排序方式: 共有19条查询结果,搜索用时 15 毫秒
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Willy Baccaglini Felipe A. Glina Cristiano Linck Pazeto Luis G. Medina Fernando Korkes Wanderley M. Bernardo Rene Sotelo Sidney Glina Giancarlo Marra Marco Moschini Xavier Cathelineau Rafael Sanchez-Salas 《Clinical genitourinary cancer》2021,19(1):3-11.e1
This meta-analysis focuses on the accuracy of upgrading to clinically significant prostate cancer (PCa) by multiparametric magnetic resonance imaging-targeted biopsy (MRI-TB) versus systematic biopsy (SB). We searched the Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Literatura Latino Americana em Ciências da Saúde databases through January 2020 for comparative, retrospective/prospective, paired-cohort, and randomized clinical trials with paired comparisons. The population consisted of patients with low-risk PCa in active surveillance with at least 1 index lesion on imaging. We evaluated the quality of evidence by using the Quality Assessment of Diagnostic Accuracy Studies-2 score. Group comparisons considered the differences between the area under the curve summary receiver operating characteristic curve in a 2-tailed method. We also compared the positive predictive value of the best single method (MRI-TB or SB) and the referral study test (combined biopsy, a combination of MRI-TB and SB). The meta-analysis included 6 studies enrolling 741 patients. The pooled sensitivity for the 2 groups was 0.79 (95% confidence interval, 0.74-0.83; I2 = 75%) and 0.67 (95% confidence interval, 0.63-0.74; I2 = 55.4%), respectively. The area under the curve for the MRI-TB and SB groups were 0.99 and 0.92 (P < .001), respectively. The positive predictive value for the MRI-TB and combined biopsy groups were similar. The accumulated evidence suggests better results for MRI-TB compared with SB. Therefore, use of MRI-TB alone may be preferable in patients in active surveillance harboring low-risk PCa. 相似文献
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Chun FK Steuber T Erbersdobler A Currlin E Walz J Schlomm T Haese A Heinzer H McCormack M Huland H Graefen M Karakiewicz PI 《European urology》2006,49(5):820-826
OBJECTIVE: Previous reports indicate that as many as 43% of men with low grade PCa at biopsy will be diagnosed with high-grade PCa at RP. We explored the rate of upgrading from biopsy to RP specimen in our contemporary cohort, and developed a model capable of predicting the probability of biopsy Gleason sum upgrading. MATERIALS AND METHODS: The study cohort consisted of 2982 men treated with RP, with available clinical stage, serum prostate specific antigen and biopsy Gleason scores. These clinical data were used as predictors in multivariate logistic regression models (LRM) addressing the rate of Gleason sum upgrading between biopsy and RP pathology. LRM regression coefficients were used to develop a nomogram predicting the probability of Gleason sum upgrading and was subjected to 200 bootstrap resamples for internal validation and to reduce overfit bias. RESULTS: Overall, 875 patients were upgraded (29.3%). In multivariate LRMs, all predictors were highly significant (all p values <0.0001). Bootstrap-corrected predictive accuracy of the nomogram predicting the probability of Gleason sum upgrading between biopsy and RP was 0.804. CONCLUSION: We developed a highly accurate clinical aid for treatment decision-making. It may prove useful when the possibility of a more aggressive Gleason variant may change the treatment options. 相似文献
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Cosimo De Nunzio Antonio Luigi Pastore Riccardo Lombardo Giuseppe Simone Costantino Leonardo Riccardo Mastroianni Devis Collura Giovanni Muto Michele Gallucci Antonio Carbone Andrea Fuschi Lorenzo Dutto Joern Heinrich Witt Carlo De Dominicis Andrea Tubaro 《European journal of surgical oncology》2018,44(6):835-839
Purpose
To evaluate the differences between the old and the new Gleason score classification systems in upgrading and downgrading rates.Materials and methods
Between 2012 and 2015, we identified 9703 patients treated with retropubic radical prostatectomy (RP) in four tertiary centers. Biopsy specimens as well as radical prostatectomy specimens were graded according to both 2005 Gleason and 2014 ISUP five-tier Gleason grading system (five-tier GG system). Upgrading and downgrading rates on radical prostatectomy were first recorded for both classifications and then compared. The accuracy of the biopsy for each histological classification was determined by using the kappa coefficient of agreement and by assessing sensitivity, specificity, positive and negative predictive value.Results
The five-tier GG system presented a lower clinically significant upgrading rate (1895/9703: 19,5% vs 2332/9703:24.0%; p = .001) and a similar clinically significant downgrading rate (756/9703: 7,7% vs 779/9703: 8%; p = .267) when compared to the 2005 ISUP classification. When evaluating their accuracy, the new five-tier GG system presented a better specificity (91% vs 83%) and a better negative predictive value (78% vs 60%). The kappa-statistics measures of agreement between needle biopsy and radical prostatectomy specimens were poor and good respectively for the five-tier GG system and for the 2005 Gleason score (k = 0.360 ± 0.007 vs k = 0.426 ± 0.007).Conclusions
The new Epstein classification significantly reduces upgrading events. The implementation of this new classification could better define prostate cancer aggressiveness with important clinical implications, particularly in prostate cancer management. 相似文献5.
