Apparent Diffusion Coefficient and Other Preoperative Magnetic Resonance Imaging Features for the Prediction of Positive Surgical Margins in Prostate Cancer Patients Undergoing Radical Prostatectomy

Alessi, S.; Maggioni, Roberta; Luzzago, Stefano; Colombo, Alberto; Pricolo, Paola; Summers, Paul; Saia, Giulia; Manzoni, M.; Renne, Giuseppe; Marvaso, Giulia; Cobelli, Ottavio De; Bellomi, Massimo; Jereczek-Fossa, Barbara A.; Petralia, Giuseppe

doi:10.1016/j.clgc.2021.04.004

Cited by 10 publications

(16 citation statements)

References 27 publications

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“…This is consistent with the previous parameters of Alessi et al. ( 29 ), who also showed that ADC performs well in PSMs prediction, with lower ADC values observed in PSMs patients. The ADC model, however, tends to oversimplify the complexity of prostate tissue while ignoring the biological specificity of PCa, which results in poor predictive performance ( 30 ).…”

Section: Discussionsupporting

confidence: 93%

Multiparametric MRI-based nomograms in predicting positive surgical margins of prostate cancer after laparoscopic radical prostatectomy

et al. 2022

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BackgroundPositive surgical margins (PSMs) are an independent risk factor of biochemical recurrence in patients with prostate cancer (PCa) after laparoscopic radical prostatectomy; however, limited MRI-based predictive tools are available. This study aimed to develop a novel nomogram combining clinical and multiparametric MRI (mpMRI) parameters to reduce PSMs by improving surgical planning.MethodsOne hundred and three patients with PCa (55 patients with negative surgical margins [NSMs] and 48 patients with PSMs) were included in this retrospective study. The following parameters were obtained using GE Functool post-processing software: diffusion-weighted imaging (DWI); intravoxel incoherent motion model (IVIM); and diffusion kurtosis imaging (DKI). Patients were divided into different training sets and testing sets for different targets according to a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) regression algorithm was used to analyze the data set to select the optimal MRI predictors. Preoperatively clinical parameters used to build a clinical nomogram (C-nomogram). Multivariable logistic regression analysis was used to build an MRI nomogram (M-nomogram) by introducing the MRI parameters. Based on the MRI and clinical parameters, build an MRI combined with clinical parameters nomogram (MC-nomogram). Comparisons with the M-nomogram and MC-nomogram were based on discrimination, calibration, and decision curve analysis (DCA). A 3-fold cross-validation method was used to assess the stability of the nomogram.ResultsThere was no statistical difference in AUC between the C-nomogram (sensitivity=64%, specificity=65% and AUC=0.683), the M-nomogram (sensitivity=57%, specificity=88% and AUC=0.735) and the MC-nomogram (sensitivity= 64%, specificity=82% and AUC=0.756). The calibration curves of the three nomograms used to predict the risk of PSMs in patients with PCa showed good agreement. The net benefit of the MC-nomogram was higher than the others (range, 0.2-0.7).ConclusionsThe mpMRI-based nomogram can predict PSMs in PCa patients. Although its AUC (0.735) is not statistically different from that of the clinical-based nomogram AUC (0.683). However, mpMRI-based nomogram has higher specificity (88% VS. 63%), model stability, and clinical benefit than clinical-based nomogram. And the predictive ability of mpMRI plus clinical parameters for PSMs is further improved.

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Section: Discussionsupporting

confidence: 93%

Multiparametric MRI-based nomograms in predicting positive surgical margins of prostate cancer after laparoscopic radical prostatectomy

et al. 2022

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“…Although a period of 6 weeks between biopsy and surgery has been recommended to minimize post-biopsy adhesive changes, radical prostatectomy could be safely offered without the additional risk of PSM even if the time between biopsy and surgery was shortened to < 6 weeks; however, other perioperative outcomes need to be considered. However, interestingly, MR findings, including visible focal lesion on MR, its size and location were not significantly associated with PSM after surgery which was not in accordance with previous studies 22 , 23 . These findings are thought to show that detailed biopsy-related variables might be at least as important as some MR findings in predicting PSM after surgery in patients with clinically localized prostate cancer with PSA < 20 ng/mL.…”

Section: Discussioncontrasting

confidence: 79%

“…These findings are thought to show that detailed biopsy-related variables might be at least as important as some MR findings in predicting PSM after surgery in patients with clinically localized prostate cancer with PSA < 20 ng/mL. However, because the current study included very long period of MR-imaging, it is not easy to extract some important MR-related factors such as apparent diffusion coefficients values 23 and the impacts of these variables cannot be evaluated in this study.…”

