Faculty Bibliography
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237
Solid variant of papillary cystadenoma of the epididymis [Letter]
PMID: 25406742
ISSN: 1365-2559
CID: 1626832
Whole-lesion apparent diffusion coefficient metrics as a marker of percentage Gleason 4 component within Gleason 7 prostate cancer at radical prostatectomy
PURPOSE: To retrospectively assess the utility of whole-lesion apparent diffusion coefficient (ADC) metrics in characterizing the Gleason 4 component of Gleason 7 prostate cancer (PCa) at radical prostatectomy. MATERIALS AND METHODS: Seventy patients underwent phased-array coil 3T-magnetic resonance imaging (MRI) before prostatectomy. A uropathologist mapped locations and Gleason 4 percentage (G4%) of Gleason 7 tumors. Two radiologists independently reviewed ADC maps, aware of tumor locations but not G4%, and placed a volume-of-interest (VOI) on all slices including each lesion on the ADC map to obtain whole-lesion mean ADC and ADC entropy. Entropy reflects textural variation and increases with greater macroscopic heterogeneity. Performance for characterizing Gleason 7 tumors was assessed with mixed-model analysis of variance (ANOVA) and logistic regression. RESULTS: Among 84 Gleason 7 tumors (G4% 5%-85%, median 30%; 59 Gleason 3+4, 25 Gleason 4+3), ADC entropy was significantly higher in Gleason 4+3 than Gleason 3+4 tumors (R1: 5.27 +/- 0.61 vs. 4.62 +/- 0.78, P = 0.001; R2: 5.91 +/- 0.32 vs. 5.57 +/- 0.56, P = 0.004); mean ADC was not significantly different between these groups (R1: 0.90 +/- 0.15*10-3 cm2 /s vs. 0.98 +/- 0.21*10-3 cm2 /s, P = 0.075; R2: 1.06 +/- 0.19*10-3 cm2 /s vs. 1.14 +/- 0.16*10-3 cm2 /s, P = 0.083). The area under the receiver operating characteristic (ROC) curve (AUC) for differentiating groups was significantly higher with ADC entropy than mean ADC for one observer (R1: 0.74 vs. 0.57, P = 0.027; R2: 0.69 vs. 0.61, P = 0.329). For R1, correlation with G4% was moderate for ADC entropy (r = 0.45) and weak for mean ADC (r = -0.25). For R2, correlation with G4% was moderate for ADC entropy (r = 0.41) and mean ADC (r = -0.32). For both readers, ADC entropy (P = 0.028-0.003), but not mean ADC (P = 0.384-0.854), was a significant independent predictor of G4%. CONCLUSION: Whole-lesion ADC entropy outperformed mean ADC in characterizing Gleason 7 tumors and may help refine prognosis for this heterogeneous PCa subset. J. Magn. Reson. Imaging 2014. (c) 2014 Wiley Periodicals, Inc.
PMCID:4696491
PMID: 24616064
ISSN: 1053-1807
CID: 918092
T2-weighted imaging of the prostate: Impact of the BLADE technique on image quality and tumor assessment
PURPOSE: To retrospectively compare standard and BLADE T2-weighted imaging (T2WI) sequences of the prostate in terms of image quality and tumor assessment. METHODS: 49 prostate cancer patients (64 +/- 6 years) who underwent 3 T phased-array coil MRI before prostatectomy were included. T2WI was acquired using standard rectilinear and BLADE techniques. Two readers (R1, R2) independently localized the dominant lesion using T2WI alone and using multi-parametric imaging; recorded presence of extraprostatic extension (EPE) in each lobe; and scored lesion conspicuity and absence of motion artifact (1-5 scale; 5 = highest quality). A third reader, unblinded to pathology, placed ROIs to record tumor-to-peripheral-zone contrast. Standard and BLADE T2WI were compared using paired Wilcoxon tests. RESULTS: BLADE showed a trend toward improved motion artifact for R1 (3.4 +/- 1.3 vs. 2.9 +/- 1.5; p = 0.054) but not R2 (4.0 +/- 1.0 vs. 3.9 +/- 1.1; p = 0.880). Dominant lesions showed significantly lower conspicuity using BLADE for R1 (2.8 +/- 2.0 vs. 3.2 +/- 2.0; p = 0.011) but not R2 (2.3 +/- 1.6 vs. 2.4 +/- 1.7; p = 0.353), and significantly lower tumor-to-peripheral-zone contrast using BLADE (0.35 +/- 0.13 vs. 0.42 +/- 0.15; p
PMID: 25156471
ISSN: 0942-8925
CID: 1162262
Association between changes in suspicious prostate lesions on serial MRI examinations and follow-up biopsy results
We assessed changes in prostate lesions on serial magnetic resonance imaging (MRI) examinations in predicting biopsy results. Fifty-five men undergoing two prostate MRI examinations >/=6months apart, followed by targeted biopsy, were included. Two radiologists assessed dominant lesions for an increase in size or suspicion score. Progression on MRI had lower sensitivity (23.5%-35.3%) and higher specificity (76.2%-90.5%) than prostate-specific antigen (PSA) velocity (sensitivity 70.6%, specificity 52.4%) for predicting positive biopsy. Highest accuracy was achieved by PSA velocity (63.6%) for positive biopsy, and by MRI (65.5%-72.7%) for Gleason >6 tumor. Findings support lesion progression on MRI serving as a basis for performing subsequent targeted biopsy.
