1.Imaging evaluation of duplication of the internal auditory canal
Chunmei WU ; Simeng LU ; Shuilian YU ; Miao LEI ; Yongxin LI ; Bentao YANG
Chinese Archives of Otolaryngology-Head and Neck Surgery 2024;31(2):92-96
OBJECTIVE To analyze the MSCT and MRI imaging manifestations of patients with duplication of the internal auditory canal(DIAC),improve understanding of the deformity,to provide preoperative basis for cochlear implantation.METHODS Retrospective observation of 20 cases(24 ears)of DIAC inner ear multi-spiral CT(MSCT)and MRI data,measurement and analysis of the width of the internal auditory canal(IAC)and cochlear nerve canal in the lesion group and the control group.RESULTS All DIACs had stenosis of the IAC cambined with other temporal bone malformations.MSCT shows that the 21 ears IAC,while MRI hydrography shows the 16 ears IAC divided into double tubes by bone.MRI hydrography shows a slender vestibulocochlear nerve.There were statistically significant differences(P<0.001)in the width of IAC and cochlear nerve canal between the lesion group and the control group.Six cases(8 ears)had varying degrees of hearing recovery after cochlear implant surgery.CONCLUSION DIAC shows stenosis of the IAC;The bone septa shown on MSCT are its characteristic fertures;MRI hydrography shows underdeveloped vestibular and cochlear nerves;The combination of two imaging examination methods can provide objective reference for the diagnosis of this disease and artificial auditory implantation.
2.Biparametric magnetic resonance imaging radiomics for predicting biochemical recurrence in elderly prostate cancer patients after radical prostatectomy
Wen LIU ; Miao WANG ; Zhengtong LYU ; Huimin HOU ; Miaomiao WANG ; Chunmei LI ; Ming LIU
Chinese Journal of Geriatrics 2024;43(2):180-186
Objective:To investigate the predictive value of a radiomics model based on biparametric magnetic resonance imaging(bpMRI)for biochemical recurrence(BCR)after radical prostatectomy(RP)in elderly prostate cancer patients(≥60 years old).Methods:A retrospective analysis was conducted on data from 175 patients treated at Beijing Hospital from August 2017 to December 2021.Based on pathological results, image segmentation was performed on preoperative bpMRI T2, diffusion weighted imaging(DWI), and apparent diffusion coefficient(ADC)sequences.Pyradiomics was utilized to extract radiomic features, and Cox regression, Spearman correlation coefficient, and LASSO regression were employed for feature dimensionality reduction, leading to the construction of radiomic labels.Clinical models and image-clinical combined models were developed using multifactorial Cox regression analysis, and the performance of these models in predicting BCR was evaluated using the concordance index(C-index).Results:The 175 patients were randomly divided into a training set(122 cases)and a test set(53 cases)at a ratio of 7∶3, with 24 cases(19.7%, 24/122)and 11 cases(20.8%, 11/53)experiencing BCR, respectively.A total of 5 775 radiomic features were extracted from the three sequences, and after dimensionality reduction, 5 features were selected to construct the radiomic labels.The radiomics model exhibited C-index values of 0.764(95% CI: 0.655-0.872)and 0.769(95% CI: 0.632-0.906)in the training and test sets, respectively.Multifactorial Cox regression analysis revealed serum prostate-specific antigen(PSA)( HR=1.032, 95% CI: 1.010-1.054), postoperative pathology International Society of Urological Pathology(ISUP)grade grouping( HR=1.682, 95% CI: 1.039-2.722), and positive surgical margins( HR=2.513, 95% CI: 1.094-5.774)as independent predictors of BCR.The clinical model exhibited C-index values of 0.751(95% CI: 0.655-0.846)and 0.753(95% CI: 0.630-0.877)in the training and test sets, respectively.Following combined modeling of clinical factors and radiomic labels, the image-clinical combined model demonstrated the highest C-index values, namely 0.782(95% CI: 0.679-0.874)and 0.801(95% CI: 0.677-0.915)in the training and test sets, respectively. Conclusions:The radiomics model based on bpMRI can predict the occurrence of BCR after RP in elderly prostate cancer patients.Combined modeling of clinical factors and radiomic labels can enhance predictive efficiency.
