cancer. MGB (targeted and systematic biopsies) was performed using fully integrated mobile fusion imaging (KOELIS). The primary endpoint was the rate of csPCa (defined as an ISUP grade ≥ 2) diagnosed after a first negative MGB.

RESULTS

A total of 381 men with a negative MGB and a median age of 65 (IQR: 59-69, range: 46-85) years were included. During the median follow-up of 31 months, 124 men (32.5%) had a new MRI, and 76 (19.9%) were referred for a new MGB, which revealed csPCa in 16 (4.2%) of them. We found no statistical difference in the characteristics of men diagnosed with csPCa compared with men with no csPCa after the second MGB.

CONCLUSION

We observed a risk of significant prostate cancer in 4% of men two years after a negative MRI-guided biopsy. Performing a repeat MRI could improve the selection of men who will benefit from a repeat MRI-guided biopsy, but a clear protocol is needed to follow these patients.

LEVEL OF EVIDENCE: 4

Selection of an early biomarker for vascular normalization using dynamic contrast-enhanced ultrasonography to predict outcomes of metastatic patients treated with bevacizumab

BACKGROUND

Dynamic contrast-enhanced ultrasonography (DCE-US) has been used for evaluation of tumor response to antiangiogenic treatments. The objective of this study was to assess the link between DCE-US data obtained during the first week of treatment and subsequent tumor progression.

PATIENTS AND METHODS

Patients treated with antiangiogenic therapies were included in a multicentric prospective study from 2007 to 2010. DCE-US examinations were available at baseline and at day 7. For each examination, a 3 min perfusion curve was recorded just after injection of a contrast agent. Each perfusion curve was modeled with seven parameters. We analyzed the correlation between criteria measured up to day 7 on freedom from progression (FFP). The impact was assessed globally, according to tumor localization and to type of treatment.

RESULTS

The median follow-up was 20 months. The mean transit time (MTT) evaluated at day 7 was the only criterion significantly associated with FFP (P = 0.002). The cut-off point maximizing the difference between FFP curves was 12 s. Patients with at least a 12 s MTT had a better FFP. The results according to tumor type were significantly heterogeneous: the impact of MTT on FFP was more marked for breast cancer (P = 0.004) and for colon cancer (P = 0.025) than for other tumor types. Similarly, the differences in FFP according to MTT at day 7 were marked (P = 0.004) in patients receiving bevacizumab.

CONCLUSION

The MTT evaluated with DCE-US at day 7 is significantly correlated to FFP of patients treated with bevacizumab. This criterion might be linked to vascular normalization.

AFSSAPS NO

2007-A00399-44.

Detection of local recurrences of limb soft-tissue sarcomas: Is magnetic resonance imaging (MRI) relevant?

10582

Background: The role of systematic magnetic resonance imaging (MRI) surveillance after resection of soft-tissue sarcomas (STS) of the limb is opened to debate. The aim of our study was to retrospectively evaluate the effectiveness of a MRI surveillance schedule performed in adult patients. Methods: 124 adult patients have been treated from 1996 to 2006 for a non-metastatic limb STS at our centre: 86 patients (70%) had clear resection margins (R0) and 111 patients (90%) received an adjuvant radiotherapy. 663 MRI examinations were performed, with a median of 5 per patient [range: 1 to 5]. The rythm of surveillance schedule was respected in 57% of the examinations. Results: Forty-one patients (33%) prematurely withdrew from the planned radiological surveillance due to metastasis diagnosis (15 cases), 5-year remission duration (5 cases), other reasons (12 cases), and drop out (9 cases). Among the 11 local recurrences (9%) which were observed, MRI was able to detect only 2 asymptomatic local recurrences, 1 with and 1 without synchronous metastasis, both had microscopically involved margins (R1). In contrast, MRI showed 11 false-positive cases. As the predictive positive value of MRI was 42%, clinical surveillance seems to be more effective. The evaluation of the cost of the systematic MRI surveillance is 200,000 euros. Clinical examination failed in 2 cases (2 asymptomatic local recurrences detected by MRI) as did MRI surveillance (2 false negative cases). In our study, cost-effectiveness was better with clinical examination than MRI surveillance. Conclusions: As observed in our study, systematic MRI surveillance is not relevant for the follow-up of all limb soft-tissue sarcomas. A prospective study could be promoted to evaluate the MRI surveillance of patient at high risk of local recurrence.

