Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

ABSTRACT Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Associação entre o consumo de tabaco e a progressão do câncer superficial da bexiga / Amount of tobacco consumption is associated with superficial bladder cancer progression

Objective: To evaluate the association between smoking habits and outcome of patients with superficial bladder cancer. Methods: A retrospective study was performed evaluating 99 patients (67.0 ± 13.2 years, ranging from 31.4-93.4 years, 72.7% males and 27.3% females) treated at our institution with non muscle-invasive bladder cancer, between 1994 and 2000, with a mean follow-up of 49.3 months (range 4.0-177.9 months). Patients were divided according to smoking status, and the main measured outcome was progression to invasive disease. Additional cohort analysis was performed dividing patients according to previous tobacco exposure: smokers and non-smokers. Smokers were stratified into former smokers, early-quitters, late quitters and continued smokers. Results: Smoking habit was significantly more common in males (p = 0.03). Cancer also occurred at an earlier age among smokers (70.8 versus 64.8 years, p = 0.030). Tobacco consumption was present in 62.7% of the patients with bladder cancer. There was a significant higher progression rate to muscle-invasive disease in patients that had more than 60 pack-years of exposure (52.9 versus 26.2%, p = 0.037). These patients had a mean progression time of 59.3 months, whereas patients who had smoked less than 60 pack-years progressed after a mean time of 131.8 months. Conclusions: A direct association between the amount of tobacco consumed and disease progression is observed in patients with bladder cancer, as suggested by the present study. Tobacco consumption has a direct association with progression of superficial bladder cancer to invasive disease and also shortens the period of time for muscle invasion. Larger and prospective studies are still necessary to bring further definitive conclusions about reproducibility of our data and to better understand how smoking cessation affects progression of superficial bladder cancer.

Objetivo: Avaliar a relação entre os hábitos tabágicos e a evolução de pacientes com carcinoma urotelial de bexiga superficial. Métodos: Foi realizado um estudo retrospectivo com 99 pacientes (67,0 ± 13,2 anos, variando de 31,4-93,4 anos, 72,7% homens e 27,3% mulheres) tratados de carcinoma urotelial de bexiga não-invasivo entre 1994 e 2000, com seguimento médio de 49,3 meses (4,0-177,9 meses). Os pacientes foram divididos em tabagistas e não-tabagistas, e os tabagistas foram subestratificados entre ex-tabagistas, interruptores precoces, interruptores tardios e tabagistas persistentes. O principal desfecho avaliado foi a progressão para doença invasiva. Resultados: O tabagismo foi mais comum entre os homens (p = 0,03), sendo que 62,6% do total de pacientes avaliados eram tabagistas. O diagnóstico do câncer ocorreu em uma idade mais precoce entre os tabagistas (70,8 versus 64,8 anos, p = 0,03). Observou-se uma progressão significativamente maior para doença invasiva entre os pacientes com carga tabágica acima de 60 maços/ano (52,9 versus 26,2%, p = 0,037). Estes pacientes tiveram um tempo de progressão de 59,3 versus 131,8 meses para aqueles com menor carga tabágica. Conclusões: Há associação direta entre a carga tabágica e progressão do carcinoma urotelial de bexiga para doença músculo-invasiva em um curto intervalo de tempo. Estudos prospectivos e com maior número de pacientes são necessários para entender como a interrupção do tabagismo afeta a progressão do carcinoma superficial de bexiga.

Estudo experimental da resposta tecidual à presença de celulose produzida por Acetobacter xylinum no dorso nasal de coelhos / Experimental study of the tissue reaction caused by the presence of cellulose produced by Acetobacter Xylinum in the nasal dorsum of rabbits

Vários materiais são propostos para reconstrução nasal, não havendo consenso sobre qual o melhor. A manta de celulose produzida por bactéria pode ser mais um elemento para adição cartilaginosa. Não há estudos deste material no dorso nasal. OBJETIVO: Avaliar a resposta tecidual à presença da celulose bacteriana no dorso nasal de coelhos. MATERIAL E MÉTODO: Foram utilizados 22 coelhos Nova Zelândia, sendo que em 20 deles foi implantada a manta de celulose no dorso nasal e em 2 controles nada foi feito. Foram acompanhados por um período de três e seis meses, sendo então retirados as regiões do dorso nasal e narinas dos coelhos e realizado estudo histopatológico levando em consideração parâmetros definidos de condição inflamatória como congestão vascular, intensidade do processo inflamatório e presença de exsudato purulento. RESULTADOS: O processo inflamatório manteve-se estável, demonstrando sua relação com o procedimento cirúrgico, e não com a presença da manta de celulose. Nos demais parâmetros estudados não houve diferença estatisticamente significante. CONCLUSÃO: A manta de celulose de Acetobacter xylinum mostrou boa biocompatibilidade e manteve-se estável no decorrer do tempo de estudo, podendo ser considerada um bom material para uso na elevação do dorso nasal.

Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose. AIM: to study tissue reaction to cellulose in the dorsal nose of rabbits. MATERIALS AND METHODS: 22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate. RESULTS: The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters. CONCLUSION: The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.