PMID: 25457528
ISSN: 0899-7071
CID: 1370712
Transition zone prostate cancer: revisiting the role of multiparametric MRI at 3 T
OBJECTIVE. The purpose of this study was to retrospectively evaluate the impact of multiparametric prostate MRI, including diffusion-weighted imaging (DWI) performed using different b values as well as dynamic contrast-enhanced MRI (DCE-MRI) on the accuracy, sensitivity, and specificity for transition zone (TZ) tumor detection and localization. MATERIALS AND METHODS. We included 106 prostate cancer patients (mean age [+/- SD], 62 +/- 7 years) who underwent 3-T MRI with a pelvic phased-array coil before radical prostatectomy. Three radiologists independently reviewed cases to record the likelihood of tumor in each of six TZ regions. Scores were initially assigned using T2-weighted imaging alone, reassigned after integration of DWI at b = 1000 s/mm(2) and corresponding apparent diffusion coefficient (ADC) maps, reassigned again after integration of DWI at b = 2000 s/mm(2), and reassigned a final time after integration of DCE-MRI. Generalized estimating equations based on binary logistic regression were used to compare sessions for TZ tumor detection, using prostatectomy findings as reference standard. RESULTS. Of the TZ sextants, 9.7% (62/636) contained tumor. All readers had higher sensitivity for T2-weighted imaging integrated with DWI at b = 1000 s/mm(2) and ADC compared with T2-weighted imaging alone (reader 1, 54.8% vs 33.9%; reader 2, 53.2% vs 22.6%; and reader 3, 50.0% vs 19.4% [p /= 0.054). Other measures were similar across the four sessions (reader 1, specificity 97.4-98.3% and accuracy 91.2-95.9%; reader 2, specificity 95.8-98.4% and accuracy 91.0-92.6%; reader 3, specificity 90.9-96.7% and accuracy 88.1-89.2%). CONCLUSION. DWI assists TZ tumor detection through higher sensitivity, particularly when using a very high b value; DCE-MRI lacks further additional benefit.
PMID: 25714311
ISSN: 0361-803x
CID: 1473862
Papillary or pseudopapillary tumors of the kidney
Papillary architecture is one of the most common morphological patterns in renal cell neoplasms. Many renal cell neoplasms can also exhibit, diffusely or focally, papillary growth pattern. This article reviews all the renal cell neoplasms with papillary or pseudopapillary architecture, with an emphasis on recently described new histological types. New insights into the "old" entities, including their immunohistochemical and genetic features, will also be discussed.