3.Combining 18F-PSMA PET/CT and biparametric MRI predicts pathological upgrading after radical prostatectomy for prostate cancer
Wen LIU ; Miao WANG ; Guilan HU ; Jiangyu MA ; Chunmei LI ; Wei ZHANG ; Hui ZHU ; Min CHEN ; Li HUO ; Ming LIU
Chinese Journal of Urology 2024;45(3):180-186
Objective:To investigate the application value of the maximum standardized uptake value (SUVmax) of 18F prostate-specific membrane antigen (PSMA) PET/CT combined with the minimum apparent diffusion coefficient (ADCmin) of biparametric magnetic resonance imaging (bpMRI) in predicting pathological upgrading after radical prostatectomy (RP) for prostate cancer. Methods:The data of 89 patients with localized prostate cancer treated at Beijing Hospital from April 2019 to October 2023 were retrospectively analysed. The average age of patients was (68.4±7.0) years old, with prostate-specific antigen (PSA) level of 7.7 (5.4, 12.9) ng/ml, prostate volume of 34.6 (26.9, 47.1) ml, tumor diameter of 1.3 (1.0, 1.8) cm, prostate imaging reporting and data system(PI-RADS) score of 5 in 29 cases (32.6%), clinical stage ≥T 3 in 13 cases (14.6%). There were 31 cases (34.8%) in group 1 of targeted biopsy International Society of Urological Pathology (ISUP)grading groups, 36 cases (40.4%) in group 2, 11 cases (12.4%) in group 3, and 11 cases (12.4%) in group 4. All patients underwent 18F-PSMA PET/CT and bpMRI examinations before RP. The index lesion, identified as the highest Gleason score in pathological whole-mount sections, were outlined. SUVmax and ADCmin values were calculated from the images' region of interest. Pathological upgrading was defined as the post-RP grade group higher than the targeted-biopsy grade group. Clinical data of patients with and without pathological upgrading were compared. Spearman correlation coefficient analysis was used to assess the correlation between SUVmax and ADCmin. Multivariate logistic regression analysis was conducted to evaluate the factors influencing pathological upgrading. Receiver operating characteristic (ROC) curve analysis was employed to assess the predictive value of each indicator for pathological upgrading. Results:Among the 89 cases, 31 cases (34.8%) experienced pathological upgrading. Compared with the patients without pathological upgrading, the SUVmax [11.3 (8.1, 16.4) vs. 6.7 (4.6, 9.2)], SUVmax/ADCmin ratio [3.1 (2.0, 4.6) vs. 1.4 (0.9, 2.1)], PSA [9.8 (6.3, 15.6) ng/ml vs. 7.1 (5.1, 10.5) ng/ml], PSA density [0.3 (0.2, 0.5) ng/ml 2 vs. 0.2 (0.1, 0.3) ng/ml 2], and post-RP ISUP grade group [≥3 group 17 cases (54.8%) vs. 13 cases(22.4%) ]were higher in patients with pathological upgrading, while ADCmin [3.8 (3.0, 5.3) ×10 -4 mm 2/s vs. 5.2 (3.6, 6.1)×10 -4 mm 2/s] and targeted biopsy ISUP grade group [≤2 group 27 cases(87.1%) vs. 40 cases(69.0%) ] were lower (all P<0.05). Spearman analysis showed a negative correlation between SUVmax and ADCmin ( R = -0.227, P = 0.032). Multivariate logistic regression analysis revealed that SUVmax ( OR = 1.108, 95% CI 1.020-1.238), ADCmin ( OR=0.607, 95% CI 0.390-0.874), and SUVmax/ADCmin ratio ( OR = 1.815, 95% CI 1.282-2.949) independently predicted pathological upgrading. The AUC of the SUVmax/ADCmin ratio for predicting pathological upgrading (AUC = 0.817) was higher than that of SUVmax (AUC = 0.774) and ADCmin (AUC=0.686), indicating a higher predictive efficiency. Conclusions:SUVmax, ADCmin, and SUVmax/ADCmin ratio can independently predict pathological upgrading in targeted biopsy of prostate cancer. The SUVmax/ADCmin ratio has a stronger predictive value for pathological upgrading.
