Objective To investigate the pathological characteristics of false-positive lesions of prostate cancer on 68 Ga-PSMA-11 PET/CT based on the pathology of whole mount specimens,in order to more accurately assess the degree of malignancy within the prostate tissue and avoid overdiagnosis and unnecessary treatment.Methods A total of 77 patients who underwent 68Ga-PSMA-11 PET/CT before radical prostatectomy in Nanjing Drum Tower Hospital during Jan.2018 and Dec.2022 were retrospectively analyzed.The pathology of whole mount specimens was detected.Two nuclear physicians examined all imaging plates without knowing the pathological results.Two pathological physicians completed all pathological diagnosis without knowing the imaging results.The pathological characteristics of false-positive lesions were determined by matching 68Ga-PSMA-11 PET/CT and pathological specimens.To analyze the pathological features of false-positive lesions,true-negative lesions were randomly delineated and defined.The pathological features of false-positive and true-negative lesions were analyzed and compared using Fisher exact test.Results After the imaging and pathological sections were matched,21(16.3％)false-positive lesions were identified.The pathological characteristics of the 21 false-positive lesions were as follows:16(76.2％)simple atrophy with cyst formation,3(14.3％)prostatic nodular hyperplasia,and 2(9.5％)inflammation.The pathological characteristics of 21 true-negative lesions were:13(61.9％)normal glands,5(23.8％)prostatic nodular hyperplasia and 3(14.3％)simple atrophy with cyst formation.Fisher exact test showed that the proportion of simple atrophy with cyst formation in the pathological features of false-positive lesions and true-negative lesions was statistically significant(76.2％vs.14.3％,P＜0.001).Conclusion Simple atrophy with cyst formation may be a characteristic pathological type of the false-positive lesions of prostate cancer on 68Ga-PSMA-11 PET/CT.
Background:Robot-assisted laparoscopic radical prostatectomy (RARP) has gradually become the standard surgical procedure for prostate cancer. This video, http://links.lww.com/CURRUROL/A10 aimed to demonstrate a new and improved surgical approach for prostate cancer that passes through the pouch of Douglas and allows retrograde release of the neurovascular bundle (NVB). The technique is Hem-o-lok-free and Retzius-sparing and is performed without opening the pelvic floor fascia during RARP.Methods:A 69-year-old man was diagnosed with prostate cancer (clinical stage T2bN0M0). We followed the process of Retzius-sparing RARP [published by Galfano et al. in 2013] and did some modification. The critical technical points associated with this technique included locating the fascial layer at the prostatic apex and performing complete retrograde release of the NVB along the anatomical structure. We used diathermy to perform precision hemostasis on large vessels, especially those around the basal part of prostate, with relatively less damage. In addition, Hem-o-lok was not used in this procedure.Results:Negative surgical margin and stage T2bN0M0 were confirmed. Continence was achieved immediately after cathter removal. One month after surgery, prostate specific antigen was undetectable. Erectile function was preserved 3 months postoperatively.Conclusions:Hem-o-lok-free and Retzius-sparing RARP is a feasible surgical approach that combines the benefits of complete retrograde release of the NVB, preserving the nerves and vascular structures around the prostate, protecting the pelvic floor structure, and ensuring rapid recovery of micturition control.
Partial nephrectomy(PN)is the optimal treatment of localized small renal masses.In most cases,PN is performed with renal artery occlusion to maintain clear visualization,which leads to ipsilateral ischemia reperfusion injury and acute kidney injury(AKI)in severe cases.AKI after PN is generally evaluated with AKIN or RIFLE criteria.However,the increased level of total creatinine is clearly not accurate enough to assess unilateral kidney injury,because unilateral injury and loss of normal renal parenchyma also induce increase of serum creatinine.In order to avoid the interference of the above factors to the diagnosis,we modified AKI criteria in renal cancer patients with solitary kidney and emphasized that the role of parenchymal mass reduction should always be considered during AKI evaluation.We used"Extreme Value Theory"and quantified the degree of AKI in renal cancer patients who have a functional contralateral kidney.Furthermore,we discussed the long-term impact of AKI on the operated kidney and potential methods to alleviate ischemic injury during PN.
Abstract BACKGROUND: The golden standard for the treatment of muscle-invasive or high-grade bladder cancer is radical cystectomy combined with various forms of urinary diversion, but postoperative paralytic ileus is an troublesome postoperative complication.The purpose of this research is to build and verify the nomogram prediction model of postoperative ileus.METHODS: From January 2015 to December 2020, the clinical data of patients who underwent radical cystectomy in the urology department of Guizhou Provincial People's Hospital for bladder cancer were collected. The risk factors related to postoperative ileus were obtained by logitic single factor and multiple factor regression analysis. Then, the prediction model of postoperative ileus was constructed based on the risk factors and its identification ability and accuracy were verified.RESULT: 252 patients were included, 51 of whom had ileus. Statistical analysis showed that preoperative creatinine level, postoperative creatinine level, and postoperative serum albumin concentration were correlated with postoperative ileus. The area under ROC curve of nomogram predictive model constructed based on the risk factors was 0.748 (95%CI 0.672-0.824). The bootstrap correction curve of the prediction model shows that the prediction accuracy of the model is close to that of the ideal model.CONCLUSION: Preoperative creatinine level, postoperative creatinine level, and postoperative serum albumin concentration were correlated with postoperative ileus and were risk factors for ileus after radical cystectomy, which could be used as predictors of clinical prediction models. The prediction model of nomogram based on these predictors can predict the probability of postoperative intestinal obstruction.
目的 探讨伴Stauffer综合征的肾癌患者的诊疗及预后.方法 回顾性分析 2014 年 9 月—2019 年8 月于江阴市人民医院接受手术治疗的 17 例伴 Stauffer综合征的肾癌患者的临床病理资料及随访结果.通过Kaplan-Meier法及 log-rank检验进行生存分析,单因素和多因素Cox回归分析影响肾癌患者预后的相关因素.结果 17 例患者中术后病理结果为透明细胞癌者14 例,乳头状肾细胞癌 2 例,组织分化差、类型难定者 1 例.手术后 3 个月内肝功能恢复正常者 5 例,6 个月内恢复者 3 例,1 年内恢复者 4 例,持续未恢复者 3 例.17 例患者术后随访 6～72 个月,平均 54.1 个月,术后 1、3、5 年生存率分别为 88.2%(15/17)、76.5%(13/17)、52.9%(9/17).生存分析显示伴 Stauffer综合征的肾癌患者肿瘤特异性生存率偏低,且肿瘤大小、美国癌症联合委员会(AJCC)分期、淋巴结转移和 Stauffer综合征是肾癌患者的不良预后因素.结论 伴 Stauffer综合征的肾癌患者整体预后较差,应早期手术干预.术后多数患者肝功能可逐渐恢复正常,连续监测肝功能对肿瘤的复发、转移及患者预后有重要的指导意义.
