The purpose of this study was to evaluate in a multicenter dataset the performance of an artificial intelligence (AI) detection system with attention mapping compared with multiparametric MRI (mpMRI) ...interpretation in the detection of prostate cancer.
MRI examinations from five institutions were included in this study and were evaluated by nine readers. In the first round, readers evaluated mpMRI studies using the Prostate Imaging Reporting and Data System version 2. After 4 weeks, images were again presented to readers along with the AI-based detection system output. Readers accepted or rejected lesions within four AI-generated attention map boxes. Additional lesions outside of boxes were excluded from detection and categorization. The performances of readers using the mpMRI-only and AI-assisted approaches were compared.
The study population included 152 case patients and 84 control patients with 274 pathologically proven cancer lesions. The lesion-based AUC was 74.9% for MRI and 77.5% for AI with no significant difference (
= 0.095). The sensitivity for overall detection of cancer lesions was higher for AI than for mpMRI but did not reach statistical significance (57.4% vs 53.6%,
= 0.073). However, for transition zone lesions, sensitivity was higher for AI than for MRI (61.8% vs 50.8%,
= 0.001). Reading time was longer for AI than for MRI (4.66 vs 4.03 minutes,
< 0.001). There was moderate interreader agreement for AI and MRI with no significant difference (58.7% vs 58.5%,
= 0.966).
Overall sensitivity was only minimally improved by use of the AI system. Significant improvement was achieved, however, in the detection of transition zone lesions with use of the AI system at the cost of a mean of 40 seconds of additional reading time.
ERG rearrangements and PTEN (phosphatase and tensin homolog deleted on chromosome 10) loss are two of the most common genetic alterations in prostate cancer. However, there is still significant ...controversy regarding the order of events of these two changes during the carcinogenic process. We used immunohistochemistry (IHC) to determine ERG and PTEN status, and calculated the fraction of cases with homogeneous/heterogeneous ERG and PTEN staining in a given tumor.
Using a single standard tissue section from the index tumor from radical prostatectomies (N=77), enriched for relatively high grade and stage tumors, we examined ERG and PTEN status by IHC. We determined whether ERG or PTEN staining was homogeneous (all tumor cells staining positive) or heterogeneous (focal tumor cell staining) in a given tumor focus.
Fifty-seven percent (N=44/77) of tumor foci showed ERG positivity, with 93% of these (N=41/44) cases showing homogeneous ERG staining in which all tumor cells stained positively. Fifty-three percent (N=41/77) of tumor foci showed PTEN loss, and of these 66% (N=27/41) showed heterogeneous PTEN loss. In ERG homogeneously positive cases, any PTEN loss occurred in 56% (N=23/41) of cases, and of these 65% (N=15/23) showed heterogeneous loss. In ERG-negative tumors, 51.5% (N=17/33) showed PTEN loss, and of these 64.7% (N=11/17) showed heterogeneous PTEN loss. In a subset of cases, genomic deletions of PTEN were verified by fluorescence in situ hybridization in regions with PTEN protein loss as compared with regions with intact PTEN protein, which did not show PTEN genomic loss.
These results support the concept that PTEN loss tends to occur as a subclonal event within a given established prostatic carcinoma clone after ERG gene fusion. The combination of ERG and PTEN IHC staining can be used as a simple test to ascertain PTEN and ERG gene rearrangement status within a given prostate cancer in either a research or clinical setting.
Triple negative breast cancer (TNBC) comprises approximately 15 to 20 per cent of all breast cancer cases. Many studies have detected less lymph node metastasis in TNBC than sporadic breast cancers. ...In this study, we studied capillary and lymphatic invasion in tumors of patients with TNBC. To differentiate the capillary invasion and lymphovascular invasion. We used the Antihuman CD34 and antihuman D2-40 antibodies. Antihuman CD34 antibodies stain the blood vessels and lymphatics. However, antihuman D2-40 antibodies stain lymphatics specifically. Two experienced pathologists blinded to clinical data evaluated capillary and lymphatic invasion existence in 39 TNBC patients' tumor samples. Tumor samples were immunohistochemically stained with CD34 (endothelial cell marker) and D2-40 (podoplanin, a membrane protein, specific for lymphatic endothelium). The CD34-positive samples were categorized into two groups depending on their reaction with D2-40: lymphatic (D2-40-positive) and capillary (D2-40-negative) invasion. We have detected vascular invasion in 15 of 39 samples (38.5%) with CD34. Among those, capillary invasion was found in 14 (35.9%) and lymphatic invasion in three (7.7%) and both in two (5.1%) tumors. We did not find any significant correlation among capillary invasion, lymphatic invasion, vascular invasion, tumor grade, menopause status, history of cancer, and TNM. Capillary invasion is more commonly observed than lymphatic invasion in patients with TNBC. This finding supports the fact that more hematogenous metastasis (spreading) and less lymph node metastasis are seen in patients with TNBC.