4.The diagnostic value of 18F-PSMA PET/CT PRIMARY score combined with mpMRI PI-RADS sore in clinically significant prostate cancer
Hui ZHU ; Wenrui XU ; Yue GUO ; Longteng LIU ; Miao WANG ; Huimin HOU ; Chunmei LI ; Wei ZHANG ; Fugeng LIU ; Ming LIU
Chinese Journal of Urology 2024;45(6):439-444
Objective:To explore the diagnostic value of 18F-prostate specific membrane antigen (PSMA) PET/CT PRIMAY score combined with multiparameter MRI (mpMRI) PI-RADS score for clinically significant prostate cancer (CsPCa). Methods:The data of 63 patients with prostate cancer who underwent radical prostatectomy at Beijing Hospital from January 2019 to December 2023 were retrospectively analyzed. The median age was 70 (64, 75) years old with prostate-specific antigen (PSA) level of 8.46 (5.40, 14.80) ng/ml. All patients underwent 18F-PSMA PET/CT and mpMRI examination before surgery, and pathological large sections of prostate specimens were made after surgery. The prostate lesions were diagnosed and located by two radiologists and one pathologist respectively. Lesions with Gleason scores (GS)≥3+ 4 from the surgical pathology were diagnosed with CsPCa, and lesions with negative or GS=6 were diagnosed with non-CsPCa. The PSMA PET/CT images were evaluated using the PRIMARY study criteria (5-level PRlMARY score): no pattern (score of 1), diffuse transition zone or central zone(not focal) (score of 2), focal transition zone(score of 3), focal peripheral zone(score of 4), or an SUV max of at least 12 (score of 5). The degree of uptake of imaging agent in prostate lesions was semi-quantitatively evaluated using lesion-to-background ratios (LBR) of SUV max. MpMRI was evaluated according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. The patients were divided into CsPCa group and non-CsPCa group based on patients and lesions. Mann-Whitney U test and chi-square test were used to compare the differences between groups. Multivariate logistic regression analysis was performed to determine the independent predictive factors of CsPCa. Receiver operator characteristic (ROC) curve was used to determine the optimal diagnostic threshold for each independent predictor. Predictive models were constructed for PRIMARY score, PI-RADS score, and their combined application, and the diagnostic performance of each model for CsPCa was compared. Results:Of all 63 patients, there were 54 cases in CsPCa group (85.7%) and 9 cases in non-CsPCa group (14.3%).There was significant difference between CsPCa group and non-CsPCa group in the serum PSA level [9.64 (6.1, 15.3) ng/ml vs. 5.6 (4.6, 7.6) ng/ml]( P<0.05). There was no statistically significant difference in age [71 (64, 75) years vs. 65 (63, 69) years], and number of lesions [2 (1, 2) vs. 2 (1, 3)] (all P>0.05). Of all 109 lesions, there were 81 lesions in CsPCa group(including 49 lesions with Gleason score = 3+ 4, 16 lesions with Gleason score=4+ 3, 14 lesions with Gleason score = 8, and 2 lesions with Gleason score>8) and 28 lesions in non-CsPCa group(including 14 lesions with Gleason score = 3+ 3 and 14 with benign prostate lesions). There was significant difference between CsPCa group and non-CsPCa group in PRIMARY score [4 (3, 5) vs. 2 (1, 4)], LBR [2.69 (2.08, 4.48) vs. 1.89 (1.45, 2.48)], PI-RADS score [4 (3, 5) vs. 2 (2, 3)] (all P<0.05). There was no statistically significant difference in the lesion distribution including the number of lesions located in the transition zone [15(18.5%) vs. 8(28.6%)] and in the peripheral zone[66(81.5%) vs. 20(71.4%)]( P>0.05). Multivariate logistic regression analysis indicated that PRIMARY score ( OR=2.134, 95% CI 1.429-3.187) and PI-RADS score ( OR=2.689, 95% CI 1.618-4.469) were independent predictors of CsPCa (both P<0.01). ROC curves analysis revealed that the cut-off value for diagnosing CsPCa was both 3 for PRIMARY score and PI-RADS score. The accuracy for PRIMARY score, PI-RADS score, and their combined complication in diagnosing CsPCa was 72%, 67%, and 83%, respectively. The sensitivity was 72%, 63%, and 91%, and the specificity was 75%, 79%, and 57%, respectively. The positive predictive value was 89%, 89%, and 86%, and the negative predictive value was 48%, 42%, and 70%, respectively. The area under the curve of the PRIMARY score, PI-RADS score, and their combined complication of the ROC curve for CsPCa were 0.733 (95% CI 0.624-0.842), 0.708 (95% CI 0.599-0.817), and 0.743 (95% CI 0.623-0.862), respectively. The diagnostic efficacy of their combined complication was higher than PRIMARY score or PI-RADS score alone (both P<0.01). Conclusions:Both the 18F-PSMA PET/CT PRIMAY score and the mpMRI PI-RADS score have good diagnostic value for CsPCa. The combined application of the two imaging parameters can improve the accuracy, sensitivity, and negative predictive value, which have a higher diagnostic efficiency of CsPCa.
