Arnaud Marien

Magnetic Resonance Imaging–Transectal Ultrasound Image-fusion Biopsies Accurately Characterize the Index Tumor: Correlation with Step-sectioned Radical Prostatectomy Specimens in 135 Patients

BACKGROUND Prostate biopsies targeted by elastic fusion of magnetic resonance (MR) and three-dimensional (3D) transrectal ultrasound (TRUS) images may allow accurate identification of the index tumor (IT), defined as the lesion with the highest Gleason score or the largest volume or extraprostatic extension. OBJECTIVE To determine the accuracy of MR-TRUS image-fusion biopsy in characterizing ITs, as confirmed by correlation with step-sectioned radical prostatectomy (RP) specimens. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 135 consecutive patients who sequentially underwent pre-biopsy MR, MR-TRUS image-fusion biopsy, and robotic RP at two centers between January 2010 and September 2013. INTERVENTION Image-guided biopsies of MR-suspected IT lesions were performed with tracking via real-time 3D TRUS. The largest geographically distinct cancer focus (IT lesion) was independently registered on step-sectioned RP specimens. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A validated schema comprising 27 regions of interest was used to identify the IT center location on MR images and in RP specimens, as well as the location of the midpoint of the biopsy trajectory, and variables were correlated. RESULTS AND LIMITATIONS The concordance between IT location on biopsy and RP specimens was 95% (128/135). The coefficient for correlation between IT volume on MRI and histology was r=0.663 (p<0.001). The maximum cancer core length on biopsy was weakly correlated with RP tumor volume (r=0.466, p<0.001). The concordance of primary Gleason pattern between targeted biopsy and RP specimens was 90% (115/128; κ=0.76). The study limitations include retrospective evaluation of a selected patient population, which limits the generalizability of the results. CONCLUSION Use of MR-TRUS image fusion to guide prostate biopsies reliably identified the location and primary Gleason pattern of the IT lesion in >90% of patients, but showed limited ability to predict cancer volume, as confirmed by step-sectioned RP specimens. PATIENT SUMMARY Biopsies targeted using magnetic resonance images combined with real-time three-dimensional transrectal ultrasound allowed us to reliably identify the spatial location of the most important tumor in prostate cancer and characterize its aggressiveness.

Three-dimensional navigation system integrating position-tracking technology with a movable tablet display for percutaneous targeting

To assess the feasibility of a novel percutaneous navigation system (Translucent Medical, Inc., Santa Cruz, CA, USA) that integrates position‐tracking technology with a movable tablet display.

Robotic implantation of biodegradable regenerative urinary conduit: Experimental study

PURPOSE To determine the feasibility and develop a robotic technique for intracorporeal implantation of a biodegradable tubular scaffold seeded with adipose-sourced smooth muscle cells (Neo-Urinary-Conduit) that, when implanted as a conduit for urinary diversion, facilitates regeneration of native-like neourinary tissue. MATERIALS AND METHODS Robotic NUC implantation was performed in two fresh male cadavers. The greater omentum was widely detached from the greater curvature of the stomach, in preparation for final wrapping of the conduit. Bilateral ureters were mobilized for implantation. The NUC, with two precreated ureteral openings, was inserted into the abdomen. Bilateral, stented uretero-NUC anastomoses were created. The NUC was circumferentially wrapped with the predissected omentum, exteriorized through the abdominal wall, and maturated. RESULTS Both procedures were successfully completed intracorporeally. Operative time for NUC implantation was 90 and 100 minutes, respectively. Examination of gross anatomy showed no injury to other organs. There was no omental kinking, rotation, eversion, or stripping from the NUC. Bilateral stents were confirmed to be in situ with the proximal coil in the kidney. Uretero-NUC anastomoses and omentum were tension free. The entire NUC, including its distal edge and posterior aspect, was circumferentially wrapped 360 degrees. CONCLUSION We demonstrated the feasibility and developed a robotic technique for intracorporeal implantation of a biodegradable regenerative urinary conduit. This study serves as the foundation for the robotic surgical technique before the clinical application.

Robotic transmural ablation of bladder tumors using high-intensity focused ultrasound: Experimental study.

