Ahmed Eissa

Value of triphasic MDCT in the differentiation of small renal cell carcinoma and oncocytoma

Introduction Although differentiation between benign and malignant small renal tumors (≤4 cm) is still difficult, it is a demand for decision making and determining the treatment strategy. Our aim is to evaluate the role of multidetector row computed tomography (MDCT) in the differentiation of small renal clear cell carcinoma (RCC) and renal oncocytoma (RO). Methods We reviewed triphasic computed tomographic (CT) scans performed in 43 patients diagnosed with RCC (n = 23) and RO (n = 21). After an unenhanced CT phase of the upper abdomen, triple-phase acquisition included a cortico-medullary phase (CMP), a nephrographic phase (NP), and a pyelographic phase (PP), and lesions were evaluated both qualitatively and quantitatively. Results RCCs were hypervascular in 13 cases and hypovascular in 10 cases, while ROs were hypervascular in nine cases and hypovascular in 12 cases. Mean attenuation values (MAVs) for hypervascular RCCs and hypervascular ROs on unenhanced examination were 34.0 ± 7.1 and 31.3 ± 8.1 HU, respectively. Enhancement in CMP was 173.1 ± 45.2 HU for RCCs and 151.1 ± 36.0 HU for ROs and a gradual wash-out in NP (148.8 ± 34.3 and 137.1 ± 33.9 HU for RCCs and ROs, respectively) and in PP (98.2 ± 36.0 HU for RCCs and 79.4 ± 21.5 HU for ROs) was observed. MAV for hypovascular RCCs and hypovascular ROs on unenhanced examination were 32.4 ± 12.0 and 28.9 ± 8.0 HU, respectively. Both hypovascular RCCs and ROs showed a statistically significant difference in each post contrastographic phase. Conclusions Absolute attenuation and the quantitative amount of the enhancement were not strong predictors for RO and RCC differentiation.

The prostate cancer management dilemma: is it time to start a new era?

Prostate cancer is one of the most common lethal cancers in men in the developed countries. In the USA, it is estimated to affect 161,360 men (19% of all the newly diagnosed cancers) with an estimated mortality of 26,730 men (8% of all cancer deaths) in 2017. This renders it the most commonly diagnosed cancer and the third most common cause of cancer death in the USA in 2017 (1). Prostate cancer is an unique malignancy in that most of patients die with and not because of it (2).

Re: Positron Emission Tomography/Computed Tomography-based Assessments of Androgen Receptor Expression and Glycolytic Activity as a Prognostic Biomarker for Metastatic Castration-resistant Prostate Cancer

Experts’ summary: Fox et al [1] analyzed the characteristics of positron emission tomography (PET)/computed tomography (CT) scans using [F]-fluorodeoxyglucose ([F]-FDG) for detection of tumor glycolytic activity (Glyc) and [F]-fluorodihydrotestosterone ([F]-FDHT) for detection of androgen receptor (AR) expression, and their value as predictors of overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC). They conducted lesion-by-lesion and patient-based analyses. In addition, histological correlation was performed for selected lesions (59 biopsies). The authors report that the number of lesions and the [F]-FDG maximum standardized uptake value (SUVmax) were significantly associated with OS, with cutoff values of 12 lesions and 7.6, respectively. All lesion phenotypes negatively affected OS; AR0Glyc1 lesions (detectable only by [F]-FDG) were associated with the highest risk of death and AR1Glyc0 lesions (detectable only by [F]-FDHT) with the lowest risk of death. Moreover, histological correlation showed that non-prostatic primary cancers were all from the AR0Glyc1 subgroup.

MiniArc Sling for the Treatment of Female Stress Urinary Incontinence

MiniArc® Sling for the Treatment of Female Stress Urinary Incontinence Treatment of female stress urinary incontinence (SUI) has been revolutionized over the years and many corrective procedures have been described showing varying degrees of success. A recent development in this direction has been the introduction of MiniArc® sling which avoid blind needle passage in the retropubic space and the groin. Despite of its surgical principle, MiniArc® did not avoid the known complications associated with other mid-urethral slings (MUS). In addition, the data regarding MiniArc® effectiveness was insufficient and conflicting. We recommend the use of MiniArc® sling in the setting of clinical trials till it proves its safety and longterm efficacy relative to MUS.