5.A qualitative study of the family-centred care needs of neonatal parents in the post-pandemic era
Geping QIAN ; Jing MIAO ; Futing JI ; Chunmei LU ; Laishuan WANG
Chinese Journal of Practical Nursing 2023;39(10):757-761
Objective:To explore the needs of parents of hospitalized neonates with the challenges of implementing family-centered care during the Covid-19 pandemic.Methods:Using a method of phenomenological interviewing and Colaizzi′s method of data analysis, the information of 18 parents of admitted infants of Children′s Hospital of Fudan University from January 1 to 20, 2022 were collected and analyzed.Results:In the post-epidemic era, 5 themes of needs for parents of hospitalized neonates during family-centered care were identified: closeness to babies; emotional support; training about feeding; accommodation services; financial support.Conclusions:In the post-epidemic era, experiencing worry, anxiety, uncertainty, helplessness, loss and other negative psychological experience, the parents of hospitalized neonates have many unsatisfied needs. Hospital administrators need to focus on the needs of parents for family-centered nursing care, and actively explore effective coping strategies.
6.The preliminary experience of immediate radical prostatectomy after the diagnosis of prostate cancer by targeted prostate biopsy combined with intraoperative frozen section
Xuan WANG ; Zhengtong LV ; Miao WANG ; Jia CHEN ; Chunmei LI ; Hui ZHU ; Longteng LIU ; Wei ZHANG ; Ming LIU ; Jianye WANG
Chinese Journal of Geriatrics 2023;42(6):696-700
Objective:To investigate the practicality and safety of performing a radical prostatectomy(RP)shortly after the diagnosis of prostate cancer using a combination of prostate targeted biopsy and intraoperative frozen section.Methods:Prospective enrollment was conducted for patients suspected of having prostate cancer based on abnormal prostate specific antigen(PSA)levels.The inclusion criteria for the study were as follows: patients aged 80 years or younger with an ECOG score of 1 or lower.Prior to biopsy, patients underwent both prostate magnetic resonance imaging(MRI)and prostate specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)to determine the likelihood of prostate cancer with clinical stages within T 2-3aN 0M 0.In order to be included in the study, patients must agree to receive RP after their prostate cancer diagnosis has been confirmed by biopsy.All enrolled patients underwent a targeted prostate biopsy, consisting of 1-2 cores.These specimens were then examined through frozen section analysis.For patients diagnosed with prostate cancer through intraoperative frozen section pathology, RP was immediately performed.In this study, transperineal prostate targeted+ systematic biopsy was utilized for patients with undiagnosed prostate cancer.Additionally, routine pathological examination of specimens was conducted.The study analyzed the baseline data, surgical conditions, pathological results, and follow-up information of patients in a descriptive manner. Results:Seven patients, ranging in age from 54 to 77 years with a mean age of 66.7 years, were enrolled in the study.Their mean PSA level was 12.668 μg/L, ranging from 4.359 to 22.195 μg/L.Of these patients, 4 had a PI-RADS score of 4 and 3 had a score of 5.The maximum diameter of the index lesion was 1.3 cm, ranging from 0.5 to 2.2 cm.PSMA PET/CT scores were 4 in 1 case and 5 in 6 cases.The index lesions detected by PSMA PET/CT were consistent with those detected by MRI, and the maximum standardized uptake value(SUVmax)was 15.7, ranging from 5.3 to 39.4.Prostate cancer was diagnosed through targeted biopsy and intraoperative frozen section pathology.Four cases had a Gleason score of 3+ 3=6, while one case had a Gleason score of 3+ 4=7, another had a score of 4+ 3=7, and the last had a score of 4+ 4=8.All patients underwent RP treatment immediately after the prostate cancer diagnosis.Only one patient had slight adhesion at the apex of the prostate, while the other six patients were evaluated by surgeons as having no obvious adhesion at the apex.All surgeries were completed successfully, with a mean operation time of 149.7(ranging from 108 to 255)minutes.After RP, whole mount pathology results indicated that all cases were prostate adenocarcinoma, with a Gleason score of 3+ 4=7 in four cases and 4+ 3=7 in three cases.The pathological stages were pT2 in three cases and pT3a in four cases, with five cases having negative surgical margins and two cases with positive surgical margins.During the study, all patients were monitored for a period of 5.4 months(ranging from 3 to 7 months)and no complications of Clavien Dino≥Ⅰ were observed.PSA levels were measured at 6 weeks and 3 months after surgery, with readings of 0.020 μg/L(ranging from 0 to 0.079 μg/L)and 0.016 μg/L(ranging from 0 to 0.087 μg/L), respectively.No hormonal therapy or radiotherapy was administered during this time.Four patients were able to recover from urinary continence.Conclusions:Based on a combination of MRI and PSMA PET/CT, it is both safe and feasible to promptly perform RP following the diagnosis of prostate cancer through targeted biopsy for index lesions, along with intraoperative frozen section.
