mpMRI in planning nerve-sparing RARP in patients with localized prostate cancer of low and intermediate risk of progression.
Pilot Research
Rezvykh I.A.1, Rapoport L.M.1, Belysheva E.S.1, Chybarov A.A.1,
Paramonova N.I.1, Shelokova E.E.1, Strakhov Y.S.1, Shariya M.A.1,2,
Vorobyev A.A.1, Fokin I.V.1, Chuvalov L.L.1, Enikeev M.E.1
|
Purpose. To study the significance of multiparametric magnetic resonance imaging (MPMRI), to predict extracapsular extension (ECE), seminal vesicle infiltration (SV), neurovascular bundles (NVB) and positive surgical margin status (PSM) in robot assisted radical prostatectomy (RARP) with fascia and nerve-sparing (FaN) technique in patients with low and intermediate oncological risk. To evaluate the safety of RARP with FAN in terms of cancer outcomes. Materials and methods. 7 men underwent 3M Tesla MRI without endorectal coil. mpMP results were analyzed using PIRADSv2. We analyzed the level of PSA, the results of a biopsy of the prostate gland (PG), nomograms. All patients were included in groups with low and intermediate cancer risk. Patients underwent RARP with FaN. The prostates removed during the operation were stained with tissue dye, and sent for pathomorphological analysis. Comparison of the localization of foci according to the mpMRI and pathomorphological findings was performed. Patients were classified at risk according to the criteria of the National Comprehensive Cancer Network (NCCN) and D’Amico. Results and conclusion. In all cases, a complete coincidence of the localization of foci of prostate cancer was revealed. mpMRT plays a significant role in planning RANP with FaN, achieving negative PSM in patients with low and intermediate cancer risk. In addition to confirming the localized process, for planning the surgery and reducing the amount of PCBs, the mMRI data on the main localization of the cancer site (apex, base, right or left lobe) and the gland configuration, especially the apex, are of applied importance. |
1 - I.M.Sechenov First Moscow State Medical University. (Sechenov University). 2 - National Medical Research Center for Cardiology, Ministry of Health of the Russian Federation.
Moscow, Russia. |
Keywords: prostate cancer, multiparametric mpMRI, robot-assisted radical prostatectomy, nerve-sparing prostatectomy, anatomical-sparing prostatectomy.
Corresponding author: Rezvikh I.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Rezvykh I.A., Rapoport L.M., Belysheva E.S., Chybarov A.A., Paramonova N.I., Shelokova E.E., Strakhov Y.S., Shariya M.A., Vorobyev A.A., Fokin I.V., Chuvalov L.L., Enikeev M.E. MpMRI in planning nerve-sparing RARP in patients with localized prostate cancer of low and intermediate risk of progression. Pilot research. REJR 2020; 10(2):140-147. DOI:10.21569/2222-7415-2020-10-2-140-147.
.
Received: 14.01.20 Accepted: 03.03.20
Exploring the possibilities of Ultrasonic Shear Wave Elastography (SWE) in controlling the formation of bone calluses at different stages of its development.
Material and methods. A study of 51 patients (29 men, 22 women from 17 to 65 years) with fractures of long tubular bones of the upper and lower limbs was conducted. Ultrasound tests were performed on the SuperSonic Aixplorer (France) device with an assessment of tissue stiffness in the kPa and the use of multifrequency probes 2-15 MHz. In the area of the fracture scanned bone corn, surrounding soft tissues and vessels, excluded interposition. The formation of bone calluses was studied at different stages of its development, from 0-7 days to 6 months.
Results. According to the SWE, the most intensive increase in bone calluses is in the first 1.5 months after the fracture, followed by the build-up of bone calluses. For each stage of bone callos formation determined sensitivity, specificity of the method of SWE.
Discussion. The use of the SWE method to control the formation of bone calluses is possible from the first days after bone fracture. The stiffness of bone calluses at SWE is determined in the kPa. Ultrasound also allows you to study the condition of bone fragments, surrounding tissues and vessels. Conducting ultrasound with the use of SWE, dopplerography allows in dynamics to trace the formation of bone calluses in all three stages of its development.
Conclusion. SWE wave allows to determine the stiffness of the bone calluses in the dynamics, starting from the first days after the fracture and to its complete formation. SWE implements a new approach to assess the stiffness of bone calluses, which allows to get accurate quantitative results in real time. The sensitivity and specificity of the SWE in determining the stiffness of bone calluses is highest in the first – connective tissue stage of its formation (94% and 90% respectively).