Radikal prostatektomi öncesi multiparametrik prostat MRG: Patolojiyi, postoperatif fonksiyonel sonuçları ve hastalık nüksünü öngörebilir mi?
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Dosyalar
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Multiparametrik Prostat MRG (MpMRG) son zamanlarda prostat kanseri tanı ve evrelemesinde gittikçe daha yaygın kullanılarak, tecrübe ve cihaz kalitesininde artmasıyla önemini arttırmıştır. Çalışmamızda radikal prostatektomi öncesi MpMRG'de saptanan malignite kuşkulu odakların histopatolojik korelasyonu, MpMRG bulguları ile postoperatif fonksiyonel sonuçlar ve biyokimyasal nüks arasındaki ilişkinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2012 – Haziran 2018 arasında, Ege Üniversitesi Tıp Fakültesi Üroloji Kliniği'nde, prostat kanseri sebebiyle RP yapılan, operasyon öncesi MpMRG uygulanan ve diğer dahil edilme kriterlerini karşılayan 93 hastanın verisi incelenmiştir. Hastalara ait yaş, pre-operatif Prostat-Spesifik Antijen (PSA) değeri, operasyon tipi, postoperatif idrar kaçırma, erektil disfonksiyon ve PSA değerleri retrospektif olarak hasta dosyalarından toplanmıştır. Patoloji spesmeni tekrar incelenerek post-operatif gleason skoru, Uluslararası Ürolojik Patoloji Derneği (ISUP) derecesi, diğer patolojik bulgular (lenf nodu tutulumu ve ekstraprostatik yayılım), preoperatif yapılan MpMRG tekrar incelenerek PIRADS skoru, ekstrakapsüler uzanım, seminal vezikül invazyonu, nörovasküler demet invazyonu ve lenf nodu tutulumu ile ADC değerleri kaydedilmiştir. İstatistiksel analiz için SPSS for Windows 22.0 paket programı kullanılmıştır. Bulgular: MpMRG'de saptanan 164 lezyonun 151'i (%92,07) histopatolojik olarak korele edildi. Patolog tarafından belirlenen 248 lezyonun 151'i (%60,88) radyolog tarafından teyit edildi. MpMRG'de seminal vezikül invazyonu saptanan hastaların %80'i, ekstrakapsüler uzanım saptanan hastaların %28,8'i, lenf nodu tutulumu saptanan hastaların %42,9'u histopatolojik olarak korele edildi. PIRADS skorları ile ISUP derece grupları arasında anlamlı ilişki gösterilmiştir. ADC değerleri ile ISUP derece grupları arasında negatif korelasyon saptanmıştır. Postoperetif idrar kaçırma ile hiçbir MR bulgusu arasında ilişki gösterilmemiştir. MpMRG'de ekstrakapsüler uzanım ile ED arasında anlamlı ilişki gösterilmiştir. Biyokimyasal rekürrens ile PIRADS skorları, seminal vezikül invazyonu, ISUP derece grubu, Gleason skoru, preoperatif PSA, kapsül invazyonu ve nörovasküler demet invazyonu arasında anlamlı ilişki gösterilmiştir. Perioperatif ve postoperatif komplikasyon ile seminal vezikül invazyonu ve operasyon tipi (RRP yapılanlarda daha fazla) arasında anlamlı ilişki gösterilmiştir. Sonuç: Çalışmamız, MpMRG'nin saptadığı lezyonların yüksek oranda histopatolojik korelasyon gösterdiğini kanıtlamıştır. Ancak azımsanamayacak oranda lezyon MpMRG tarafından atlanmıştır. MpMRG bulgularına dayanarak definitif tedavi kararı değiştirilebilir ya da operasyona karar verildiyse operasyonun tipi ve sinir koruyucu yaklaşım kararı değiştirilebilir. MpMRG bulgularına dayanarak hastalara operasyon öncesi takipte gelişebilecek sorunlar ve ek tedavi gereksinimi konusunda bilgi verilebilir.