7.Evaluation of image quality of deep learning-based reconstruction of prostate T 2WI and diagnostic performance for prostate cancer in transition zone
Bowen YANG ; Hao CHENG ; Ming LIU ; Huimin HOU ; Miao WANG ; Chen ZHANG ; Chunmei LI ; Min CHEN
Chinese Journal of Radiology 2023;57(11):1208-1214
Objective:To evaluate the image quality of prostate T 2WI reconstructed based on deep learning (deep learning T 2WI) and the diagnostic performance for prostate cancer (PCa) in the transition zone. Methods:Totally 79 patients who underwent prostate MRI for elevated prostate specific antigen from December 2020 to September 2022 were prospectively consecutively collected from Beijing Hospital. Scan sequences included axial standard T 2WI, deep learning T 2WI, and diffusion-weighted imaging. The scan time was recorded. The image quality was scored subjectively including image quality, diagnostic confidence, noise level, artifacts, clarity and lesion detectability. For objective evaluation of image quality, signal-to-noise ratio (SNR) and contrast signal-to-noise ratio (CNR) were calculated. Two-parameter MRI prostate imaging reporting and data system version 2.1 (PI-RADS v2.1) scoring was performed for transition zone lesions using deep learning T 2WI and standard T 2WI, respectively. The subjective and objective image quality evaluation metrics for deep learning T 2WI and standard T 2WI were compared using the Wilcoxon signed-rank test. For transition zone lesions, the diagnostic performance of PI-RADS scores with deep learning T 2WI and standard T 2WI for PCa was evaluated by the receiver operating characteristic curve based on the lesion (all lesions in the transition zone) and the patient (the most malignant lesions in the transition zone), respectively, using the pathologic results as the gold standard. The area under the curve (AUC) was compared using the DeLong test. Results:Deep learning T 2WI significantly reduced the examination time by 64.6.%, from 4 min 37 s to 1 min 38 s. The scores of subjective image quality of deep learning T 2WI and standard T 2WI all were 5 (4, 5). The differences in image quality and lesion detectability were statistically significant ( Z=-2.32, -2.36, P=0.020, 0.018), and the differences of all other image quality evaluation metrics were not statistically significant ( P>0.05). The SNR of deep learning T 2WI and standard T 2WI were 17.11 (14.09, 21.92) and 9.15 (7.16, 11.17), with a statistically significant difference ( Z=-7.72, P<0.001). The CNR of deep learning T 2WI and standard T 2WI were 20.78 (13.42, 31.42) and 11.05 (7.82, 16.25), with a statistically significant difference ( Z=-7.54, P<0.001). Based on the lesion (40 PCa and 48 benign lesions), the AUC of the two-parameter PI-RADS score with deep learning T 2WI and standard T 2WI for diagnosing PCa in the transition zone were 0.915 (95%CI 0.856-0.975) and 0.916 (95%CI 0.857-0.976), without statistically significant difference ( Z=0.03, P=0.973). Based on the patient (33 PCa and 46 benign patients), the AUC of the two-parameter PI-RADS score with deep learning T 2WI and standard T 2WI were 0.921 (95%CI 0.857-0.984) and 0.939 (95%CI 0.886-0.992), without statistically significant difference ( Z=0.59, P=0.558). Conclusions:Compared with standard T 2WI, deep learning T 2WI of the prostate reduces scanning time while maintaining image quality and has comparable diagnostic performance for PCa in the transition zone.
