The concordance between the volume hotspot and the grade hotspot: a 3-D reconstructive model using the pathology outputs from the PROMIS trial

Title: The concordance between the volume hotspot and the grade hotspot: a 3-D reconstructive model using the pathology outputs from the PROMIS trial
Authors: Bosaily, AE-S
Valerio, M
Hu, Y
Freeman, A
Jameson, C
Brown, L
Kaplan, R
Hindley, RG
Barratt, D
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: 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.
Issue Date: 12-Jul-2016
Date of Acceptance: 26-Jan-2016
ISSN: 1365-7852
Publisher: Nature Publishing Group
Start Page: 258
End Page: 263
Journal / Book Title: Prostate Cancer and Prostatic Diseases
Volume: 19
Issue: 3
Copyright Statement: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit by/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
Aged, 80 and over
Biomarkers, Tumor
Image-Guided Biopsy
Imaging, Three-Dimensional
Magnetic Resonance Imaging
Middle Aged
Neoplasm Grading
Prostatic Neoplasms
Tumor Burden
1112 Oncology And Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine

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