Risk prediction models including the Prostate Health Index (phi) for prostate cancer have been well established and evaluated in the Western population. The aim of this study is to build phi-based risk calculators in a prostate biopsy population and evaluate their performance in predicting prostate cancer (PCa) and high-grade PCa (Gleason score ≥7) in the Chinese population. We developed risk calculators based on 635 men who underwent initial prostate biopsy. Then, we validated the performance of prostate-specific antigen (PSA), phi, and the risk calculators in an additional observational cohort of 1045 men. We observed that the phi-based risk calculators (risk calculators 2 and 4) outperformed the PSA-based risk calculator for predicting PCa and high-grade PCa in the training cohort. In the validation study, the area under the receiver operating characteristic curve (AUC) for risk calculators 2 and 4 reached 0.91 and 0.92, respectively, for predicting PCa and high-grade PCa, respectively; the AUC values were better than those for risk calculator 1 (PSA-based model with an AUC of 0.81 and 0.82, respectively) (all P < 0.001). Such superiority was also observed in the stratified population with PSA ranging from 2.0 ng ml^-1to 10.0 ng ml^-1. Decision curves confirmed that a considerable proportion of unnecessary biopsies could be avoided while applying phi-based risk calculators. In this study, we showed that, compared to risk calculators without phi, phi-based risk calculators exhibited superior discrimination and calibration for PCa in the Chinese biopsy population. Applying these risk calculators also considerably reduced the number of unnecessary biopsies for PCa.
Aged ; Asian People/statistics & numerical data* ; Biopsy ; China ; Humans ; Male ; Neoplasm Grading ; Prostate/pathology* ; Prostate-Specific Antigen/blood* ; Prostatic Neoplasms/pathology* ; Risk Assessment/methods*

Recommendations for managing clinically localized prostate cancer are structured around clinical risk criteria, with prostate biopsy (PB) Gleason score (GS) being the most important factor. Biopsy to radical prostatectomy (RP) specimen upgrading/downgrading is well described, and is often the rationale for costly imaging or genomic studies. We present simple, no-cost analyses of clinical parameters to predict which GS 6 and GS 8 patients will change to GS 7 at prostatectomy. From May 2006 to December 2012, 1590 patients underwent robot-assisted radical prostatectomy (RARP). After exclusions, we identified a GS 6 cohort of 374 patients and a GS 8 cohort of 91 patients. During this era, >1000 additional patients were enrolled in an active surveillance (AS) program. For GS 6, 265 (70.9%) of 374 patients were upgraded, and the cohort included 183 (48.9%) patients eligible for AS by the Prostate Cancer Research International Active Surveillance Study (PRIAS) standards, of which 57.9% were upgraded. PB features that predicted a >90% chance of upgrading included ≥ 7 cores positive, maximum foci length ≥ 8 mm in any core, and total tumor involvement ≥ 30%. For GS 8, downgrading occurred in 46 (50.5%), which was significantly higher for single core versus multiple cores (80.4% vs 19.6%, P = 0.011). Biochemical recurrence (BCR) occurred in 3.4% of GS 6 upgraded versus 0% nonupgraded, and in GS 8, 19.6% downgraded versus 42.2% nondowngraded. In counseling men with clinically localized prostate cancer, the odds of GS change should be presented, and certain men with high-volume GS 6 or low-volume GS 8 can be counseled with GS 7-based recommendations.
Biopsy ; Humans ; Male ; Middle Aged ; Neoplasm Grading/statistics & numerical data* ; Neoplasm Recurrence, Local/pathology* ; Prostate/surgery* ; Prostate-Specific Antigen/blood* ; Prostatectomy ; Prostatic Neoplasms/surgery* ; Retrospective Studies ; Sensitivity and Specificity

ObjectiveTo determine whether a short interval (≤2 weeks) between 12-core prostate biopsy and laparoscopic radical prostatectomy (LRP) affects perioperative parameters and the outcome of surgery.

METHODSThis retrospective study included 102 cases of prostate cancer treated by LRP after 12-core prostate biopsy from January 2012 to December 2016. Based on the interval between prostate biopsy and LRP, we divided the patients into three groups: ≤2 wk (n = 35), >2－6 wk (n = 21), and >6 wk (n = 46). The patients averaged 69.87 (59－84) years in age, 24.99 (15.62－33.14) kg/m2 in the body mass index (BMI), 24.41 (0.41－111.78) μg/L in the baseline PSA level, 56.05 (15.97－216.52) ml in the prostate volume, and 7.51 (6－9) in the Gleason score. We analyzed the clinical data, perioperative parameters and outcomes of surgery, and compared them among the three groups of patients.