Prostatic leiomyoma is a benign and rare condition of the prostate. Robotic surgery is increasingly being applied in the surgical management of prostate cancer.
Herein, a mass lesion that was located ...in the posterior part of the prostate between seminal vesicles that was identified during robotic surgery is presented. This lesion further challenged the console surgeon during performing a robotic radical prostatectomy procedure for a 200 g large prostate with prostate cancer.
Prostatic leiomyomas that are benign mesenchymal smooth muscle tumors might present as a posteriorly located mass lesion between seminal vesicles that could challenge the surgeon during surgery, which should be kept in mind.
Amaç: Toksik nodüler (TNG) ve toksik multinodüler guatr (TMNG), bir veya birden fazla otonomfonksiyone tiroid nodülünün varlığı ile karakterize hipertiroidiye yol açan hastalıklardır. ...Hipertiroidinintiroid kanserine karşı koruyucu olduğu inancına karşın son yıllarda bu hastalarda da tiroid kanserriskinin azımsanmayacak kadar olduğu ve nodüllerin diğer hastalarda olduğu gibi değerlendirilmesigerektiği yönünde yayınlar çoğalmaktadır. Bu çalışmanın amacı TNG/TMNG nedeniyle cerrahiuygulanan hastalarda tiroid kanser sıklığını belirlemek ve kanser ile ilişkili olabilecek preoperatifözellikleri değerlendirmektir.Materyal ve Metot: Çalışmaya Ocak 2017 ile Aralık 2014 arasında TNG veya TMNG nedeniyletiroidektomi yapılan hastalar alınmıştır. Retrospektif olarak taranan hastaların klinik özellikleri,laboratuar ve ultrasonografi (US) sonuçları, sitolojik ve histopatolojik bulguları kayıt edilmiştir.Histopatolojik sonucu benign ve malign saptanan hastaların klinik özellikleri, nodüllerin preoperatif USözellikleri ve sitolojik sonuçları karşılaştırılmıştır.Bulgular: Çalışmaya alınan 482 hastanın 335’i (%69,50) kadın, 147’si (%30,50) erkekti ve ortanca yaş 56(18‐79) idi. 74 (%15,35) hastada TNG, 408 (%84,65) hastada TMNG vardı. Histopatolojik olarak 380(%78,84) hastada benign, 102 (%21,16) hastada malign patoloji saptandı. Benign ve malign hastalarda yaş,cinsiyet dağılımı, antitiroid kullanımı, antikor pozitifliği, nodül sayısı açısından fark yoktu. Malignhastalarda ultrasonografik olarak parankimde tiroidit varlığı anlamlı şekilde yüksekti (%75,26 ve %87,24;p<0,001). Malign hastalarda sitoloji sonuçları nedeniyle tiroidektomi uygulanan hasta oranı benignhastalara oranla yüksekti. Benign hastalarda ise dev nodül nedeniyle tiroidektomi yapılan hasta oranımalign hastalara oranla yüksekti. Preoperatif US verileri incelenen 1263 tiroid nodülünün 1222’si(%96,75) histopatolojik olarak benign, 41’i (%3,25) malign idi. Malign nodüllerde hipoekojenite oranıbenign nodüllere göre anlamlı şekilde yüksekti. Benign ve malign nodüller arasında diğer US özellikleriaçısından fark saptanmadı. Sintigrafik değerlendirmesi olan nodüllerden benign olanların 406’sı(%71,99), malign olanların 19’u (%67,86) sintigrafik olarak aktifti (p=0,853).Sonuç: Bu çalışmada TNG/TMNG nedeniyle cerrahi uygun görülen hastalarda tiroid kanser sıklığı ihmaledilemeyecek oranda saptanmıştır. Bu hastalarda malign ve benign nodüllerin US özellikleri benzerbulunmuştur. TNG/TMNG’lı hastalardaki nodüllerde, nodül aktif dahi olsa, ince iğne aspirasyon biyopsiendikasyonunun diğer hastalarda olduğu gibi konulması, cerrahi planlandığında özellikle TMNGvarlığında total veya totale yakın tiroidektomi tercih edilmesi önerilir.
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