No significant financial relationships to disclose.

[Primary dural lymphoma: a report of two cases with review of the literature]

Primary lymphoma arising in dura is exceedingly rare. We report the clinicopathologic findings of two patients with primary B-cell lymphoma of dura. Both were female, 38 and 45 years old. Prior to biopsy they were felt to have meningioma on preoperative magnetic resonance imagery. Histologically, tumors were classified as MALT-type lymphoma. Literature describe only 14 reports of similar entity. Primary lymphomas arising in dura appear to have a more favourable clinical course compared to PCNSL and may require a less aggressive treatment.

[Local staging of prostate carcinoma with phased array MR imaging: prospective study over 5 years]

PURPOSE

To assess by MRI, using a pelvic phased array coil, the accuracy for staging prostate carcinoma and to correlate the results with the rate of positive surgical margins.

MATERIALS AND METHODS

Between January 1995 and December 1999, 176 patients with localized prostate carcinoma underwent a preoperative MRI examination using a pelvic phased-array coil (1 Tesla). MRI and histological results were compared in a prospective study.

RESULTS

131 were classified T2 and 45 were classified T3 at MRI. Pathologic findings showed 103 pT2 and 73 pT3. The accuracy of MRI (extra capsular or vesicle extension) was 75%. The risk for a patient labelled T2 or T3 at MRI to have a positive surgical margin was respectively 13.7% and 31%.

CONCLUSION

This study shows that the phased-array coil has a low sensitivity but a good specificity to distinguish between organ-confined cancer or not. It shows that the risk of positive surgical margins is higher for T3 lesions at MRI. The low sensitivity should be improved by using a multi coil phased array.

[Assessing the quality of patients' medical records at the Claudius-Regaud Institute]

In 1999, the Claudius-Regaud Institute of Toulouse, France, specialized in oncology, set up a workshop in order to assess the quality of its patients medical records. A retrospective evaluation was performed on a 100-chart-sample drawn from all the charts in the institution. Results show that the medical records are subdivised into three parts: medical care, nursing care and imaging. Some of the explored charts show a lack of data, and a certain inconsistency in the charts' organization and in the structure of information was reported. Patient's record is a key to communication between the different care providers in oncology. To improve its quality, efforts will have to be done in restructuring the charts, creating guidelines and training the different caregivers.

Assessment of the risk of positive surgical margins with pelvic phased-array magnetic resonance imaging in patients with clinically localized prostate cancer: a prospective study

OBJECTIVES

We assessed magnetic resonance imaging (MRI) performance in the prediction of positive surgical margins (PSMs) before radical prostatectomy in a prospective study correlating the MRI results and pathologic findings.

METHODS

Between January 1995 and December 1999, 176 patients (mean age 64.2 years, range 49 to 75), with localized prostate cancer (49 with Stage T1 and 127 with Stage T2) underwent preoperative MRI with a pelvic phased-array coil (Tesla-1, Siemens) at a mean interval of 35 days after randomized transrectal biopsies. The mean preoperative prostate-specific antigen level was 10.9 ng/mL (range 1.2 to 39). The MRI studies and specimen analysis were performed by one radiologist unaware of the clinical and biopsy findings and by one pathologist, respectively. Multivariate analysis was performed to compare the predictive value of MRI staging, prostate-specific antigen value, and preoperative Gleason score to identify the PSM rate.

RESULTS

Of the 176 patients, 131 (74%) had Stage T2 disease by MRI and 45 (26%) Stage T3 disease by MRI. Pathologic staging showed 103 with pT2 and 73 with pT3. Overall, the PSM rate of the series was 18%. The PSM rate was 13.7% and 31% for patients with T2 and T3 disease by MRI, respectively. For the T3 MRI cases, the PSM rate was 2.32-fold higher. MRI staging, like the prostate-specific antigen value, was a predictive factor of PSMs (P = 0.05).

