28 research outputs found
Clinical Management of Intraductal Carcinoma of the Prostate
No full textIntraductal carcinoma of the prostate (IDC-P) has emerged as a distinct entity with significant clinical implications in prostate cancer (PCa) management. Despite historically being considered an extension of invasive PCa, IDC-P shows unique biological characteristics that challenge traditional diagnostic and therapeutic settings. This review explores the clinical management of IDC-P. While the diagnosis of IDC-P relies on specific morphological criteria, its detection remains challenging due to inter-observer variability. Emerging evidence underscores the association of IDC-P with aggressive disease and poor clinical outcomes across various PCa stages. However, standardized management guidelines for IDC-P are lacking. Recent studies suggest considering adjuvant and neoadjuvant therapies in specific patient cohorts to improve outcomes and tailor treatment strategies based on the IDC-P status. However, the current level of evidence regarding this is low. Moving forward, a deeper understanding of the pathogenesis of IDC-P and its interaction with conventional PCa subtypes is crucial for refining risk stratification and therapeutic interventions
The Prostate Is Not a Pill and Therefore Has No Capsule
No full textTumor staging of prostate cancer is a fundamental principle in management and therapy, with a hallmark being tumor growth beyond the organ boundary. Often, this is referred to as “capsule penetration”, suggesting the existence of a true prostatic capsule that would facilitate the determination of tumor penetration. In fact, the prostate does not have a true capsule and, depending on the anatomic area, it blends with the surrounding fibrous, adipose and muscular tissue. This makes it sometimes difficult or impossible to unequivocally identify extraprostatic tumor extension. It is necessary to appreciate this difficulty in order to better understand the significance of extraprostatic tumor extension
The Genetic Complexity of Prostate Cancer
No full textInternational audienceProstate cancer (PCa) is a major concern in public health, with many genetically distinct subsets. Genomic alterations in PCa are extraordinarily complex, and both germline and somatic mutations are of great importance in the development of this tumor. The aim of this review is to provide an overview of genetic changes that can occur in the development of PCa and their role in potential therapeutic approaches. Various pathways and mechanisms proposed to play major roles in PCa are described in detail to provide an overview of current knowledge
Cribriform versus Intraductal: How to Determine the Difference
No full textInternational audienceSimple Summary Prostate cancer is a common and challenging disease among men, driving researchers to find better ways to understand and manage it. The understanding of two specific types, cribriform and intraductal prostate cancer (IDC-P), has evolved significantly over the years. This review aims to help pathologists differentiate between cribriform prostate cancer and IDC-P, and addresses current recommendations. Recent studies show that including these features in decision-making tools enhances predictions of cancer recurrence, spread, and patient outcomes. Future research should further focus on their pathological and molecular aspects to improve risk stratification, treatment approaches, and patient care.Abstract Over the years, our understanding of cribriform and intraductal prostate cancer (PCa) has evolved significantly, leading to substantial changes in their classification and clinical management. This review discusses the histopathological disparities between intraductal and cribriform PCa from a diagnostic perspective, aiming to aid pathologists in achieving accurate diagnoses. Furthermore, it discusses the ongoing debate surrounding the different recommendations between ISUP and GUPS, which pose challenges for practicing pathologists and complicates consensus among them. Recent studies have shown promising results in integrating these pathological features into clinical decision-making tools, improving predictions of PCa recurrence, cancer spread, and mortality. Future research efforts should focus on further unraveling the biological backgrounds of these entities and their implications for clinical management to ultimately improve PCa patient outcomes
PD-L1 (SP142) testing is concordant between Benchmark Ultra and Bond-III stainers
No full textInternational audienceBackground Atezolizumab is an inhibitor of programmed death-ligand 1 (PD-L1), used to treat advanced or metastatic bladder cancer, and in trials for non-invasive disease. In order to be eligible for treatment, patients require a PD-L1 immune cell score ≥ 5%, using the Ventana SP142 PD-L1 assay. Many laboratories do not have access to the required Ventana Benchmark Ultra stainer, and it is unclear if the assay performs similarly on other stainers. In this study, we compare SP142 assay results between Ventana Benchmark Ultra and Leica Bond-III stainers. Methods Serial sections of 90 samples of transurethral bladder resections (comprising 51 pTaHG, 8 pTis, 18 pT1, 10 pT2 tumors) were stained using the SP142 PD-L1 antibody on Ventana Benchmark Ultra and Leica Bond-III stainers, manually scored, and compared using accuracy and Cohen's kappa measures. Results Both devices yielded highly concordant PD-L1 immune cell scores (accuracy 0.84, Cohen's κ 0.732). Moreover, we found similar tumor cell (TC) PD-L1 scores using both stainers, and a trend towards greater TC scores in pT2 stage samples (p = 0.05). Conclusion This study is the first to compare the SP142 antibody in bladder cancer on two different stainers. Our results indicate that both Benchmark Ultra and Bond-III stainers yield highly concordant results using the SP142 PD-L1 antibody
Odontología en terreno
