TY - JOUR
T1 - The concordance between the volume hotspot and the grade hotspot
T2 - A 3-D reconstructive model using the pathology outputs from the PROMIS trial
AU - El-Shater Bosaily, A.
AU - Valerio, M.
AU - Hu, Y.
AU - Freeman, A.
AU - Jameson, C.
AU - Brown, L.
AU - Kaplan, R.
AU - Hindley, R. G.
AU - Barratt, D.
AU - Emberton, M.
AU - Ahmed, H. U.
N1 - Funding Information:
PROMIS trial funding is provided by National Institute of Health Research-Health Technology Assessment: (Project number 09/22/67).
Funding Information:
ME and HUA would like to acknowledge funding from the Medical Research Council (UK), the Pelican Cancer Foundation charity, Prostate Cancer UK, St Peters Trust charity, Prostate Cancer Research Centre, the Wellcome Trust, National Institute of Health Research-Health Technology Assessment programme, and the US National Institute of Health-National Cancer Institute. ME receives funding in part from the UK National Institute of Health Research UCLH/UCL Comprehensive Biomedical Research Centre. ME and HUA receive funding from USHIFU, GSK, AngioDynamics and Advanced Medical Diagnostics for clinical trials. ME is a paid consultant to AngioDynamics, Steba Biotech and SonaCare Medical (previously called USHIFU). Both have previously received consultancy payments from Oncura/GE Healthcare and Steba Biotech. None of these sources had any input whatsoever into this article. YH is funded by the Health Technology Innovation Fund, a parallel funding partnership between the Wellcome Trust and the Department of Health. RGH has previously received payments from SonaCare Medical (formerly USHIFU) and Nuada Medical for consultancy work. The remaining authors declare no conflicts of interest.
Funding Information:
PROMIS trial funding is provided by National Institute of Health Research-Health Technology Assessment: (Project number 09/22/67). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the health technology assessment programme, NIHR, NHS or the Department of Health. Prostate Cancer UK supported funding for blood and urine collection and processing for the translational aspect of PROMIS (PROMIS-T). PROMIS is also supported and partially funded by UCLH/UCL Biomedical Research Centre and The Royal Marsden and Institute for Cancer Research Biomedical Research Centre and is coordinated by the Medical Research Council Clinical Trials Unit (MRC CTU) at UCL. It is sponsored by University College London (UCL).
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Objectives:The rationale for directing targeted biopsy towards the centre of lesions has been questioned in light of prostate cancer grade heterogeneity. In this study, we assess the assumption that the maximum cancer Gleason grade (Gleason grade hotspot) lies within the maximum dimension (volume hotspot) of a prostate cancer lesion.Methods:3-D histopathological models were reconstructed using the outputs of the 5-mm transperineal mapping (TPM) biopsies used as the reference test in the pilot phase of Prostate Mri Imaging Study (PROMIS), a paired validating cohort study investigating the performance of multi-parametric magnetic resonance imaging (MRI) against transrectal ultrasound (TRUS) biopsies. The prostate was fully sampled with 5 mm intervals; each core was separately labelled, inked and orientated in space to register 3-D cancer lesions location. The data from the histopathology results were used to create a 3-D interpolated reconstruction of each lesion and identify the spatial coordinates of the largest dimension (volume hot spot) and highest Gleason grade (Gleason grade hotspot) and assess their concordance.Results:Ninety-four men, with median age 62 years (interquartile range, IQR= 58-68) and median PSA 6.5 ng ml -1 (4.6-8.8), had a median of 80 (I69-89) cores each with a median of 4.5 positive cores (0-12). In the primary analysis, the prevalence of homogeneous lesions was 148 (76%; 95% confidence interval (CI) ±6.0%). In all, 184 (94±3.2%) lesions showed concordant hotspots and 11/47 (23±12.1%) of heterogeneous lesions showed discordant hotspots. The median 3-D distance between discordant hotspots was 12.8 mm (9.9-15.5). These figures remained stable on secondary analyses using alternative reconstructive assumptions. Limitations include a certain degree of error within reconstructed models.Conclusions:Guiding one biopsy needle to the maximum cancer diameter would lead to correct Gleason grade attribution in 94% of all lesions and 79% of heterogeneous ones if a true hit was obtained. Further correlation of histological lesions, their MRI appearance and the detectability of these hotspots on MRI will be undertaken once PROMIS results are released.
AB - Objectives:The rationale for directing targeted biopsy towards the centre of lesions has been questioned in light of prostate cancer grade heterogeneity. In this study, we assess the assumption that the maximum cancer Gleason grade (Gleason grade hotspot) lies within the maximum dimension (volume hotspot) of a prostate cancer lesion.Methods:3-D histopathological models were reconstructed using the outputs of the 5-mm transperineal mapping (TPM) biopsies used as the reference test in the pilot phase of Prostate Mri Imaging Study (PROMIS), a paired validating cohort study investigating the performance of multi-parametric magnetic resonance imaging (MRI) against transrectal ultrasound (TRUS) biopsies. The prostate was fully sampled with 5 mm intervals; each core was separately labelled, inked and orientated in space to register 3-D cancer lesions location. The data from the histopathology results were used to create a 3-D interpolated reconstruction of each lesion and identify the spatial coordinates of the largest dimension (volume hot spot) and highest Gleason grade (Gleason grade hotspot) and assess their concordance.Results:Ninety-four men, with median age 62 years (interquartile range, IQR= 58-68) and median PSA 6.5 ng ml -1 (4.6-8.8), had a median of 80 (I69-89) cores each with a median of 4.5 positive cores (0-12). In the primary analysis, the prevalence of homogeneous lesions was 148 (76%; 95% confidence interval (CI) ±6.0%). In all, 184 (94±3.2%) lesions showed concordant hotspots and 11/47 (23±12.1%) of heterogeneous lesions showed discordant hotspots. The median 3-D distance between discordant hotspots was 12.8 mm (9.9-15.5). These figures remained stable on secondary analyses using alternative reconstructive assumptions. Limitations include a certain degree of error within reconstructed models.Conclusions:Guiding one biopsy needle to the maximum cancer diameter would lead to correct Gleason grade attribution in 94% of all lesions and 79% of heterogeneous ones if a true hit was obtained. Further correlation of histological lesions, their MRI appearance and the detectability of these hotspots on MRI will be undertaken once PROMIS results are released.
UR - https://www.scopus.com/pages/publications/84978168287
U2 - 10.1038/pcan.2016.7
DO - 10.1038/pcan.2016.7
M3 - Article
C2 - 27401032
AN - SCOPUS:84978168287
SN - 1365-7852
VL - 19
SP - 258
EP - 263
JO - Prostate Cancer and Prostatic Diseases
JF - Prostate Cancer and Prostatic Diseases
IS - 3
ER -