CONCLUSIONS

The results of this study show that preoperative MRI staging with the phased-array coil may be helpful in predicting the PSM risk in radical prostatectomy candidates with clinically localized prostate cancer.

[Postpneumonectomy thoracic empyema and dosimetric CT scan. Report of two cases and review of the literature]

Following a pneumonectomy for cancer, the patients are classically observed by clinical examination and standard chest X-ray. However, torpid empyemas can be missed when they occur after the period of hospitalization and when they are not accompanied by a fever. At the time of postoperative radiotherapy, the dosimetric CT scan constitutes the first examination providing objective information of the endothoracic content. It is therefore necessary on this occasion to assure the normality of the postpneumonectomy pleural space while checking that the substituted liquid is homogeneous and above all that the internal mediastinal part of the cavity has a concave appearance. If that is not the case, an empyema should be suspected. The diagnosis, confirmed by a cytobacteriological examination of the pleural fluid, constitutes a counterindication of the radiotherapy. We present two cases of postpneumonectomy paucisymptomatic empyema which were diagnosed during the course of postoperative radiotherapy when the initial dosimetric CT scan was pathologic and could have allowed an earlier diagnosis.

[Surgical treatment strategies for baldness]

Many surgical techniques are proposed for the treatment of baldness. We have made a selection of these techniques using criteria of efficacy, good patient tolerance and ease of implementation. Based on a retrospective analysis of 150 patients, we elaborated a strategy for surgical treatment of baldness.

[The use of MRI with a pelvic phased array antenna in the evaluation of the gland and tumor volume of clinically localized prostatic adenocarcinoma]

Prostate cancer is clinically understaged in 50% of cases. It was improved with the use of random biopsies, PSA analysis (balanced and unbalanced) and Gleason grade on biopsies. Traditional imaging techniques such as endorectal ultrasonography and CT Scan are known to be of no interest. MRI is a non-evasive technique which allows the three dimensional study of an organ with a high quality of tissue contrast. Moreover, the positioning of surface antennae or "phased array" allowed improvement in spatial resolution.

OBJECTIVE

To determine whether MRI allows an accurate staging of clinically localised adenocarcinoma by the direct estimation of capsular effraction, measure of glandular and tumor volumes and finally by obtaining reliable PSAd.

MATERIAL AND METHODS

A prospective study was done from March 1995 to November 1996 on 55 patients with a clinically localised adenocarcinoma. MRI 1 Tesla Imager (SIEMENS), pelvic phased array antennae. FSE sequences (T1 and T2), axial and frontal. Evaluation of volumes by on-screen. Standford protocol for histo-pathologic reading on the axial cuts. Direct planimetry on a millimetre paper.

RESULTS

Reliable estimation of glandular volume (average difference 0.7 cc). Sub-evaluation of tumoral volume (average difference 1.04 cc) with a 30% margin of error, accuracy 87%. Tumoral stage exact in almost 90% of the cases with a PPV of 94%.

CONCLUSION

Prostatic MRI, using surface antennae, allows to complete the conventional stage by stage development by correctly diagnosing 75% of locally evolved stages. Its limits are linked to the nature of the signal of the tumorous tissue as to the localisation of neoplasic lesions.

[Systemic granulomatosis caused by a Dacron prosthetic ligament]

An uncommon systemic reaction mimicking sarcoidosis after ligament reconstruction is reported. Clinical and radiological outcome after surgical treatment led to the diagnosis of a a specific injury caused by the ligament reconstruction device.

[Adventitial cyst of the popliteal artery. Imaging and percutaneous treatment]

Adventitial cystic disease of the popliteal artery is a rare cause of calf claudication in young patients. A case explored by magnetic resonance imaging is reported: a water rich mass around the popliteal artery compressed the arterial lumen. Treatment consisted in CT-guided percutaneous aspiration. Good functional outcome except for severe efforts, despite persistance of cystic images was observed. Echography, computed tomography or magnetic resonance imaging are more useful to establish the diagnosis than arteriography because these techniques can directly visualize the arterial wall. Percutaneous treatment preserves the intima and can be performed in out-patients. When feasible, it could be preferred to conventional surgery.