8.Diagnostic value of 18F-prostate specific membrane antigen PET/CT combined with multiparametric-MRI in identifying the grade group of prostate cancer
Miao WANG ; Huimin HOU ; Xuan WANG ; Hui ZHU ; Hao CHENG ; Chunmei LI ; Chen LIU ; Hui LI ; Wei ZHANG ; Longteng LIU ; Xin DING ; Yaqun ZHANG ; Zhi YANG ; Jianye WANG ; Ming LIU
Chinese Journal of Urology 2022;43(2):116-121
Objective:To investigate the diagnostic value of the combination of 18F-prostate specific membrane antigen (PSMA) PET/CT and multiparametric magnetic resonance imaging (mpMRI) in identifying the grade group of prostate cancer, using parameters derived from the two imaging modalities. Method:Prostate cancer patients diagnosed by histopathology and received 18F-PSMA PET/CT and mpMRI during September 2018 to May 2021 in our hospital were retrospectively studied. The median age was 68(64-75), with the median PSA level of 14.74(7.75-24.19)ng/mL. All patients received mpMRI before biopsy. On biopsy, 6(12.2%) patients had International Society of Urological Pathology grade group(ISUP GG) 1 diseases, 16(32.7%) had ISUP GG 2 diseases, 12(24.5%) had ISUP GG 3 diseases, and 15(10.9%) had ISUP GG 4 or 5 diseases. Patients were then divided into high-grade group (ISUP 4-5) and low-grade group(ISUP 1-3). The median age of patients in high-grade group and low-grade group were 65(62-76) and 71(65-74), respectively. The PSA level in high-grade group and low-grade group were 15.11(6.63-42.86) ng/ml and 12.31(7.94-18.25) ng/ml, respectively. No significant differences were found in age and PSA level between the two groups ( P=0.334, P=0.448). All patients underwent 18F-PSMA PET/CT within 4 weeks after biopsy. The maximum standardized uptake value(SUV max) and the minimum apparent diffusion coefficient(ADC min)were recorded, and the ratio of SUV max/ ADC minwere calculated. The correlation between the above parameters and ISUP grade group were analyzed.The diagnostic value of the parameters was evaluated by the receiver operating characteristic (ROC) curve. Results:The data of 49 patients were analyzed. The average ADC minwas (0.57±0.16)×10 -3 mm 2/s, with the average SUV max and SUV max/ADC min of 15.30±12.54 and (29.69±23.72)×10 3, respectively. Statistical differences were found in SUV max ( P=0.012) and SUV max/ADC min ( P=0.002) between the high- and low-grade groups, while ADC min ( P=0.411) showed no statistical differences between the two groups. Significant positive correlations were found between SUV max(r=0.501, P<0.001), SUV max/ADC min (r=0.527, P<0.001) and ISUP grade group, respectively. There was a negative correlation between ADC min and ISUP grade group (r=-0.296, P=0.039). SUV max/ADC min was the best index to distinguish high-grade group from low-grade group prostate cancer with the area under the curve(AUC) of 0.749. In contrast, the AUC of SUV maxand ADC min were 0.731 and 0.615, respectively. The diagnostic sensitivity and specificity of SUV max/ADC min were 73.3% and 85.3%, respectively, with a critical value of 37.23×10 3. Conclusion:The combination use of 18F-PSMA PET/CT and mpMRI could improve the diagnostic efficiency for prostate cancer, compared to either modality alone. The ratio of SUV max/ADC min has a positive correlation with ISUP grade group, and is a promising index for distinguishing the high-grade prostate cancer from low-grade cancer.