PMID: 25804447
ISSN: 0740-2570
CID: 1523032
Clinicopathologic Outcomes of Cystic Renal Cell Carcinoma
BACKGROUND: The purpose of this study was to describe the clinicopathologic characteristics and oncologic outcomes of patients who underwent nephrectomy for cystic renal masses. PATIENTS AND METHODS: Using an institutional review board-approved database, we retrospectively reviewed the clinical, pathologic, radiologic, and oncologic outcome data of patients who received nephrectomy for a complex cystic renal mass. RESULTS: Sixty-one patients were identified who received nephrectomy for a complex cystic lesion. Average age was 64 years. Thirty-nine (64%) patients were male. At the time of resection, 1 (1.6%), 3 (4.8%), 53 (86.8%), and 4 (6.5%) had a Bosniak category II, IIF, III, and IV cystic lesion, respectively. Nineteen (31.1%) patients were initially managed expectantly but underwent surgery because of progression of complexity on follow-up. Mean pathologic tumor size was 3.3 cm (range, 0.7-12 cm). Forty-eight (78.6%) of the lesions were found to be malignant. Thirty-seven (77.1%), 5 (10.4%), 4 (8.3%), and 2 (4.1%) were stage T1a, T1b, T2a, and T3a, respectively. Clear cell was the most common histologic subtype (44%), followed by papillary (21.3%), and unclassified RCC (4.9%). With a mean and median follow-up of 48.4 and 43.0 months, respectively, no patients developed a local or metastatic recurrence. All patients were alive at last follow-up. CONCLUSION: In our series with moderate follow-up, cystic RCCs do not appear to recur or progress regardless of size, histologic subtype, or grade. These findings suggest the malignant potential of cRCCs is significantly less than solid RCCs. Further investigation is required to determine if cRCCs should be classified and managed independently from solid RCCs.
PMID: 25088469
ISSN: 1558-7673
CID: 1105172
Whole-lesion diffusion metrics for assessment of bladder cancer aggressiveness
PURPOSE: To explore associations of whole-lesion histogram diffusion metrics with pathologic findings and subsequent metastatic disease in bladder cancer patients undergoing radical cystectomy. METHODS: Twenty-three bladder cancer patients (21M, 2F; mean 70 +/- 11 years) underwent MRI before cystectomy. A volume-of-interest was placed on all slices on the ADC map encompassing each lesion. Whole-lesion mean, kurtosis, and skewness of ADC were calculated and compared with T stage and pelvic nodal status at cystectomy and with subsequent metastasis in 20/25 patients with available follow-up. RESULTS: At cystectomy, 39 % (9/23) were stage T2, 61 % (14/23) >/=T3, and 28 % (5/23) exhibited positive nodes; 35 % (7/20) developed later metastases. Mean ADC was significantly lower in stage >/=T3 than in lower stage tumors (1.20 +/- 0.36 x 10-3 vs. 1.55 +/- 0.36 x 10-3 mm2/s; p = 0.044), but showed no association with nodal or metastatic disease (p = 0.362-0.709). Kurtosis was significantly lower in tumors with, compared to without, nodal disease (-0.05 +/- 0.29 vs. 0.91 +/- 1.16; p = 0.037), and showed a non-significant decrease in tumors with, compared to without, later metastases (0.23 +/- 0.63 vs. 0.83 +/- 0.89; p = 0.088). Kurtosis was not associated with T stage (p = 0.811), and skew was not associated with any outcome (p = 0.516-0.643). Mean ADC achieved highest AUC for identification of stage >/=T3 (AUC = 0.754 vs. 0.516-0.643 for other metrics). Kurtosis achieved highest AUC for nodal disease (AUC = 0.811 vs. 0.522-0.556 for other metrics) and metastases (AUC = 0.736 vs. 0.516-0.626 for other metrics). Only difference in AUC between skewness and kurtosis for nodal disease was significant (p = 0.031). CONCLUSION: While requiring larger studies, kurtosis has potential to complement mean ADC in bladder cancer prognosis using whole-lesion histogram analysis.
PMID: 25106502
ISSN: 0942-8925
CID: 1141422
Atypical Cribriform Lesions of the Prostate Are Often Localized in the Vicinity of High Grade Cancer and Have a Similar Clinical and Pathological Significance as Intraductal Carcinoma of the Prostate [Meeting Abstract]
ISI:000348948002094
ISSN: 1530-0307
CID: 1486652
AR-V7, a Splicing Variant of Androgen Receptor, Is Upregulated in High-Grade Urothelial Carcinomav [Meeting Abstract]
ISI:000348948001463
ISSN: 1530-0307
CID: 1486982