RESULTSOperations were completed successfully in all the 102 cases without transferring to open surgery. There were no statistically significant differences among the three groups of patients in age, BMI, baseline PSA level, prostate volume, Gleason score, or T stage, nor in the operation time, estimated intraoperative blood loss, blood transfusion rate, intestinal injury, positive incision margin rate, or urinary continence rate at 3 months after surgery.

CONCLUSIONSLaparoscopic radical prostatectomy at ≤2 weeks after 12-core prostate biopsy is safe and effective in the treatment of prostate cancer and does not affect the perioperative parameters and outcomes of surgery.

Aged ; Aged, 80 and over ; Biopsy ; Blood Loss, Surgical ; Body Mass Index ; Humans ; Laparoscopy ; Male ; Middle Aged ; Neoplasm Grading ; Operative Time ; Prostate ; pathology ; surgery ; Prostate-Specific Antigen ; Prostatectomy ; methods ; statistics & numerical data ; Prostatic Neoplasms ; pathology ; surgery ; Retrospective Studies ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. METHODS: A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment. RESULTS: Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy. CONCLUSIONS: A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral.
Adult ; Aged ; Aged, 80 and over ; Biopsy/statistics & numerical data ; Diagnostic Errors/*statistics & numerical data ; Female ; Gastroscopy/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Observer Variation ; Referral and Consultation/statistics & numerical data ; Reoperation/statistics & numerical data ; Republic of Korea ; Retrospective Studies ; Stomach/*pathology ; Stomach Neoplasms/*pathology ; Young Adult

OBJECTIVETo investigate the prevalence of esophageal and gastric cardia cancer and various precancerous lesions in high-risk rural areas.

METHODSRandom cluster sampling method was used to select people aged 40-69 years of some natural villages as screening objects in Feicheng, Shangdong province, from 2006 to 2012. The screening program was conducted by endoscopy with iodine staining and indicative biopsy followed by pathological examination.

RESULTSA total of 24 759 subjects were screened during 2006-2012 years. The positive detection rates of esophagus and gastric cardia cancers were 1.37% and 0.42%, respectively, the early diagnosis rates were 84.71% and 65.05%, and the treatment rates were 92.65% and 92.23%, respectively. The detection rates of all lesions in males were significantly higher than those in females (P < 0.05), and were gradually increased with age (P < 0.05). The time trend analysis showed that detection rates of all lesions in the two sites showed no significant changes during this period, and the detection rates of esophageal lesions were higher than those of gastric cardia.

CONCLUSIONSThere are considerable numbers of patients with precancerous lesions in the general population from the high risk areas. Men and the elderly are the key populations calling for cancer control programs. Endoscopy using iodine staining is an effective method to increase the detection rate of precancerous lesions and cancers. The root of mucosal fold in gastric cardia must be carefully observed so as to increase the detection rate of early gastric cardia lesions.

Adult ; Aged ; Biopsy ; Carcinoma, Squamous Cell ; Cardia ; Coloring Agents ; Early Detection of Cancer ; statistics & numerical data ; Esophageal Neoplasms ; diagnosis ; epidemiology ; Esophagoscopy ; Female ; Gastroscopy ; Humans ; Iodine ; Male ; Middle Aged ; Precancerous Conditions ; diagnosis ; epidemiology ; Prevalence ; Rural Population ; statistics & numerical data ; Sex Distribution ; Stomach Neoplasms ; diagnosis ; epidemiology

