1,720,984 research outputs found
Underestimated role of MRI in EAU guidelines on prostate cancer.
No full textCancer guidelines should be clear, accurate and precise for an optimal diagnosis and management.
We have read with great interest the “European Association of Urology (EAU) Guidelines on Prostate Cancer. Part1: Screening, Diagnosis, and Local Treatment with Curative Intent-Update 2013” of Heidenreich et al. [1]. In the chapter 6 Diagnosis and staging of prostate cancer (PCa), the role of imaging and in particular of magnetic resonance imaging (MRI) in the diagnosis of PCa is underestimated.
Conventional transrectal ultrasound (TRUS) guided biopsy for the diagnosis of PCa results in high false negative rates because neither targeting nor tracking the spatial location of tumor within the prostate is a part of this routine procedure [2].
The literature data indicate an emerging role for multiparametric MRI (mpMRI) combining T2-weighted imaging, diffusion-weighted imaging, contrast-enhanced MRI, and spectroscopy as the most accurate tool available in targeted biopsies for patients with high PSA levels suggestive of PCa and previously negative biopsies. However, this method is not used as first approach for PCa diagnosis [3], [4] and [5].
MpMRI offers greatly improved imaging of PCa. In particular, mpMRI-US fusion allows the informations to be used to direct needle biopsy under US guidance, with improvement of prostate biopsy in an office-based procedure [2].
In EAU guidelines on PCa the statement “The main tools to diagnose PCa include DRE, serum concentration of PSA, and transrectal ultrasound (TRUS)-guided biopsy” is incomplete. This statement should include the fusion of MRI with US to guide biopsy, as follows: “The main tools to diagnose PCa include DRE, serum concentration of PSA, multiparametric magnetic resonance imaging-ultrasound (mpMRI-US) fusion-guided prostate biopsy and transrectal ultrasound (TRUS)-guided biopsy”.
Also, the EAU guidelines state that “Ultrasound-guided transrectal or transperineal laterally directed 18G core biopsy has become the standard way to obtain material for histopathologic examination [6] and [7]”. The correct statement is “mpMRI is the method of choice in the detection of PCa, but it, used in certain centers and in specific patient populations, is expensive and time consuming, requires MRI-compatible equipment, often a general anesthetic, and is not available in most hospitals. Consequently, ultrasound-guided transrectal or transperineal laterally directed 18G core biopsy remains the standard way to obtain material for histopathologic examination [2], [6] and [7]”.
In conclusion, to date mpMRI is the more accurate procedure in the detection and staging of PCa. MpMRI-US fusion improves the false negative results of TRUS-guided biopsy
Resection of Congenital Cystic Intrapulmonary Lesions Is Always Necessary
No full textRecently we correlated histology and computed tomographic imaging of intrapulmonary congenital cystic lesions of the adult, including intrapulmonary cysts and congenital cystic adenomatoid malformation type I.
West and colleagues [1] described a carcinoma after a congenital lesion in a young patient. They underlined the possibility of underestimation of these lesions.
Then Lantuejoul and colleagues [2] confirmed the relation between carcinoma and this kind of congenital lesions in their study.
These two studies unequivocally demonstrate the carcinogenetic potential of type I congenital cystic adenomatoid malformation (CCAM).
This finding will radically modify the therapeutic approach to the congenital pulmonary cystic lesions in the adults.
Beside CCAM, other pulmonary cystic malformations are: congenital lobar emphysema, pulmonary sequestrions, bronchogenic cysts, and other foregut cysts, including intrapulmonary cysts [3].
The intrapulmonary bronchogenic cysts may be asymptomatic and are identified in the adult on routine imaging. All the other cystic malformations are symptomatic and found in the childhood.
In our recent experience when they are intrapulmonary lesions, the bronchogenic cysts are radiologically indistinguishable from large single CCAM type I. Only histologic examination can establish the cystic nature of the lesion. The presence of parietal cartilage islands, bronchial glands, smooth muscle, and occasionally calcifications and ossification is conclusive for intrapulmonary bronchogenic cysts in the differential diagnosis with CCAM type I [4].
Because the differential diagnosis between solitary IBC and type 1 CCAM is not possible by radiologic procedures, generally a complete surgical resection is advisable in solitary cystic congenital intrapulmonary lesions in adults at the time of diagnosis, even if asymptomatic. A delayed or incomplete resection may expose the patient to tumour development in the case of type 1 CCAM
Dynamic contrast-enhanced MR imaging for differentiation of renal cell carcinoma subtypes: myth or reality?
No full textSplit-Bolus Spectral Multidetector CT of the Pancreas: Problem Solving in the Detection of "Isoattenuating" Pancreatic Cancer?
No full textWe read with great interest the article by Dr Brook and colleagues in the October 2013 issue of Radiology (1). We greatly appreciate the protocol for a 43% reduction in radiation dose,
but there are some concerns to be discussed. Pancreatic ductal adenocarcinoma (PDA), which is “isoattenuating” at computed tomography (CT), is reported in 5%–45% of cases (2–5). In the
study by Dr Brook and colleagues, an equal percentage of tumors were detected with both standard and split-bolus CT techniques, and results of short-term follow-up did not reveal any
missed lesions.
