Artificial Intelligence-assisted Prostate Cancer Diagnosis: Radiologic-Pathologic Correlation.

The classic prostate cancer (PCa) diagnostic pathway that is based on prostate-specific antigen (PSA) levels and the findings of digital rectal examination followed by systematic biopsy has shown multiple limitations. The use of multiparametric MRI (mpMRI) is now widely accepted in men with clinical suspicion for PCa. In addition, clinical information, PSA density, risk calculators, and genomic and other "omics" biomarkers are being used to improve risk stratification. On the basis of mpMRI and MRI-targeted biopsies (MRI-TBx), new diagnostic pathways have been established, aiming to improve the limitations of the classic diagnostic approach. However, these pathways still show limitations associated with mpMRI and MRI-TBx. Definitive PCa diagnosis is made on the basis of histopathologic Gleason grading, which has demonstrated an excellent correlation with clinical outcomes. However, Gleason grading is done subjectively by pathologists and involves poor reproducibility, and PCa may have a heterogeneous distribution of histologic patterns. Thus, important discrepancies persist between biopsy tumor grading and final whole-organ pathologic assessment after radical prostatectomy. PCa offers a unique opportunity to establish a real radiologic-pathologic correlation, as whole-mount radical prostatectomy specimens permit a complete spatial relationship with mpMRI. Artificial intelligence is increasingly being applied to radiologic and pathologic images to improve clinical accuracy and efficiency in PCa diagnosis. This review delineates current PCa diagnostic pathways, with a focus on the role of mpMRI, MRI-TBx, and pathologic analysis. An overview of the expected improvements in PCa diagnosis derived from the use of artificial intelligence, integrated radiologic-pathologic systems, and decision support tools for multidisciplinary teams is provided. An invited commentary by Purysko is available online. Online supplemental material is available for this article. ©RSNA, 2021.

Recommendations for the clinical and radiological evaluation of response to treatment in metastatic renal cell cancer.

The evaluation of response to treatment is a critical step for determining the effectiveness of oncology drugs. Targeted therapies such as tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors are active drugs in patients with metastatic renal cell carcinoma (mRCC). However, treatment with this type of drugs may not result in significant reductions in tumor size, so standard evaluation criteria based on tumor size, such as Response Evaluation Criteria in Solid Tumors (RECIST), may be inappropriate for evaluating response to treatment in patients with mRCC. In fact, targeted therapies apparently yield low response rates that do not reflect increased disease control they may cause and, consequently, the benefit in terms of time to progression. To improve the clinical and radiological evaluation of response to treatment in patients with mRCC treated with targeted drugs, a group of 32 experts in this field have reviewed different aspects related to this issue and have put together a series of recommendations with the intention of providing guidance to clinicians on this matter.

[Tuberculous epididymitis caused by Mycobacterium bovis]. / Epididimitis tuberculosa por Micobacterium bovis.

OBJECTIVES: To focus on the need of including tuberculosis among differential diagnoses of any epidymo-testicular mass, especially if its evolution is torpid. METHODS/RESULTS: A 73-year-old man who presented with scrotum abscess underwent surgical drainage and antibiotic treatment, but suppuration relapsed through cutaneous fistulae. A epipidymectomy was then performed, which demonstrated tuberculous granulomas. Torax Rx showed a cystic apical pulmonary wound which was treated with 3 antituberculostatics for 12 months. Sputum culture was positive for Micobacterium Bovis. CONCLUSIONS: Aspirative punction under sonographic control is a valuable technique to avoid mutilating surgeries and to permit an almost always effective treatment, before the appearance of permanent lesions which lead to sterility.

Epididimitis tuberculosa porMicobacterium Bovis / Mycobacterium bovis tuberculous epididymitis

OBJETIVOS: Enfatizar sobre la necesidad de incluir la tuberculosis en el diagnóstico diferencial de cualquier masa epidimo-testicular especialmente si su curso es tórpido. MÉTODO/RESULTADOS: Presentamos a un varón de 73 años que acude por clínica compatible con absceso escrotal que es drenado y tratado con antibióticos pero que presenta recidiva de la supuración apareciendo trayectos fistulosos cutáneos por lo que se practica epidimectomía que mostró afectación tuberculosa del mismo. Se comprobó entonces una lesión pulmonar quístico-cavitaria apical izquierda iniciándose tratamiento antituberculostático con 3 drogas durante 12 meses. El cultivo de esputo resultó positivo para M. Bovis. CONCLUSIÓN: La PAAF con control ecográfico es una técnica muy útil para evitar cirugías mutilantes y permitir un tratamiento, casi siempre efectivo, antes de que aparezcan lesiones permanentes que conduzcan a la esterilidad (AU)