《Urologic oncology》2015,33(7):329.e13-329.e19
BackgroundTo date, no study has examined clinical, pathological, and surgical characteristics of D׳Amico low-risk patients according to active surveillance (AS) eligibility.Material and methodsWe relied on patients with low-risk prostate cancer, who were classified based on the D׳Amico classification, treated with radical prostatectomy (RP) between 2008 and 2013 at the Martini-Clinic Prostate Cancer Center. We assessed differences in clinical, pathological, and surgical characteristics in D׳Amico low-risk patients according to AS eligibility (prostate-specific antigen [PSA]≤10 ng/ml, Gleason score≤3+3, ≤2 positive cores,≤50% tumor content per core, and≤cT1-2a). Multivariable logistic regression analyses targeted 2 end points: (1) presence of either intermediate- or high-risk characteristics (Gleason score≥3+4 or≥pT3 or pN1) or (2) exclusive presence of high-risk characteristics (Gleason score≥4+4 or≥pT3 or pN1) at RP.ResultsOf 1,331 patients low-risk prostate cancer classified based on the D׳Amico classification, 825 (62%) men were eligible for AS. AS candidates were less frequently either upgraded (55% vs. 78%, P<0.001) or upstaged (8% vs. 15%, P<0.001). Similarly, at final pathology, AS candidates less frequently harbored either intermediate- or high-risk (56% vs. 78%, P<0.001), or exclusive high-risk characteristics (9% vs. 16%, P<0.001). Tumor involvement per core (>50%) (most powerful), number of positive cores, PSA values, and age were independent predictors for either intermediate- or high-risk characteristics at RP. Tumor involvement per core and PSA values were independent predictors for exclusive high-risk characteristics at RP.ConclusionsD׳Amico low-risk patients did not have a homogeneous histology at RP. Especially, non-AS candidates were at a higher risk of either upgrading or upstaging at final pathology. Tumor involvement greater than 50% per core was the most powerful indicator of adverse pathology. Therefore, DʼAmico low-risk criteria are not safe enough to identify AS candidates. 相似文献
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Isabelle Deshaies Louise Provencher Simon Jacob Gary Côté Jean Robert Christine Desbiens Brigitte Poirier Jean-Charles Hogue 《Breast (Edinburgh, Scotland)》2011,20(1):50-55
Previous studies have shown that 4-54% of breast lesions reported on core biopsies as atypical ductal hyperplasia (ADH) are upgraded on further excision to ductal carcinoma in situ (DCIS) or invasive carcinoma. We evaluated the rate of upgrading ADH to carcinoma at surgery for ADH diagnosed by percutaneous biopsy, and examined characteristics associated with malignancy. We identified 13,488 consecutive biopsies conducted at one center over a nine-year period. A total of 422 biopsies with ADH in 415 patients were included. DCIS or invasive carcinoma was found in 132 cases (31.3% upgrading). Multivariate model revealed that ipsilateral breast symptoms, mammographic lesion other than microcalcifications alone, 14G core needle biopsy, papilloma co-diagnosis, severe ADH and pathologists with lower volume of ADH diagnosis were factors statistically associated with malignancy. However, no subgroups were identified for safe clinical-only follow-up. Surgery is recommended in all cases of ADH diagnosed by percutaneous breast biopsy. 相似文献
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Accuracy and Upgrading of CNB and BI-RADS Diagnoses Compared to Excision: A Clinicopathological-Radiological Correlation of Papillary Breast Lesions and Neoplasms