Section: Discussionmentioning

confidence: 92%

Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy

Jeong

Choo

Cho

et al. 2022

Sci Rep

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We evaluated the surgical margin status after radical prostatectomy according to sites positive for prostate cancer on standard 12-core transrectal ultrasound-guided prostate biopsy. Among patients who underwent radical prostatectomy at Boramae Medical Center, 520 patients with preoperative prostate-specific antigen (PSA) level < 20 ng/mL and locally confined prostate cancer on preoperative magnetic resonance imaging, treated with nerve-sparing radical prostatectomy, were included in the analysis. The surgical margin was positive for cancer in 166 (31.9% of the total) patients. The preoperative PSA level (9.3 vs. 8.0, ng/mL p = 0.001) and number of positive cores on 12-core prostate biopsy (4.1 vs. 3.4, p = 0.003) were significantly higher in patients with positive surgical margins. Moreover, the biopsy Gleason grade was higher in patients with positive surgical margins (p = 0.001). However, the pathologic Gleason grade and tumor volume were equivalent between the 2 groups. On multivariate analysis, the detection of prostate cancer on anterior lateral biopsy was associated with an increased rate of positive surgical margins (hazard ratio [HR]: 1.781, p = 0.008) after adjusting for other variables. Anterior lateral (HR: 1.919, p = 0.020), basal lateral (HR: 9.176, p < 0.001), basal medial (HR: 3.302, p = 0.031), and mid lateral (HR: 2.501, p = 0.044) biopsies were associated with positive apical, posterior, basal, and lateral surgical margins, respectively, after adjusting for other variables. The sites of prostate cancer on standard 12-core prostate biopsy could be useful for predicting surgical margin positivity after radical prostatectomy. In other words, clinicians should consider the sites of prostate cancer on prostate biopsy to reduce margin positivity after radical prostatectomy.

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“…Conversely, benign tumors have relatively low cell density and a large tissue gap, so the free diffusion movement of water molecules is relatively free, manifested by a high apparent diffusion coefficient. The apparent diffusion coefficient has been confirmed to have high value in identifying various malignant tumors (16)(17)(18)(19). Zheng et al found that the apparent diffusion coefficient had a high predictive value for the response to chemotherapy in gastrointestinal cancer patients with liver metastases (20).…”

Section: Discussionmentioning

confidence: 99%

Apparent diffusion coefficient is a good marker in predicting the prognosis in colorectal cancer liver metastases: a diagnostic study

Zheng¹,

Lu²,

Zhang³

et al. 2022

J Gastrointest Oncol

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Background: Colorectal cancer (CRC) is one of the most common malignant tumors. Up to 10% CRC patients can have liver metastases at the first diagnosis. At present, clinical diagnosis of CRC liver metastasis (CRCLM) is mostly based on imaging, and there is a certain false-positive rate and false-negative rate.Improving the diagnostic accuracy of imaging for CRCLM is highly significant. Apparent diffusion coefficients showed high predicting value in other cancers. The aim of the present study was to explore the diagnostic value of apparent diffusion coefficients based on magnetic resonance diffusion weighted imaging for CRCLM.Methods: Fifty patients with CRCLM admitted to Hebei Yanda Hospital from January 2018 to December 2018 were retrospectively collected, and the data of 50 patients with benign liver nodules were collected at the same time. The diagnostic value of apparent diffusion coefficients on liver metastatic cancer was analyzed using receiver operating characteristic curve. The correlation between apparent diffusion coefficients and clinical pathological features of patients with CRCLM was also analyzed. The diagnosis of liver metastatic cancer was based on pathological biopsy. Three-year follow up after surgery was conducted in clinic or via phone.Results: Compared with the benign liver nodule group, the apparent diffusion coefficients of patients in the CRCLM group were significantly decreased [(1.14±0.26 vs. 2.06±0.57)×10−3 mm 2 /s, P<0.001]. The apparent diffusion coefficient was of high value in differentiating between benign liver nodules and liver metastatic cancer. The area under the curve was 0.927 [95% confidence interval (CI): 0.879-0.975, P<0.001]. Compared with patients with highly differentiated tumors, the apparent diffusion coefficients of patients with moderately and poorly differentiated tumors were significantly reduced [(1.08±0.26 vs. 1.29±0.22)×10−3 mm 2 /s, P=0.010]. Compared with patients who survived 3 years after operation, the apparent diffusion coefficients of patients who died were significantly lower [(1.05±0.26 vs. 1.23±0.23)×10−3 mm 2 /s, P=0.011]. The apparent diffusion coefficients of liver nodules in patients with CRCLM is a good marker in predicting postoperative 3-year survival, and the area under the curve was 0.728 (95% CI: 0.580-0.876, P=0.006). Conclusions:The apparent diffusion coefficient can sever as a marker in diagnosing CRCLM and predicting prognosis.

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Apparent Diffusion Coefficient and Other Preoperative Magnetic Resonance Imaging Features for the Prediction of Positive Surgical Margins in Prostate Cancer Patients Undergoing Radical Prostatectomy

Cited by 10 publications

References 27 publications

Multiparametric MRI-based nomograms in predicting positive surgical margins of prostate cancer after laparoscopic radical prostatectomy

Multiparametric MRI-based nomograms in predicting positive surgical margins of prostate cancer after laparoscopic radical prostatectomy

Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy

Apparent diffusion coefficient is a good marker in predicting the prognosis in colorectal cancer liver metastases: a diagnostic study

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