Defining prostate cancer size and treatment margin for focal therapy: does intralesional heterogeneity impact the performance of multiparametric MRI?

BJU International - Tập 128 Số 2 - Trang 178-186 - 2021
Edwin Jonathan Aslim1, Yu Xi Terence Law2, Stephanie Man Chung Fook‐Chong3, Henry Sun Sien Ho1, John Shyi Peng Yuen1, Weber Kam On Lau1, Lui Shiong Lee4, Christopher Wai Sam Cheng4, Nye Thane Ngo5, Yan Mee Law6, Kae Jack Tay1
1Department of Urology, Singapore General Hospital, Singapore City, Singapore
2Department of Urology, National University Hospital, Singapore City, Singapore
3Health Services Research Unit, Singapore General Hospital, Singapore City, Singapore
4Department of Urology, Sengkang General Hospital, Singapore City, Singapore
5Department of Anatomical Pathology, Singapore General Hospital, Singapore City, Singapore
6Department of Diagnostic Radiology, Singapore General Hospital, Singapore City, Singapore

Tóm tắt

ObjectivesTo evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer.Patients and MethodsWe identified men who underwent primary radical prostatectomy for organ‐ confined prostate cancer over a 3‐year period. Cancer foci on whole‐mount histology were marked out, coding low‐grade (LG; Gleason 3) and high‐grade (HG; Gleason 4–5) components separately. Measurements of entire tumours were grouped according to intralesional proportion of HG cancer: 0%, <50% and ≥50%; the readings were corrected for specimen shrinkage and correlated with matching lesions on mpMRI. Separate measurements were also taken of HG cancer components only, and correlated against entire lesions on mpMRI. Size discrepancies were used to derive the optimal tumour size and treatment margins for FT.ResultsThere were 122 MRI‐detected cancer lesions in 70 men. The mean linear specimen shrinkage was 8.4%. The overall correlation between histology and MRI dimensions was r = 0.79 (P < 0.001). Size correlation was superior for tumours with high burden (≥50%) compared to low burden (<50%) of HG cancer (r = 0.84 vs r = 0.63; P = 0.007). Size underestimation by mpMRI was more likely for larger tumours (51% for >12 mm vs 26% for ≤12 mm) and those containing HG cancer (44%, vs 20% for LG only). Size discrepancy analysis suggests an optimal tumour size of ≤12 mm and treatment margins of 5–6 mm for FT. For tumours ≤12 mm in diameter, applying 5‐ and 6‐mm treatment margins would achieve 98.6% and 100% complete tumour ablation, respectively. For tumours of all sizes, using the same margins would ablate >95% of the HG cancer components.ConclusionsMultiparametric MRI performance in estimating prostate cancer size, and consequently the treatment margin for FT, is impacted by tumour size and the intralesional heterogeneity of cancer grades.

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Tài liệu tham khảo

10.1001/jama.2014.17942

10.1016/j.juro.2018.09.049

10.1038/s41391-018-0042-0

10.1016/j.juro.2016.07.084

10.1016/j.juro.2013.12.006

10.1001/jama.2009.1498

10.1016/j.juro.2012.07.055

10.1200/JCO.2014.55.1192

10.1200/JCO.2015.62.5764

10.1097/JU.0000000000000357

10.1016/j.juro.2015.02.080

10.1016/j.eururo.2015.08.052

10.1038/pcan.2017.8

10.1111/bju.13619

10.1148/radiol.2020192330

10.1016/j.cmpb.2020.105316

10.1097/00000478-199612000-00009

10.1097/00000478-199202000-00012

10.1016/j.ajur.2018.05.008

10.1148/radiol.2016152827

10.1016/j.eururo.2014.08.079

10.1002/1097-0142(19930201)71:3 <933::AID-CNCR2820711408>3.0.CO;2-L

10.1016/j.eururo.2015.10.041

10.1111/bju.12892

10.1097/MOU.0000000000000540

10.1007/s00345-016-1924-1

10.1016/j.eururo.2020.05.018

10.1007/s00345-018-2363-y

10.1038/nrclinonc.2010.190

10.1016/j.eururo.2015.01.030

10.2214/AJR.15.15878

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BJU International

Tập 128 Số 2

178-186

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