No full textObjetivos: realizar una metodología y una técnica simple, efectiva y acorde a los recursos a disposición en terreno desfavorable (comunidades de bajos recursos, difícil acceso y condiciones climáticas adversas). Materiales y Métodos: Los programas de salud que desarrollamos en terreno son a corta (localidades vecinas) y larga distancia (diferentes provincias). Primero se realizan actividades para integrarnos con la gente, juegos con los chicos, enseñanza de técnica de cepillado y flúor. En la atención propiamente dicha se utiliza la Técnica PRAT Modificada. Que consta en la limpieza de la cavidad de caries con instrumental de mano y la posterior obturación con materiales adhesivos. Esta técnica conserva tejidos dentarios sanos, no necesita anestesia, disminuye el dolor y trauma psicológico, no hay equipamiento adicional, es de bajo costo e ideal para la aplicación de programas masivos. También se realizan técnicas de sellado de fosas y fisuras; y remineralización con cariostáticos. Algunos de los materiales con los que se trabaja son agentes cariolíticos, flúor diamino de plata, Ionómero vítreo, elementos de aislación, cucharitas, escavadores, clamps, flúor fosfato acidulado, materiales descartables, digluconato de clorexidine, agua oxigenada, algodón, alcohol, frontolux. En las comunidades que atendemos se realiza odontología preventiva y curativa. Conclusiones: La técnica más oportuna en primera instancia es aquella que podamos realizar siempre que nos proporcione resultados positivos. Y de esta forma trasladar salud a lugares donde muy difícilmente o nunca llego.Facultad de Odontologí
Pathological reporting of cystectomy lymph nodes: a retrospective analysis of experience in Paris
No full textInternational audiencePurpose: Pathological evaluation of pelvic lymph node (LN) dissection (PLND) is important for management of cystectomy patients. However, challenges such as unclear interobserver variability of LN counting remain. Here, we assess interobserver variability of LN measures and their clinical utility, with a focus on variant histology.Methods: We retrieved radical cystectomy cases with PLND between 2010 and 2016 and reevaluated pathological parameters; number of total and metastatic LN, LN density (LND), length of metastatic LN and metastases, extranodal extension (ENE).Results: We report 96 patients: median age of 71a, 34 cases pN+, 36 cases with any extent of variant histology, median follow-up 10 months. Perivesical LN were only rarely identified, but frequently metastatic (4/9). Variant histology (34 cases) frequently exhibited LN metastasis (53% of pN+ cases). Interobserver variance was poor for total LN (kappa = 0.167), excellent for positive LN (0.85) and pN staging (0.96), and mediocre for LND (0.53). ROC analysis suggests that both LND and the sum of LN metastasis length may predict outcome (AUC 0.83 and 0.75, respectively).Conclusion: Our study confirms the notion of LND as a prognostic measure, but cautions due to strong interobserver variance of LN counts. The sum length of LN metastases could be a measure that is independent of LN counts. We find that microscopically identified perivesical LN merit particular attention. In summary, our study highlights current challenges in pathological reporting of PLND, confirms previous observations and forms a basis for further studies
Residencia Odontológica Social y Comunitaria
No full textLa Residencia Odontológica Social y Comunitaria (ROSyC) perteneciente a la Secretaria de Planificación y Extensión Universitaria de la FOLP, donde cuenta con su centro operativo. Tiene como objetivos principales brindar servicio a la comunidad y centrar la formación del odontólogo residente en el concepto de salud comunitaria. La práctica de dicha residencia esta vinculada a actividades de terreno a corta distancia (barrios periféricos a la ciudad) y larga distancia (otras provincias de la Argentina).Facultad de Odontologí
An instantly applicable machine learning model for extraprostatic extension prediction in prostate cancer: A post-hoc analysis of the RAPID 68Ga-PSMA PET/MRI trial
No full textRadical prostatectomy (RP) is a common first-line treatment for patients with localized prostate cancer (PCa), with nerve-sparing techniques recommended to minimize adverse effects on quality of life. Accurate pre-operative detection of extraprostatic extension (EPE) remains difficult, often resulting in suboptimal treatment choices. Machine learning (ML) has the potential to improve pre-operative EPE detection through the integration of multimodal data, but its clinical adoption is hindered by implementation complexities and explainability issues.
This study conducted a post-hoc analysis of a prospective clinical trial (NCT02659527) involving patients who underwent [68Ga]Ga-PSMA-11 PET/MRI from 2014 to 2019. Only the clinically used parameters were collected, including PET-derived features, blood-based markers, histology-derived parameters, and patient demographics. ML models were developed using either only non-invasive features or a combination of non-invasive and invasive features for EPE detection and were compared to conventional PET image readings.
Among the 77 patients included in the study, 44 (57%) had EPE based on post-surgical findings. The ML models outperformed traditional PET image readings in diagnostic accuracy, with the explainable boosting machine (EBM) model achieving an AUC of 0.88. The ML model incorporating invasive features showed superior predictive ability for EPE compared to visual clinical assessments (AUC 0.88 vs. 0.71, p 0.02), while the difference between the ML model with non-invasive features and clinical assessments was not significant (AUC 0.83 vs. 0.71, p 0.34).
Explainable ML models utilizing routinely acquired clinical data can greatly enhance the pre-operative detection of EPE in PCa patients, potentially leading to more accurate clinical staging, better treatment decisions, and improved patient outcomes.
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Mitosis domain generalization in histopathology images — The MIDOG challenge
No full textThe density of mitotic figures (MF) within tumor tissue is known to be highly correlated with tumor proliferation and thus is an important marker in tumor grading. Recognition of MF by pathologists is subject to a strong inter-rater bias, limiting its prognostic value. State-of-the-art deep learning methods can support experts but have been observed to strongly deteriorate when applied in a different clinical environment. The variability caused by using different whole slide scanners has been identified as one decisive component in the underlying domain shift. The goal of the MICCAI MIDOG 2021 challenge was the creation of scanner-agnostic MF detection algorithms. The challenge used a training set of 200 cases, split across four scanning systems. As test set, an additional 100 cases split across four scanning systems, including two previously unseen scanners, were provided. In this paper, we evaluate and compare the approaches that were submitted to the challenge and identify methodological factors contributing to better performance. The winning algorithm yielded an
score of 0.748 (CI95: 0.704-0.781), exceeding the performance of six experts on the same task