Is camptocormia a primary muscular disease?

STUDY DESIGN

This study analyzed computed tomographic scans, magnetic resonance images, and biopsies of the paravertebral muscles of patients with camptocormia and age-matched patients with lumbar interapophyseal osteoarthritis or lumbar vertebral stenosis.

OBJECTIVES

To define the muscular lesions and clarify their nature in this particular disorder.

SUMMARY OF BACKGROUND DATA

Progressive lumbar kyphosis or camptocormia, a rare disease of the elderly characterized by inability to immobilize the lumbar spine in relation to the pelvis appears to be a result of weakness of the paraspinal muscles. The features presented by these patients do not correspond to any myopathy previously described.

METHODS

Twenty-seven patients (5 men and 22 women) mean age 69 years, with camptocormia were compared to fifteen age-matched patients without camptocormia but with posterior interapophyseal osteoarthritis and to nine elderly patients operated for narrowing of lumbar canal. Computed tomographic scans, magnetic resonance images, light microscopy, histochemistry, and electron microscopy of paraspinal muscles were obtained in both groups.

RESULTS

In patients with camptocormia, computed tomographic scans and magnetic resonance imaging showed heterogeneous appearance of the spinal muscles with areas of low density. These features were distinct from those of patients with interapophyseal osteoarthritis and were similar to the features described in primary muscular dystrophies. The main microscopic change in camptocormia was the increase of fibrous tissue, frequently with a lobular pattern, not seen in osteoarthritic patients. Familial history of the disorder was frequent (20 out of the 27 patients).

CONCLUSION

Camptocormia, disappearing in the recumbent position, is thus very probably linked to muscle involvement. That there is often a family history of such disorder is in favor of a genetically transmitted condition. Magnetic resonance images and computed tomographic scan appearance seems to be in favor of primary muscular disease, restricted to the spinal muscles.

Inhibition of plasminogen activation by polymerized ampicillin

The polymerized beta-lactam antibiotic ampicillin inhibits the proteolytic activity of human plasmin upon 125I-labeled fibrin clots. The inhibition is dose-dependent, with half-maximal inhibition occurring at 1.25 mM of the polymerized antibiotic. Polymerized ampicillin also inhibits binding of plasmin to fibrin, and 38% inhibition of binding occurs at 10 mM of the antibiotic. Furthermore, polymerized ampicillin inhibits the activation of plasminogen by either urokinase-like plasminogen activator (uPA) or tissue type-plasminogen activator (tPA). At 7.5 mM of polymerized ampicillin, the uPA-mediated plasminogen activation is suppressed by 94%, and half-maximal inhibition is obtained at 0.66 mM. The direct activity of uPA on the chromogenic substrate L-pyroglutamyl-glycyl-L-arginine p-nitroanilide hydrochloride (S-2444) is unaffected by polymerized ampicillin levels of up to 10 mM. The inhibitory effects of the polymerized antibiotic on the activation of plasminogen by both uPA and tPA is totally abolished in presence of fibrin. These interactions may serve as a novel model for ligands that enhance the clot-specificity of thrombolytic agents.

Renal artery stent placement: long-term results with the Wallstent endoprosthesis

PURPOSE

To evaluate clinical success and long-term patency of a Wallstent in the renal artery.

MATERIALS AND METHODS

Twenty-five Wallstents were placed in 21 patients to treat delayed restenosis after previous balloon angioplasty (n = 13) or inadequate immediate postangioplasty response (n = 8). Indications for angioplasty were hypertension in all patients and renal preservation in seven. Stenosis was atheromatous in 15 patients, involving ostium in seven.

RESULTS

Stent placement was successful in all patients. At follow-up angiography (range, 12-60 months), four patients (20%) had stent restenosis. Of these, three had undergone treatment for restenosis after angioplasty and three had ostial lesions. Cumulative primary patency rate was 95%, 85%, and 77% at 7, 9, and 15 months, respectively. Hypertension was cured in three patients and improved in 18.