To evaluate the feasibility of robot‐assisted laparoscopic high‐intensity focused ultrasound for targeted, extravesical, transmural, full‐thickness ablation of intact bladder wall and tumor.

3D Fusion MRI and (18)F-Choline-Positron Emission Tomography-Targeted Prostate Biopsies: A New Concept

Abstract Background: Contemporary transrectal ultrasound (TRUS) prostate biopsy can be guided by high-resolution ultrasound (US), magnetic resonance imaging (MRI), or MRI–US fusion. Objectives: To ...

MP77-02 FIRST CLINICAL EXPERIENCE OF TRIMODAL (18)F-CHOLINE-PET/MPMRI/TRUS TARGETED PROSTATE BIOPSIES: A PILOT STUDY FOR A NEW CONCEPT.

INTRODUCTION AND OBJECTIVES: Assess the feasibility and the accuracy of targeted prostate biopsy with standard (systematic 12-core) biopsies after fusion imaging of choline-PET/CT (choline-PET) and multiparametric MRI (mpMRI) with 3D-transrectal ultrasound (TRUS) to detect prostate cancer. The Fusion of the two modality with echography 3d was try to compare the diagnostic performance for localization of primary PCa with (mpMRI) and last generation of PET/CT (Biograph mCT Flow, Siemens). METHODS: Within a prospective single-center study, from December 2014 to October 2016, 31 patients with a rising PSA ? 10ng/ ml or with an history of a negative prostate biopsies were included, and performed a choline-PET and a mpMRI. PET and T2-weighted MR volumes of the prostate were spatially registered using commercially available software. Biopsy targets were selected on both modalities. TRUS biopsy using the real-time 3D TRUS-tracking system (Urostation Touch , Koelis, France), which enabled US-guided and/or MR/US fusion targeted biopsies. The biopsy procedure was performed after registration of real-time TRUS with mpMRI and choline-PET by the same operator, using 3D TRUS-tracking system. At the time of biopsy, volume data of the mpMRI and PET 18-ch was elastically fused with TRUS. Each target was biopsied twice. Histologic results were determined from standard and targeted biopsy cores. RESULTS: Mean PSA was 13.01 ng/ml (5.32-73). Mean number of biopsy was 16 (13-21) and mean prostate volume was 63.41 cc (25-169). The cancer detection rate was 69%. The cancer detection rate with standard biopsies off target was 42% and with prostate targeted biopsy was 50% using PET, 65% using mpMRI with a sensibility of 72%, 94%, 100% respectively for PET, mpMRI or both . The average number of positive cores was respectively 1.77 (1-7) ,2.74 (3-11) for PET and mpMRI. CONCLUSIONS: We demonstrated the feasibility and accuracy of multimodal image registration for targeted prostate biopsies with echography 3D to define localization of prostate cancer, compared to standard biopsies. It was very interesting to observe sometimes a great difference in the distribution of PET choline targets and mpMRI targets in the prostate. mpMRI was probably better than PET to detected prostate cancer but it could be complementary. A new study with a novel ligands targeting prostate specific membrane antigen (PSMA) could improve our clinical results.

PD34-05 5-ALPHA REDUCTASE INHIBITORS IN PATIENTS ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER: IMPACT ON DISEASE PROGRESSION AND CURATIVE INTERVENTION

