Ex vivo MRI evaluation of prostate cancer: Localization and margin status prediction of prostate cancer in fresh radical prostatectomy specimens

Heidkamp, Jan; Hoogenboom, Martijn; Kovacs, Iringo; Veltien, Andor; Maat, Arie; Sedelaar, J.P. Michiel; Kaa, Christina A. Hulsbergen‐van de; Fütterer, Jurgen J.

doi:10.1002/jmri.25785

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…Several authors have pursued similar methods in an effort to provide surgeons with accurate perioperative information on the margin status in tumors other than VSCC. Previously, breast, bone, gastric, esophageal, tongue and prostate specimens have been examined by ex vivo MRI. As far as we are aware, employing ex vivo MRI in RLE specimens is new, but other (imaging) techniques such as FSA and optical coherence tomography (OCT) have been investigated as a means to assess the surgical tumor‐free margins.…”

Section: Discussionmentioning

confidence: 99%

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

et al. 2018

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In the surgical treatment of vulvar squamous‐cell carcinoma (VSCC), tumor‐free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor‐free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor‐free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy‐proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR‐scanner. Whole mount H&E‐stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor‐free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non‐blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty‐four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non‐blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor‐free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.

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Section: Discussionmentioning

confidence: 99%

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

et al. 2018

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“…(a) Ex vivo 7T MRI of a radical prostatectomy specimen demonstrating a lesion in the left transition zone of the prostate (T) with low signal intensity on T2W sequence concerning for prostate cancer, as well as a BPH nodule (B) and the urethra (U); (b) corresponding H&E stained histopathology slide at 100× magnification with pathologist's annotation of a prostate cancer lesion (T). Previously published in: Heidkamp et al [20]. MRI, magnetic resonance imaging; BPH, benign prostatic hyperplasia.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

The role of novel imaging in prostate cancer focal therapy: treatment and follow-up

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Enders

Kozel

et al. 2022

Current Opinion in Urology

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Purpose of reviewMultiparametric magnetic resonance imaging (mpMRI) has fundamentally changed how intraprostatic lesions are visualized, serving as a highly sensitive means for detecting clinically significant prostate cancer (csPCa) via image-targeted biopsy. However, limitations associated with mpMRI have led to the development of new imaging technologies with the goal of better characterizing intraprostatic disease burden to more accurately guide treatment planning and surveillance for prostate cancer focal therapy. Herein, we review several novel imaging modalities with an emphasis on clinical data reported within the past two years. Recent findings7T MRI, artificial intelligence applied to mpMRI, positron emission tomography combined with either computerized tomography or MRI, contrast-enhanced ultrasound, and micro-ultrasound are novel imaging modalities with the potential to further improve intraprostatic lesion localization for applications in focal therapy for prostate cancer. Many of these technologies have demonstrated equivalent or favorable diagnostic accuracy compared to contemporary mpMRI for identifying csPCa and some have even shown improved capabilities to define lesion borders, to provide volumetric estimates of lesions, and to assess the adequacy of focal ablation of planned treatment zones. SummaryNovel imaging modalities with capabilities to better characterize intraprostatic lesions have the potential to improve accuracy in treatment planning, real-time assessment of the ablation zone, and posttreatment surveillance; however, many of these technologies require further validation to determine their clinical utility.

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“…Durand et al performed ex vivo MRI with direct histological correlation of the prostate gland that approached histological spatial resolution enabling the visualization of gland microanatomy with MRM (21). More recently, a study has investigated the ability of ex vivo 7.0-T MRI to localize prostate cancer and to predict the margin status in fresh radical prostatectomy specimens using histology as the reference standard (22). The author found that ex vivo MRI was able to accurately localize prostate cancer in radical prostatectomy specimens, and the technique provided information on the margin status (22).…”

Section: Introductionmentioning

confidence: 99%

“…More recently, a study has investigated the ability of ex vivo 7.0-T MRI to localize prostate cancer and to predict the margin status in fresh radical prostatectomy specimens using histology as the reference standard (22). The author found that ex vivo MRI was able to accurately localize prostate cancer in radical prostatectomy specimens, and the technique provided information on the margin status (22). In brain tumors, Martinez-Bisbal et al combined MRM with MR spectroscopy to study metabolites of ex vivo tumors at high resolution (23).…”

Section: Introductionmentioning

confidence: 99%

Assessing Histology Structures by Ex Vivo MR Microscopy and Exploring the Link Between MRM-Derived Radiomic Features and Histopathology in Ovarian Cancer

et al. 2022

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The value of MR radiomic features at a microscopic scale has not been explored in ovarian cancer. The objective of this study was to probe the associations of MR microscopy (MRM) images and MRM-derived radiomic maps with histopathology in high-grade serous ovarian cancer (HGSOC). Nine peritoneal implants from 9 patients with HGSOC were imaged ex vivo with MRM using a 9.4-T MR scanner. All MRM images and computed pixel-wise radiomics maps were correlated with the slice-matched stroma and tumor proportion maps derived from whole histopathologic slide images (WHSI) of corresponding peritoneal implants. Automated MRM-derived segmentation maps of tumor and stroma were constructed using holdout test data and validated against the histopathologic gold standard. Excellent correlation between MRM images and WHSI was observed (Dice index = 0.77). Entropy, correlation, difference entropy, and sum entropy radiomic features were positively associated with high stromal proportion (r = 0.97,0.88, 0.81, and 0.96 respectively, p < 0.05). MR signal intensity, energy, homogeneity, auto correlation, difference variance, and sum average were negatively associated with low stromal proportion (r = –0.91, –0.93, –0.94, –0.9, –0.89, –0.89, respectively, p < 0.05). Using the automated model, MRM predicted stromal proportion with an accuracy ranging from 61.4% to 71.9%. In this hypothesis-generating study, we showed that it is feasible to resolve histologic structures in HGSOC using ex vivo MRM at 9.4 T and radiomics.

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Ex vivo MRI evaluation of prostate cancer: Localization and margin status prediction of prostate cancer in fresh radical prostatectomy specimens

Abstract: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:439-448.

Cited by 8 publications

References 23 publications

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

MRI evaluation of vulvar squamous‐cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor‐free margins

The role of novel imaging in prostate cancer focal therapy: treatment and follow-up

Assessing Histology Structures by Ex Vivo MR Microscopy and Exploring the Link Between MRM-Derived Radiomic Features and Histopathology in Ovarian Cancer

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