Purpose
To compare the safety and efficacy of n-butyl cyanoacrylate glue (NBCA) versus microspheres for prostatic artery embolization (PAE) in patients with benign prostatic obstruction (BPO).
...Materials and Methods
This institutional review board-approved, single-centre, retrospective study included consecutive patients undergoing PAE from September 2017 to July 2020. Age, medical history, previous treatment, pre- and post-PAE prostatic volumes and International Prostate Symptom Scores (IPSSs) were systematically analysed. Procedural duration, dosimetry, immediate and delayed complications were recorded. Patients at the beginning of the study were treated with microspheres and patients at the end of the study with NBCA. The main outcome measures were the absolute and relative changes in IPSS at 3 months. Statistical analyses comprised unpaired
t
-tests, Wilcoxon tests, Chi-2 tests, uni- and multivariate linear regressions.
Results
Sixty-two patients were included (median age: 65.9 years). Thirty-two patients were treated with microspheres and 30 with NBCA. There were no significant baseline differences between the two groups except for the baseline PSA (
P
= 0.0251). Average procedural and fluoroscopy times, and radiation exposure were significantly lower in the NBCA group versus the microspheres group (80.7 ± 22.5 versus 112 ± 42.1 min
P
= 0.0011, 24.2 ± 9.6 min versus 42.1 ± 20.2 min
P
= 0.0001, 12,004.6 ± 6702 uGy.m
2
versus 25,614.9 ± 15,749.2 uGy.m
2
P
= 0.0001, respectively). Immediate complications were all minor, and there were no significant differences between the two groups (4/32 12.5% with microspheres versus 7/30 23.3% with NBCA,
P
= 0.4335), nor for delayed complications (
P
= 1). No association was found between the PAE techniques and the absolute change in IPSS at 3 months (−10.2 ± 7.9 with microspheres versus −9.5 ± 7.6 with NBCA,
P
= 0.7157).
Conclusion
PAE using NBCA was safe and effective for symptomatic BPO, with faster procedures, lower radiation exposure and similar safety and efficacy compared to microspheres. Operator learning curve could have biased the procedural times and radiation exposure between groups favouring NBCA.
Whether multiparametric MRI improves the detection of clinically significant prostate cancer and avoids the need for systematic biopsy in biopsy-naive patients remains controversial. We aimed to ...investigate whether using this approach before biopsy would improve detection of clinically significant prostate cancer in biopsy-naive patients.
In this prospective, multicentre, paired diagnostic study, done at 16 centres in France, we enrolled patients aged 18–75 years with prostate-specific antigen concentrations of 20 ng/mL or less, and with stage T2c or lower prostate cancer. Eligible patients had been referred for prostate multiparametric MRI before a first set of prostate biopsies, with a planned interval of less than 3 months between MRI and biopsies. An operator masked to multiparametric MRI results did a systematic biopsy by obtaining 12 systematic cores and up to two cores targeting hypoechoic lesions. In the same patient, another operator targeted up to two lesions seen on MRI with a Likert score of 3 or higher (three cores per lesion) using targeted biopsy based on multiparametric MRI findings. Patients with negative multiparametric MRI (Likert score ≤2) had systematic biopsy only. The primary outcome was the detection of clinically significant prostate cancer of International Society of Urological Pathology grade group 2 or higher (csPCa-A), analysed in all patients who received both systematic and targeted biopsies and whose results from both were available for pathological central review, including patients who had protocol deviations. This study is registered with ClinicalTrials.gov, number NCT02485379, and is closed to new participants.
Between July 15, 2015, and Aug 11, 2016, we enrolled 275 patients. 24 (9%) were excluded from the analysis. 53 (21%) of 251 analysed patients had negative (Likert ≤2) multiparametric MRI. csPCa-A was detected in 94 (37%) of 251 patients. 13 (14%) of these 94 patients were diagnosed by systematic biopsy only, 19 (20%) by targeted biopsy only, and 62 (66%) by both techniques. Detection of csPCa-A by systematic biopsy (29·9%, 95% CI 24·3–36·0) and targeted biopsy (32·3%, 26·5–38·4) did not differ significantly (p=0·38). csPCa-A would have been missed in 5·2% (95% CI 2·8–8·7) of patients had systematic biopsy not been done, and in 7·6% (4·6–11·6) of patients had targeted biopsy not been done. Four grade 3 post-biopsy adverse events were reported (3 cases of prostatitis, and 1 case of urinary retention with haematuria).
There was no difference between systematic biopsy and targeted biopsy in the detection of ISUP grade group 2 or higher prostate cancer; however, this detection was improved by combining both techniques and both techniques showed substantial added value. Thus, obtaining a multiparametric MRI before biopsy in biopsy-naive patients can improve the detection of clinically significant prostate cancer but does not seem to avoid the need for systematic biopsy.
French National Cancer Institute.