9.The preliminary study about feasibility and accuracy of the frozen section during targeted prostate biopsy
Miao WANG ; Zhengtong LYU ; Xuan WANG ; Huimin HOU ; Yuhang FU ; Hao CHENG ; Chunmei LI ; Longteng LIU ; Jia CHEN ; Xin DING ; Jianye WANG ; Ming LIU ; Wei ZHANG
Chinese Journal of Urology 2022;43(7):490-494
Objective:To investigate the feasibility and reliability of the frozen section during targeted prostate biopsy.Methods:The clinical and pathological information of patients who received cognitive fusion transperineal targeted plus systematic biopsy and frozen section of 1-2 core targeted biopsy were consecutively collected and retrospectively studied. The median age was 70 (ranging 64-78) years, with the median prostate-specific antigen (PSA) level of 11.00 (ranging 6.63-16.52) ng/ml and the median prostate volume of 35.72 (ranging 22.59-47.71) ml. All patients received bi-parametric magnetic resonance imaging (bp-MRI) and have Prostate Imaging Reporting and Data System (PI-RADS) 3 or higher lesions diagnosed on bp-MRI. The suspected lesions would be taken by targeted biopsy of which one or two cores would be sent to prepare for the frozen sections. Then a cognitive fusion targeted and systematic biopsy covering the above targeted zones would be routinely administered under a transperineal approach as a standard protocol. The total time used for diagnosis of the frozen sections, the pathological diagnosis and the International Society of Urological Pathology (ISUP) grade groups (GG) would be recorded. The sensitivity, the positive predictive value, and the accuracy on grade groups would be analyzed, using the pathological diagnosis based on standard sections from the same targeted lesion.Results:A total of 29 patients were included in this study. Accordingly, 29 suspected lesions were identified on bp-MRI. A total of 20 lesions were finally diagnosed of PCa on frozen section, with the detection rate of 69.0%. Of those, 9(45.0%) cases were ISUP GG 1 diseases, 5(25.0%) cases were GG 2 diseases, 1(5.0%) case was GG 3 disease, and 5(25.0%) cases were GG 4-5 diseases. A total of 22 lesions were diagnosed with PCa on standard sections of cores from the same targeted lesions, with the detection rate of 75.9%. Of those, 6(27.3%) cases were GG 1 disease, 11(50.0%) cases were GG 2 diseases, 1(4.5) case was GG 3 disease, and 4(18.2%) cases were GG 4-5 diseases. The sensitivity and the positive predictive value of frozen section were 90.9% and 100%, respectively. No false positive diagnosis was made by frozen section. Compared to diagnosis from frozen sections, the GG diagnosed from final standard sections were found to upgrade and downgrade in 2 and 2 cases, respectively. The accuracy rate on GG of frozen sections was 80%. The time used for the diagnosis of frozen sections was (11±2) minutes. The histology quality control of four specimens was dissatisfactory. Two were due to tissue loss and deformation during sampling, and the other two were due to cytoclasis during low-temperature transferring.Conclusion:It is feasible and reliable to make a pathological diagnosis from frozen section of prostate targeted biopsy.
10.Clinical pathological features of transition zone prostate cancer in the elderly
Wei ZHANG ; Huimin HOU ; Miao WANG ; Yadong CUI ; Chunmei LI ; Qi YU ; Yaqun ZHANG ; Ming LIU ; Dongge LIU
Chinese Journal of Geriatrics 2021;40(3):323-328
Objective:To investigate the features of volume, distribution, grading and staging of prostate cancer(PCa)examined via whole-mount histopathology in transitional PCa.Methods:A total of 129 PCa patients undergone radical prostatectomy(RP)between July 2017 and March 2020 whose whole-mount prostate specimens were prepared after surgery were retrospectively studied.Pathological data on tumor locations, diameters and classification of the International Society of Urologic Pathology(ISUP), radiological data on regions of interest(ROI)and scores of the Prostate Imaging and Reporting Data System(PI-RADS v2)were recorded.The results of pathological whole-mount sections and prostate imaging were compared, and the characteristics and detection rates of lesions in different prostate regions were analyzed.Results:Of all 129 prostate specimens from RP, a total of 213 PCa lesions were detected through whole-mount histopathology.There were 21(9.9%)lesions involving both the peripheral zone(PZ)and the transition zone(TZ), with an average diameter of(2.82±0.71)cm.Of all lesions, 85(39.9%)involved PZ and 107(50.2%)involved TZ, with an average diameter of(1.36±0.81)cm and of(1.60±0.94)cm, respectively.The percentage of lesions involving TZ was higher than that lesions involving PZ, with larger diameters( P<0.05). Of 64 patients with complete MRI data, 105 PCa lesions were detected histopathologically by using whole mount sections, while 75 PCa lesions were detected by MRI, with a statistical difference( P<0.05). For lesions≥1.0 cm or lesions with an ISUP grade group≥2, the detection rate of MRI was lower in TZ lesions( P<0.05). Conclusions:PCa lesions within TZ account for a large proportion and have a relatively large tumor dimeter.PCa lesions within TZ are more likely to be missed in clinical examinations and on MRI, and clinicians should pay close attention during diagnosis and treatment.

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