PURPOSE: To investigate whether volumetric analysis based on T2WI and contrast-enhanced (CE) T1WI can distinguish between isocitrate dehydrogenase-1 mutation-positive (IDH1(P)) and -negative (IDH1(N)) glioblastomas (GBMs). MATERIALS AND METHODS: We retrospectively enrolled 109 patients with histopathologically proven GBMs after surgery or stereotactic biopsy and preoperative MR imaging. We measured the whole-tumor volume in each patient using a semiautomatic segmentation method based on both T2WI and CE T1WI. We compared the tumor volumes between IDH1(P) (n = 12) and IDH1(N) (n = 97) GBMs using an unpaired t-test. In addition, we performed receiver operating characteristic (ROC) analysis for the differentiation of IDH1(P) and IDH1(N) GBMs using the tumor volumes based on T2WI and CE T1WI. RESULTS: The mean tumor volume based on T2WI was larger for IDH1(P) GBMs than IDH1(N) GBMs (108.8 +/- 68.1 and 59.3 +/- 37.3 mm3, respectively, P = 0.0002). In addition, IDH1(P) GBMs had a larger tumor volume on CE T1WI than did IDH1(N) tumors (49.00 +/- 40.14 and 22.53 +/- 17.51 mm3, respectively, P < 0.0001). ROC analysis revealed that the tumor volume based on T2WI could distinguish IDH1(P) from IDH1(N) with a cutoff value of 90.25 (P < 0.05): 7 of 12 IDH1(P) (58.3%) and 79 of 97 IDH1(N) (81.4%). CONCLUSION: Volumetric analysis of T2WI and CE T1WI could enable IDH1(P) GBMs to be distinguished from IDH1(N) GBMs. We assumed that secondary GBMs with IDH1(P) underwent stepwise progression and were more infiltrative than those with IDH1(N), which might have resulted in the differences in tumor volume.
Biopsy ; Glioblastoma* ; Humans ; Isocitrate Dehydrogenase* ; Magnetic Resonance Imaging ; Retrospective Studies ; ROC Curve ; Statistics as Topic* ; Tumor Burden

PURPOSE: To investigate the prevalence and clinical significance of incidental prostate fluoro-2-deoxyglucose (FDG) uptake and to evaluate its impact on patient management. MATERIALS AND METHODS: Of 47,109 men who underwent FDG positron emission tomography between 2004 and 2014, 1,335 (2.83%) demonstrated incidental FDG uptake in the prostate, with 99 of the latter undergoing prostate biopsy. The primary end point was the histological presence of prostate adenocarcinoma in the biopsy specimen. Outcomes, including treatment methods, survival, and causes of death, were also assessed. Factors associated with the diagnosis of prostate cancer were evaluated by using logistic regression analysis. RESULTS: Patients with prostate cancer were more likely to have higher serum prostate-specific antigen (PSA) (p=0.001) and focal FDG uptake (p=0.036) than were those without. Prostate cancer occurred in 1 of 26 patients (3.8%) with serum PSA<2.5 ng/mL, compared with 40 of 67 patients (59.7%) with serum PSA> or =2.5 ng/mL. Multivariable analysis showed that focal lesions (odds ratio [OR], 5.50; p=0.038), age (OR, 1.06; p=0.031), and serum PSA (OR, 1.28; p=0.001) were independent predictors of prostate cancer diagnosis. Most patients with prostate cancer had organ-confined tumors. Of these, 12 (29.3%) underwent radical prostatectomy and 25 (60.9%) received hormone therapy. Of the 11 patients who died, 9 died of primary cancer progression, with only 1 patient dying from prostate cancer. CONCLUSIONS: The prevalence of incidental FDG uptake in the prostate was not high, although patients with elevated serum PSA had a higher incidence of prostate cancer. Patients with FDG uptake in the prostate should be secondarily evaluated by measuring serum PSA, with those having high serum PSA undergoing prostate biopsy.
*Adenocarcinoma/epidemiology/pathology/surgery ; Aged ; Biopsy ; Fluorodeoxyglucose F18/*pharmacokinetics ; Humans ; Incidental Findings ; Male ; Middle Aged ; Organ Specificity ; Positron-Emission Tomography/*adverse effects ; Prevalence ; *Prostate/drug effects/pathology ; Prostatectomy/methods/statistics & numerical data ; *Prostatic Neoplasms/epidemiology/pathology/surgery ; Radiopharmaceuticals/pharmacokinetics ; Republic of Korea/epidemiology ; Retrospective Studies ; Tissue Distribution

OBJECTIVETo evaluate the role of sentinel lymph node biopsy (SLNB) for the treatment of melanoma of the extremities.

METHODSFrom April 2007 to August 2013, forty-eight (25 men and 23 women) cases of melanoma of the extremities underwent sentinel lymph node biopsy. All the cases had sentinel lymph node biopsy and surgery. Among them 37 cases underwent limb salvage surgery, while 11 cases underwent amputation. Of the cases with limb salvage, 28 cases underwent free skin grafting or local flap grafting reconstruction after wide resection. Of the surgical margin, wide resection was performed in 37 patients, and radical resection was performed in 11 cases. There were 39 cases in stage I or II, and 9 cases in stage III. After the surgery, adjuvant chemotherapy was performed in 9 cases, and adjuvant biotherapy of interferon and interleukin was performed in 26 cases. Except for 2 cases, 46 cases were followed up with a mean follow-up period of 20.1 months (range from 2 to 60 months).