CONCLUSION

Arterial stent placement has good clinical results and high long-term patency rates after conventional renal angiography or delayed restenosis, especially in ostial lesions.

Regulation of fibrinolysis by non-esterified fatty acids

The ability of oleic acid to modulate fibrinolysis was measured by following the urokinase-mediated and plasminogen-dependent cleavage of 125I-labelled fibrin clots. Oleic acid levels within the physiological range exerted a concentration-dependent inhibition of urokinase-mediated fibrinolytic activity. SDS/PAGE revealed that oleic acid enhances urokinase activity but simultaneously increases the autolytic cleavage of the newly formed low-molecular-mass subunit of plasmin. Oleic acid-induced cleavage of this subunit containing the catalytic site of plasmin was suppressed by the plasmin substrate H-D-valyl-L-leucyl-L-lysine-p-nitroanilide (S-2251) and was prevented by alpha 2-antiplasmin. A concentration-dependent inhibition of the activity of purified plasmin on 125I-labelled fibrin clot was also observed; 93% and 50% inhibition was noted with 150 microM and 32 microM oleic acid respectively. Oleic acid at 200 microM also effectively displaced plasmin prebound to a polylysine-Sepharose column. Examination of the fatty acid specificity showed that a minimal chain length of 16 carbon atoms and the presence of at least one double bond, preferably in a cis configuration, were required for inhibition of the fibrinolytic activity of plasmin. Oleic acid at a concentration that produced only a minimal inhibition of plasmin activity induced a marked inhibition by palmitic acid, while palmitic acid alone is ineffective. The findings suggest that oleic acid stimulates plasminogen activation and modulates the fibrinolytic and autolytic activities of plasmin.

[Surgical classification of androgenetic baldness and its therapeutic implications]

In order to understand the various operative indications in baldness surgery, we describe a dynamic classification of baldness with practical implications. The most predictive factors of this classification are scalp laxity and the height of the crown.

Stimulation of plasmin activity by oleic acid

The amidolytic activity of plasmin with the chromogenic substrate H-D-valyl-L-leucyl-L-lysine p-nitroanilide (S-2251) is stimulated by oleic acid in a dose-dependent and saturable fashion. The activity of plasmin on S-2251 in the presence of oleic acid followed a sigmoidal kinetic pattern, with an almost 4-fold stimulation of activity at 60 microM-oleic acid. Half-maximal stimulation occurred at an oleic acid level of 19.5 microM. The amino acid analogue 6-aminohexanoic acid (AHA), which is known to bind to lysine-binding sites in plasmin, suppressed the stimulatory effect of oleic acid in a concentration-dependent manner; at 0.3 mM-AHA, about 70% of the oleic acid-dependent enhancement of plasmin activity was abolished. The l/v versus 1/[S] plot for plasmin changed in the presence of oleic acid from a linear to a non-linear curve, suggesting positive co-operativity. 14C-labelled oleic acid bound to plasmin, and the bound ligand was displaced by an excess of unlabelled oleic acid. Oleic acid also produced a marked (40-fold) stimulation of the plasminogen-dependent cleavage of S-2251 by urokinase. A half-maximal effect on plasminogen activation was obtained at 40 microM-oleic acid. The present findings suggest that the ability of oleic acid to stimulate plasmin activity and to enhance the conversion of plasminogen to plasmin depends on the interaction of oleic acid with specific lysine-binding sites in plasmin.

The one-stage preauricular flap for male pattern baldness: long-term results and risk factors

Following a review of the operative technique for a single-stage vertical flap for reconstruction of the frontal hairline, we present a series of 156 such flaps with a minimum follow-up of 6 months. Risk factors for necrosis or alopecia of the distal end of the flap include retroauricular design and cigarette smoking. There was not a single case of necrosis in nonsmokers with flaps shorter than 16 cm. Finally, we demonstrate that the final appearance of the donor site is directly related to the tension under which it is closed.