Purpose
To evaluate the reliability of quantitative ultrasonic measurement of renal allograft elasticity using supersonic shear imaging (SSI) and its relationship with parenchymal pathological ...changes.
Materials and methods
Forty-three kidney transplant recipients (22 women, 21 men) (mean age, 51 years; age range, 18–70 years) underwent SSI elastography, followed by biopsy. The quantitative measurements of cortical elasticity were performed by two radiologists and expressed in terms of Young’s modulus (kPa). Intra- and inter-observer reproducibility was assessed (Kruskal-Wallis test and Bland-Altman analysis), as well as the correlation between elasticity values and clinical, biological and pathological data (semi-quantitative Banff scoring). Interstitial fibrosis was evaluated semi-quantitatively by the Banff score and measured by quantitative image analysis.
Results
Intra- and inter-observer variation coefficients of cortical elasticity were 20 % and 12 %, respectively. Renal cortical stiffness did not correlate with any clinical parameters, any single semi-quantitative Banff score or the level of interstitial fibrosis; however, a significant correlation was observed between cortical stiffness and the total Banff scores of chronic lesions and of all elementary lesions (
R
= 0.34,
P
= 0.05 and
R
= 0.41,
P
= 0.03,respectively).
Conclusion
Quantitative measurement of renal cortical stiffness using SSI is a promising non-invasive tool to evaluate global histological deterioration.
Key Points
•
Supersonic shear imaging elastography can measure cortical stiffness in renal transplants
•
The level of cortical stiffness is correlated with the global degree of tissue lesions
•
The global histological deterioration of transplanted kidneys can be quantified using elastography
Assessment of minimal residual disease has emerged as a powerful prognostic factor in acute myeloid leukemia. In this study, we investigated the potential of
mutations as targets for minimal residual ...disease assessment in acute myeloid leukemia, since these mutations collectively occur in 15-20% of cases of acute myeloid leukemia and now represent druggable targets. We employed droplet digital polymerase chain reaction assays to quantify
,
, and
mutations on genomic DNA in 322 samples from 103 adult patients with primary
mutant acute myeloid leukemia and enrolled on Acute Leukemia French Association (ALFA) - 0701 or -0702 clinical trials. The median
mutant allele fraction in bone marrow samples was 42.3% (range, 8.2 - 49.9%) at diagnosis of acute myeloid leukemia, and below the detection limit of 0.2% (range, <0.2 - 39.3%) in complete remission after induction therapy. In univariate analysis, the presence of a normal karyotype, a
mutation, and an
mutant allele fraction <0.2% in bone marrow after induction therapy were statistically significant predictors of longer disease-free survival. In multivariate analysis, these three variables remained significantly predictive of disease-free survival. In 7/103 (7%) patients,
mutations persisted at high levels in complete remission, consistent with the presence of an
mutation in pre-leukemic hematopoietic stem cells. Five out of these seven patients subsequently relapsed or progressed toward myelodysplastic syndrome, suggesting that patients carrying the
mutation in a pre-leukemic clone may be at high risk of hematologic evolution.
Multiple myeloma (MM) is a hematological malignancy characterized by an abnormal clonal plasma cell proliferation in the bone marrow secreting a monoclonal component. The international standard care ...for eligible patients consists of intensive induction therapy followed by high-dose melphalan and autologous stem cell transplantation (ASCT).
Our study included two groups of newly diagnosed MM patients who received a first-line treatment of double or triple induction, ASCT, with or without consolidation and maintenance. The study participants were treated in Lyon (France) and Oran (Algeria).
The principal aim of this study was to evaluate the long-term outcome after ASCT in these 2 countries with different resources and to evaluate the potential consequences of non-identical access to the same therapeutic arsenal and means of early detection of relapse.
Despite important differences between the 2 countries, we showed a similar overall survival (OS) for the total population and patients who did not relapse and received no chemotherapy after ASCT. Surprisingly, these latter patients concerned 2/3 of Algerian patients and only 1/3 of French patients, explained by differences regarding the definition of relapse and leading to a probable underestimation in Algeria. To better explore this observation, we performed a survival analysis using the instant ratio. We found better survival in France between 0-12 months after ASCT, related to higher non-relapse mortality in Algeria. Furthermore, we showed better survival in Algeria after 48 months. This last result was enhanced by a significant difference in the time to next treatment (TTNT) between Algeria and France (median TTNT of 72.61 months and 32.77 months, respectively). For relapsing patients, we found a better OS in France for patients who received ≤3 lines of treatment after ASCT, and no difference between French patients who received ≥4 therapeutic lines and Algerian patients receiving 1 or 2 lines.
In conclusion, waiting to re-treat MM patients in Algeria, correlated with delayed TTNT, could support the hypothesis of lower healthcare costs and therapeutic savings when comparing France and Algeria. This is strengthened by a similar global long-term OS of the 2 groups.
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