RESULTS39 (81.3%) cases had negative SLNB, while 9 (18.8%) cases had positive SLNB. Recurrence or metastasis was more common in those with positive SLNB (3 of 9 cases, 33.3%) compared with those with negative SLNB (4 of 39 cases, 10.3%). The median disease-free survival of patients with negative results was 19.5 months, significantly longer than that of the positive cases (9.5 months, P = 0.03). Otherwise, sex and age showed no significant difference in the disease free survivals.

CONCLUSIONSSentinel lymph node biopsy enables us to have a better understanding of regional lymph node status through lymphoscintigraphy. It improves the accuracy of staging and provides valuable prognostic information to guide subsequent treatment decisions.

Chemotherapy, Adjuvant ; Disease-Free Survival ; Extremities ; Female ; Humans ; Lymph Nodes ; surgery ; Male ; Melanoma ; surgery ; Prognosis ; Sentinel Lymph Node Biopsy ; methods ; statistics & numerical data ; Skin ; Skin Neoplasms ; surgery

OBJECTIVETo evaluate the liability of sentinel node biopsy in the treatment of early stage oral tongue carcinoma with clinically negative neck.

METHODSEighteen patients with T1 or T2 oral tongue carcinoma were enrolled in the prospective study. Preoperative lymphoscintigraphy and intra-operative hand-held gamma probe techniques were used to detect the sentinel lymph nodes. The sentinel lymph node biopsies were sent to frozen section pathology and the results were compared with specimen of routine selective neck dissection (I ∼ III or I ∼ IV). The accuracy of cervical metastasis prediction was compared between sentinel node biopsy and tumor thickness.

RESULTSSentinel lymph nodes were identified in all 18 cases. The numbers of sentinel lymph nodes of level Ib, IIa and III were 6, 22 and 2, respectively. In this series, positive sentinel lymph nodes were revealed in 4 cases, which were also positive in the postoperative routine histology.In other cases, both sentinel lymph nodes and routine histology were negative. Both the sensitivity and specificity were 100%. Sentinel lymph node biopsy obviously improved the specificity of predicting cervical metastasis comparing with the tumor thickness. (100% vs. 36.4%).

CONCLUSIONSentinel node biopsy is effective and reliable in the treatment of early stage oral tongue cancer, and deserves clinical application.

Humans ; Lymph Nodes ; surgery ; Mouth Neoplasms ; diagnosis ; Prospective Studies ; Sentinel Lymph Node Biopsy ; methods ; statistics & numerical data ; Tongue Neoplasms ; diagnosis

BACKGROUND: Ultrasonography is an important diagnostic tool for many aspects of clinical medicine. It is a non-invasive method of examination that provides high-resolution images in real time. However, some dermatologists may be anxious about the efficacy of ultrasonography. OBJECTIVE: To evaluate the diagnostic accuracy and to assess the utility of diagnostic ultrasonography for subcutaneous benign lesions. METHODS: The study included 96 patients with subcutaneous benign lesions who underwent ultrasonography and then received a pathologic diagnosis after biopsy or surgery at our hospital from July 2010 to December 2012. This study evaluated the number of cases in which the preoperative diagnosis after ultrasonography or just after physical examination agreed to the pathologic diagnosis. RESULTS: Ultrasonography significantly increased the diagnostic yield of subcutaneous benign lesions (after physical examination, 54.2%; after ultrasonography, 84.4%; p<0.001). The sensitivity for the diagnosis of lipoma (after physical examination, 70%; after ultrasonography, 92.5%; p<0.001) and the specificity for the diagnosis of epidermal cyst (after physical examination, 84.1%; after ultrasonography, 94.2%; p<0.001) significantly increased after ultrasonography. The sensitivity for the diagnosis of epidermal cyst and pilomatricoma also tended to increase after ultrasonography. CONCLUSION: The study results suggested that ultrasonography is useful for diagnosis and/or preoperative examination of subcutaneous benign lesions.
Biopsy ; Clinical Medicine ; Epidermal Cyst ; Humans ; Lipoma ; Physical Examination ; Pilomatrixoma ; Sensitivity and Specificity ; Statistics as Topic