Incidence of nephrogenic systemic fibrosis after adoption of restrictive gadolinium-based contrast agent guidelines

Abstract

Editorial CommentDespite advances in technology and surgical techniques the promise of a complete negative surgical margin for radical prostatectomy seems to be a Chimera. Recent reports demonstrate stable results for positive surgical margins in large series of radical prostatectomies but it seems always intimately related to surgeons experience and performance rather than the surgical technique utilized. Patel and colleagues should be commended for their effort of demonstrating a multi-institutional study which the common factor is the use of robotic technology to perform radical prostatectomies for prostate cancer. The PSMs are comparable to open series and conclusions about the superiority of the robotic technology were not noted in the conclusion by the authors. On multivariate analysis pathological stage and preoperative prostate specific antigen (4 or less vs greater than 10 ng/mL OR 2.918, p < 0.001) were the most important independent predictive factors for positive surgical margins after robotic assisted radical prostatectomy. Curiously, heavier prostates were associated with a lower risk of positive surgical margins after robotic assisted radical prostatectomy and a higher body mass index was associated with a higher risk of positive surgical margins. For organ confined disease preoperative prostate specific antigen was the most important factor that independently correlated with positive surgical margins.Studies have demonstrated that even after approximately 3 decades of research trying to achieve the perfect radical prostatectomy seems to be a daunting task due to lack of complete understanding of the surgical landmarks and the suboptimal imaging and diagnostic tests to pre-operatively evaluate the true localization of the cancer in the prostate. Dr. Fernando J. Kim IMAGING _____________________________________________________________________________ Incidence of Nephrogenic Systemic Fibrosis after Adoption of Restrictive Gadolinium-based Contrast Agent GuidelinesWang Y, Alkasab TK, Narin O, Nazarian RM, Kaewlai R, Kay J, Abujudeh HH Department of Radiology and Department of Pathology, Dermatopathology Unit, Massachusetts General Hospital, 55 Fruit St, FND 213B, Boston, MA 02114 Radiology. 2011; 260: 105-11 Purpose: To retrospectively determine the incidence of nephrogenic systemic fibrosis (NSF) in a large academic medical center after the adoption of restrictive gadolinium-based contrast agent (GBCA) administration guidelines. Materials and Methods: For this retrospective HIPAA-compliant study, institutional review board approval was obtained and the requirement for informed consent was waived. Restrictive GBCA guidelines were adopted in May 2007. The guidelines (a) require a recent serum creatinine level measurement in any patient who is aged 60 years or older and/or at risk for renal disease, (b) limit the maximal weight-based GBCA dose administered to any patient with an estimated glomerular filtration rate (eGFR) lower than 60 mL/min/m(2)