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Maha Mohamed FawzyHeba ShetaAmal Abd El hafez Dina HarbMohammad ZuhdyReham AlghandourDoaa H Sakr 《Asian Pacific journal of cancer prevention》2022,23(11):3959-3969
Background: Papillary breast lesions and neoplasms (PBLs/Ns) are diagnostically challenging lesions in both core needle biopsy (CNB) and radiology. Aim: To determine the accuracy and upgrade rate of CNB and BI-RADS diagnosis of PBLs/Ns compared to final excision diagnosis and the factors linked to upgrade. Methods: The favored CNB diagnosis and BI-RADS category for 82 PBLs/Ns were assessed based on histopathology, myoepithelial marker immunohistochemistry, mammographic/ultrasonographic findings. The radiological findings were compared to the pathological diagnoses. The accuracies of CNB and BI-RADS were compared to the excision diagnosis of the corresponding PBLs/Ns. The upgrade rates to malignancy were evaluated for both CNB and BI-RADS. Results: The presence of solid, irregular masses in breasts with composition A/B with calcification in radiology was significantly associated with the diagnosis of suspicious/malignant CNB, and malignant excision specimens (p<0.05). CNB was more accurate (90%), sensitive and specific with high positive and negative predictive values than BI-RADS. Combined CNB/BI-RADS accuracy was 90.2%. Overall upgrade rate came up to 9.8%. Upgrade rates to carcinoma were 7.3% for CNB and 8.5% for BI-RADS. Factors linked to upgrade were the age, lesion-size, BI-RADS category 4A and C, and histopathological/radiological discordance. All the upgraded PBLs/Ns were diagnosed as benign lesions in CNB with present/focally present myoepithelial diagnosis reflecting a sampling error. Conclusion: Up to 9.8% of PBLs/Ns diagnosed on CNB and BI-RADS undergo upgrading upon final excision, despite the high diagnostic accuracy. These evidences should be considered for final decision on whether to excise the lesion or not. 相似文献
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Hye Won Lee Hwang Gyun Jeon Byong Chang Jeong Seong Il Seo Seong Soo Jeon Han Yong Choi Hyun Moo Lee 《Journal of Korean medical science》2015,30(3):317-322
The aim of this study was to assess surgical outcome at radical prostatectomy (RP) in Korean men with a serum prostate-specific antigen (PSA) level of 2.5 to 3.0 ng/mL and compared with those of patients who had a PSA level of 3.0-4.0 and 4.0-10.0 ng/mL. We retrospectively compared clinico-pathological characteristics and biochemical recurrence (BCR) risk in patients with PSA level of 2.5-3.0 (group 1, n = 92, 5.7%), 3.0-4.0 (group 2, n = 283, 17.5%), or 4.0-10.0 ng/mL (group 3, n = 1,242, 76.8%) who underwent RP between 1995 and 2013. The pathologic characteristics including Gleason score, pathologic stage, and percentage of significant cancer in group 1 were similar to those in group 2 and group 3. Furthermore, pathological upgrading and upstaging were found in 23 (30.7%) and 10 (14.7%) in group 1, 84 (33.9%) and 19 (8.8%) in group 2, and 321 (32.8%) and 113 (12.8%) in group 3, respectively, with no significant differences among the three groups (all P > 0.05). In multivariate analysis, PSA grouping was not an independent predictor of BCR. Within the population with PSA lower than 10 ng/mL, substratification of PSA is not a significant predictor for upgrading, upstaging, or adverse prognosis.