Background and Aim: Multiparametric Prostate MRI (MpMRI) has become increasingly important in the diagnosis and staging of prostate cancer, with increasing experience and device quality. In our study, we aimed to investigate the relationship between the histopathological correlation of the suspected malignancy detected in MpMRI and the postoperative functional results and biochemical recurrence. Materials and Methods: The data of 93 patients between January 2012 and June 2018 who underwent radical prostatectomy in the Urology Department of Ege University Medical Faculty and had preoperative MPMRG and met other inclusion criteria were examined. Age, pre-operative Prostate-Specific Antigen (PSA) value, type of operation, postoperative urinary incontinence status, erectile dysfunction and PSA values were retrospectively collected from patient files. The pathology specimen was examined again and post-operative gleason score, ISUP grade group, other pathological findings (lymph node involvement and extraprostatic extension), pre-operative MPMRI were re-examined and PIRADS score, extracapsular extension, seminal vesicle invasion, neurovascular bundle invasion, lymph node involvement and ADC values were recorded. SPSS for Windows 22.0 package program was used for statistical analysis. Results: 151 (92,07%) of 164 lesions detected in MpMRG were histopathologically correlated. Of the 248 lesions identified by the pathologist, 151 (60.88%) were confirmed by the radiologist. 80% of patients with seminal vesicle invasion, 28.8% of patients with extracapsular extension and 42.9% of patients with lymph node involvement in MpMRI were histopathologically correlated. A significant relationship was found between PIRADS scores and ISUP grade groups. There was a negative correlation between ADC values and ISUP grade groups. There was no relationship between postoperative urinary incontinence and any MRI findings. There was a significant relationship between extracapsular extension and ED in MpMRI. A significant relationship was found between biochemical recurrence and PIRADS scores, seminal vesicle invasion, ISUP grade group, Gleason score, preoperative PSA, extracapsular extension and neurovascular bundle invasion. Peroperative and postoperative complications were associated with significant relationship between seminal vesicle invasion and operation type (more in patients with RRP). Conclusions: Our study showed that the lesions detected by MpMRI showed a high histopathological correlation. However, the lesion was underestimated by MpMRI. Based on the MpMRI findings, the decision of definitive treatment may be changed or if the operation is decided, the type of operation and the decision of nerve sparing may be changed. Based on the MpMRI findings, patients can be informed preoperatively about the problems that may develop in the follow-up and the need for additional treatment.
Background and Aim: Multiparametric Prostate MRI (MpMRI) has become increasingly important in the diagnosis and staging of prostate cancer, with increasing experience and device quality. In our study, we aimed to investigate the relationship between the histopathological correlation of the suspected malignancy detected in MpMRI and the postoperative functional results and biochemical recurrence. Materials and Methods: The data of 93 patients between January 2012 and June 2018 who underwent radical prostatectomy in the Urology Department of Ege University Medical Faculty and had preoperative MPMRG and met other inclusion criteria were examined. Age, pre-operative Prostate-Specific Antigen (PSA) value, type of operation, postoperative urinary incontinence status, erectile dysfunction and PSA values were retrospectively collected from patient files. The pathology specimen was examined again and post-operative gleason score, ISUP grade group, other pathological findings (lymph node involvement and extraprostatic extension), pre-operative MPMRI were re-examined and PIRADS score, extracapsular extension, seminal vesicle invasion, neurovascular bundle invasion, lymph node involvement and ADC values were recorded. SPSS for Windows 22.0 package program was used for statistical analysis. Results: 151 (92,07%) of 164 lesions detected in MpMRG were histopathologically correlated. Of the 248 lesions identified by the pathologist, 151 (60.88%) were confirmed by the radiologist. 80% of patients with seminal vesicle invasion, 28.8% of patients with extracapsular extension and 42.9% of patients with lymph node involvement in MpMRI were histopathologically correlated. A significant relationship was found between PIRADS scores and ISUP grade groups. There was a negative correlation between ADC values and ISUP grade groups. There was no relationship between postoperative urinary incontinence and any MRI findings. There was a significant relationship between extracapsular extension and ED in MpMRI. A significant relationship was found between biochemical recurrence and PIRADS scores, seminal vesicle invasion, ISUP grade group, Gleason score, preoperative PSA, extracapsular extension and neurovascular bundle invasion. Peroperative and postoperative complications were associated with significant relationship between seminal vesicle invasion and operation type (more in patients with RRP). Conclusions: Our study showed that the lesions detected by MpMRI showed a high histopathological correlation. However, the lesion was underestimated by MpMRI. Based on the MpMRI findings, the decision of definitive treatment may be changed or if the operation is decided, the type of operation and the decision of nerve sparing may be changed. Based on the MpMRI findings, patients can be informed preoperatively about the problems that may develop in the follow-up and the need for additional treatment.
Açıklama
Anahtar Kelimeler
Prostat Kanseri, Multiparametrik MRG, Histopatolojik Korelasyon, Prostate Cancer, Multiparametric MRI, Histopathological Correlation