For quantitative analysis, Dr Brook and colleagues erroneously considered surrounding pancreatic parenchyma to the tumor as “normal pancreas.” Histologic demonstration of normal pancreas
is not reported. In our experience with multiphasic CT in 38 surgically resected PDAs (6,7), coexisting pancreatitis in the surrounding pancreas (upstream to the tumor) was revealed histologically in all cases, making diagnosis difficult because of the overlapping attenuation values between the tumor and pancreas upstream; four of the 38 PDAs (10%) were unrecognizable at quantitative analysis. In our study, the mean attenuation values at the arterial (pancreatic) phase of multiphase CT were lower than that reported in the same phase of the multiphase protocol by Dr Brook
and colleagues (83 HU ± 27 vs 105.1 HU ± 29.3, respectively). In addition, we believe that the mean attenuation values reported by Dr Brook and colleagues with split-bolus spectral multi
detector CT at 60 keV are excessively high with respect to those reported in the arterial (pancreatic) phase (212.1 HU ± 64.7 vs 83 HU ± 27, respectively). To increase the sensitivity of the
split-bolus technique in the detection of isoattenuating PDA, in addition to combined-phase images in a single scan we suggest a delayed phase in the upper abdomen at 5 minutes (8)
Detection of Small (<=20 mm) Pancreatic Adenocarcinoma: Histologic Grading and CT Enhancement Features
No full textWe read with great interest the article by Yoon and colleagues in the May 2011 issue of Radiology (1). We greatly appreciate the study, but there are some concerns to be discussed.
The authors inappropriately use the term “multiphasic” multidetector computed tomography (CT). Their study protocol provided an unenhanced scan, a pancreatic parenchymal phase scan, and a portal venous phase scan. Only pancreatic parenchymal phase CT was performed in two patients, and only portal venous phase CT was performed in nine patients. The term multiphasic (“tri-” or “quadriphasic” CT) is standardized and refers only to the helical CT volume acquisition at different phases after intravenous injection of a bolus of contrast material (2).
In the conclusion of the abstract, the authors wrote: “The prevalence of isoattenuating pancreatic cancers differed significantly according to tumor size and cellular differentiation. Most small isoattenuating pancreatic cancers showed secondary signs.” These conclusions are not supported in Materials and Methods. The cellular differentiation grading and the histologic features of “loose fibrosis” are not described in the Materials and Methods or Results sections. Furthermore, tumor size at CT was correlated with tumor size at histologic examination in only a few cases. Microscopy is, of course, considered the standard of reference for the measurement of tumor size.
In addition to using main pancreatic duct dilatation or the interrupted duct sign, which are indicators of an isoattenuating cancer (3), to detect a small pancreatic adenocarcinoma at CT, we suggest performing delayed-phase imaging in association with dual-phase helical CT (triphasic CT) (4)
Oncocytic sialolipoma of the submandibular gland with sebaceous differentiation: A new pathological entity
No full textCase Report: We report the case of an oncocytic sialolipoma of the submandibular gland with sebaceous differentiation in a 73-year-old man. The initial symptom was a right submandibular painless mass. Ultrasonography showed a hypoechoic oval mass posterior to the submandibular gland. The tumorectomy was performed with preservation of the salivary gland. The tumor was composed of mature adipose tissue surrounded by a thin fibrous capsule, multiple nodules of oncocytes, normal ductal-acinar units with focal ductal sebaceous differentiation. Discussion: We reviewed literature of the reported cases of mixed tumors of the salivary glands composed of mature adipose tissue with oncocytosis, salivary ducts, and acini with sebaceous differentiation. Conclusions: Sialolipoma and lipoadenoma with or without oncocytosis and/or sebaceous differentiation should be considered organ-specific tumors with a distinct histological appearance and specific terminology
Uselessness of percutaneous core needle renal biopsy in the management of small renal masses.
No full textIn the paper “Differentiation of oncocytoma and renal cell carcinoma in small renal masses ( <4 cm ): the role of 4-phase computerized tomography” published online August 18, 2010, in World Journal of Urology, Bird V.G. and colleagues [1] write in the Discussion: “With the advancement of imaging techniques, enhancement patterns of renal tumors on CT have evolved to be the best, though limited, non-invasive technique to predict the pathological diagnosis of renal tumors. Implementing this technique to differentiate oncocytoma from the subtypes of RCC will have a great impact on the management of patients. In conclusion, non-invasive differentiation between benign and malignant renal tumors has paramount importance in determining the management plan for patients.”We do not agree with these statements. The small renal masses (SRMs) may be defined as neoplastic lesions <4 cm in diameter, which are more and more often found, especially in elderly and comorbid patients. Today, the vast majority of SRMs are incidentally diagnosed and therefore tend to have a better prognosis [2–4]. Nephron-sparing surgery (NSS) is the standard care for SRMs (stage pT1a). Patients with SRMs who are treated with NSS exhibit similar recurrence-free (0–3%) and 5-year cancer-specific survival when compared with renal nefrectomy [5–9]. SRMs include malignant and benign tumors. In the urologic practice, all SRMs should be removed with NSS independently from their histological nature. We believe that the differentiation of oncocytoma and renal cell carcinoma in SRMs is unnecessary because the tumor should be removed with NSS independently of its histological nature. Non-invasive differentiation between benign and malignant renal tumors has paramount importance in determining the management plan for patients only when the tumor is >4 cm in diameter
PSA/biparametric MRI: An accurate potential diagnostic approach for detection and management of local recurrence after radical prostatectomy
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