INTRODUCTION AND OBJECTIVES: To report pathologic progression (PP) and curative intervention (CI) in 361 men on active surveillance (AS) in comparison between with and without use of 5alpha reductase inhibitors (5-ARI). METHODS: Total 361 patients were grouped: with use of 5-ARI (n1⁄4 119, 33%) or without use of 5-ARI (No 5-ARI), n1⁄4242 (67%). All the patients had at least two years of follow up and the median follow up time was 5.1 years for 5-ARI vs 5.3 years for No 5-ARI (p1⁄40.6). The AS protocol included PSA (6 monthly), multi-parametric transrectal ultrasound (TRUS) annually, and surveillance biopsy (2-3 yearly, or as indicated). PP was defined as upgrade on Gleason score, increase in cancer core length (>4mm) or percent (>25%), or clinical progression on the follow up. CI was defined as discontinuing AS to undergo any kind of curative or hormonal therapy. Clinical variables were compared between the two groups. Kaplan-Meier method was conducted to estimate survivals for PP and CI, and multivariable Cox regression for predictors of PP. RESULTS: At the entry, the two groups were similar: age (63 vs. 61yrs, p1⁄40.1), PSA (4.8 vs. 4.8ng/ml, p1⁄40.5), prostate volume on TRUS (41cc vs. 35cc, p1⁄40.1), clinical stage T1c/T2a (85%/13% vs. 90%/9%, p1⁄40.06), biopsy Gleason score (6/3þ4/4þ3 1⁄4 88%/10%/2% vs. 87%/11%/2%, p1⁄40.9), biopsy cancer core length (1.5mm vs. 1mm, p1⁄40.37) and percent (10% vs. 8.5%, p1⁄40.2) of index cancer, and number of positive cores (1 vs. 1, p1⁄40.1), respectively for 5-ARI vs No 5-ARI groups. Predictors of PP were: not taking 5-ARI (p1⁄40.017), entry PSA > 4ng/ml (p1⁄40.009) and Gleason pattern 4 in biopsy (p<0.001). In regression analyses, 5-ARI-group had lowered the risk of PP by 41%. Estimated probability of PP-free survival (Fig 1) and CI-free survival (Fig 2) are shown: CONCLUSIONS: The use of 5-ARI for selected patients on AS delayed PCa progression and curative intervention. Source of Funding: None

MP67-07 TRANS-RECTAL ULTRASOUND VISIBILITY OF PROSTATE LESIONS INCREASES ACCURACY OF MR-TRUS IMAGE-FUSION GUIDED BIOPSIES.

patients > 69 years ranged from 42% to 86% for individual practices (p1⁄40.0008). For patients with PSA 60 cc were less likely to predict prostate cancer detection than size < 30 cc (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.440.64 and OR 0.23, 95% CI 0.18-0.29, respectively). CONCLUSIONS: Cancer detection rates are higher than previously reported. Practice patterns and cancer yield for prostate biopsy vary widely across urology practices in Michigan. These data serve as a foundation for our efforts to understand and improve patient selection for prostate biopsy.

631 RENAL TUMOR CONTACT SURFACE AREA: A NOVEL CT-PARAMETER FOR PREDICTING PERI-OPERATIVE OUTCOMES USING ADVANCED IMAGE-PROCESSING SOFTWARE

INTRODUCTION AND OBJECTIVES: The surface area of contact that a tumor has with the adjacent renal parenchyma considerably determines the extent of resection of kidney tissue during partial nephrectomy (PN), and thus may impact on peri-operative outcomes. We present a novel method of calculating renal tumor contact surface area (CSA) using image-processing technology and correlate it with peri-operative variables in patients undergoing PN. METHODS: From January 2010 August 2011, 162 patients underwent minimally invasive PN for tumor, and had CSA data available using image rendering software (3D Synapse Fuji film&©). Pre-operative CT scans were evaluated using 3D synapse to calculate CSA for each tumor (figure). This was performed by first calculating the tumor volume and percentage of tumor located within the renal parenchyma. The total surface area (4 r) of the tumor was then multiplied by the percent intra-parenchymal component to give the CSA for each tumor. CSA was then correlated with baseline demographics and peri-operative outcomes. RESULTS: Mean tumor size was 3.1 cm and mean CSA was 18.3 cm. Univariate analysis demonstrated that CSA significantly correlated with blood loss (p 0.0001), operative time (p 0.003), length of hospital stay (p 0.0028), and post-operative eGFR (0.0124). On multivariable logistic regression a CSA 20 cm was an independent predictor of overall complications and adverse perioperative outcomes. CONCLUSIONS: In patients undergoing partial nephrectomy, tumors with greater contact surface area with surrounding renal parenchyma require a more extensive resection, thus impacting on perioperative outcomes including blood loss, operative duration, complications and renal function. If these findings are validated in larger cohorts, future nephrometry systems could incorporate CSA measurements to objectively quantify renal tumor complexity and predict peri-operative outcomes of partial nephrectomy surgery.