在机器人辅助根治性前列腺切除术中，利用新型成像模式检测根尖癌，预测根尖边缘阳性率。

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-10-18 DOI:10.1016/j.clgc.2024.102240

Vinayak G. Wagaskar, Ashutosh Maheshwari, Osama Zaytoun, Yashaswini Agarwal, Neeraja Tillu, Asher Mandel, Ash Tewari

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引用次数: 0

摘要

目的利用术前磁共振成像[MRI]、显微超声[MUS]、前列腺特异性膜抗原正电子发射断层扫描[PSMA PET]扫描、活检位置以及机器人辅助前列腺癌根治术[RARP]中深部静脉复合体[DVC]结扎的术中时机，评估顶端边缘阳性率：方法：2022 年 11 月至 2024 年 3 月期间，经机构审查委员会批准，对接受机器人辅助前列腺癌根治术（RARP）的患者进行回顾性研究。所有患者均接受了术前 MRI、MUS 和 PSMA PET 扫描。患者采用标准 DVC（先行根尖切除术）结扎术或延迟 DVC（前列腺切除术后）技术进行 RARP。所有患者均由经验丰富的泌尿生殖系统病理学家进行术中冰冻切片分析。进行了描述性统计。使用 R 软件 4.3.3 版分析数据：共有 619 名前列腺癌患者接受了 RARP 治疗。其中，365 名男性采用延迟 DVC 结扎技术进行了 RARP，254 名男性采用标准 DVC 结扎技术进行了 RARP。两组患者在人口统计学参数、MRI、MUS 和 PSMA-PET 扫描特征方面无明显差异。磁共振成像、MUS、PSMA-PET 和前列腺活组织检查发现顶端阳性边缘的敏感性分别为 66%、81%、81% 和 73%。核磁共振成像、MUS、PSMA-PET 和前列腺活组织检查发现顶端阳性边缘的特异性分别为 45%、14%、16% 和 30%。如果将所有方法综合使用，仅有1%的病例漏诊了根尖癌：结论：在术前正确理解根尖病灶位置的情况下，DVC结扎的时机（标准与延迟）不会影响根尖阳性手术切缘。MRI、MUS、PSMA-PET和前列腺活组织检查相结合可显著降低根尖手术切缘阳性率。

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Detection of Apical Cancer with Novel Imaging Modalities to Predict Apical Margin Positivity in Robotic Assisted Radical Prostatectomy

Objectives

To evaluate margin positivity at apex utilizing preoperative magnetic resonance imaging [MRI], micro-ultrasound [MUS], prostate specific membrane antigen positron emission tomography PSMA PET] scan, biopsy location and intraoperative timing of deep venous complex [DVC] ligation during robot assisted radical prostatectomy [RARP].

Methods

Institution review board approved retrospective study underwent RARP between November 2022 to March 2024. All patients underwent preoperative MRI, MUS and PSMA PET scan. Patients underwent RARP using either standard DVC [done prior apical dissection] ligation or delayed DVC [after prostate removal] technique. All patients underwent intra operative frozen section analysis by an experienced genitourinary pathologist. Descriptive statistics were performed. Data analyzed using R software version 4.3.3.

Results

Total 619 prostate cancer patients underwent RARP. Of these, 365 men underwent RARP using delayed DVC ligation technique and 254 men using standard DVC ligation technique. There was no statically significant difference in 2 groups on demographic parameters, MRI, MUS and PSMA-PET scan features. Sensitivity of MRI, MUS, PSMA-PET and prostate biopsy for detection of apical positive margin were 66%, 81%, 81% and 73% respectively. Specificity of MRI, MUS, PSMA-PET and prostate biopsy for detection of apical positive margin were 45%, 14%, 16% and 30% respectively. When all modalities are used accumulatively, apical cancer was missed only in 1% of cases.

Conclusions

With proper preoperative understanding of apical lesion location, timing of DVC ligation [standard vs delayed] doesn't impact apical positive surgical margins. Combination of MRI, MUS, PSMA-PET and prostate biopsy reduce apical positive surgical margin rates significantly.

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.