Image Guided Focal Therapy for Magnetic Resonance Imaging Visible Prostate Cancer: Defining a 3-Dimensional Treatment Margin Based on Magnetic Resonance Imaging Histology Co-Registration Analysis

No AccessJournal of UrologyAdult Urology1 Aug 2015Image Guided Focal Therapy for Magnetic Resonance Imaging Visible Prostate Cancer: Defining a 3-Dimensional Treatment Margin Based on Magnetic Resonance Imaging Histology Co-Registration Analysis Julien Le Nobin, Andrew B. Rosenkrantz, Arnauld Villers, Clément Orczyk, Fang-Ming Deng, Jonathan Melamed, Artem Mikheev, Henry Rusinek, and Samir S. Taneja Julien Le NobinJulien Le Nobin Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York Departments of Urology, University Hospital of Lille, Lille and Unités Mixtes de Recherche 6301-CERVOxy Group, University Hospital of Caen, Caen, France More articles by this author , Andrew B. RosenkrantzAndrew B. Rosenkrantz Department of Radiology, New York University Langone Medical Center, New York, New York More articles by this author , Arnauld VillersArnauld Villers Departments of Urology, University Hospital of Lille, Lille and Unités Mixtes de Recherche 6301-CERVOxy Group, University Hospital of Caen, Caen, France More articles by this author , Clément OrczykClément Orczyk Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York More articles by this author , Fang-Ming DengFang-Ming Deng Department of Pathology, New York University Langone Medical Center, New York, New York More articles by this author , Jonathan MelamedJonathan Melamed Department of Pathology, New York University Langone Medical Center, New York, New York More articles by this author , Artem MikheevArtem Mikheev Department of Radiology, New York University Langone Medical Center, New York, New York More articles by this author , Henry RusinekHenry Rusinek Department of Radiology, New York University Langone Medical Center, New York, New York More articles by this author , and Samir S. TanejaSamir S. Taneja Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York Financial interest and/or other relationship with Hitachi-Aloka, Biobot, Healthtronics, Elsevier and Trod. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.080AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared prostate tumor boundaries on magnetic resonance imaging and radical prostatectomy histological assessment using detailed software assisted co-registration to define an optimal treatment margin for achieving complete tumor destruction during image guided focal ablation. Materials and Methods: Included in study were 33 patients who underwent 3 Tesla magnetic resonance imaging before radical prostatectomy. A radiologist traced lesion borders on magnetic resonance imaging and assigned a suspicion score of 2 to 5. Three-dimensional reconstructions were created from high resolution digitalized slides of radical prostatectomy specimens and co-registered to imaging using advanced software. Tumors were compared between histology and imaging by the Hausdorff distance and stratified by the magnetic resonance imaging suspicion score, Gleason score and lesion diameter. Cylindrical volume estimates of treatment effects were used to define the optimal treatment margin. Results: Three-dimensional software based registration with magnetic resonance imaging was done in 46 histologically confirmed cancers. Imaging underestimated tumor size with a maximal discrepancy between imaging and histological boundaries for a given tumor of an average ± SD of 1.99 ± 3.1 mm, representing 18.5% of the diameter on imaging. Boundary underestimation was larger for lesions with an imaging suspicion score 4 or greater (mean 3.49 ± 2.1 mm, p <0.001) and a Gleason score of 7 or greater (mean 2.48 ± 2.8 mm, p = 0.035). A simulated cylindrical treatment volume based on the imaging boundary missed an average 14.8% of tumor volume compared to that based on the histological boundary. A simulated treatment volume based on a 9 mm treatment margin achieved complete histological tumor destruction in 100% of patients. Conclusions: Magnetic resonance imaging underestimates histologically determined tumor boundaries, especially for lesions with a high imaging suspicion score and a high Gleason score. A 9 mm treatment margin around a lesion visible on magnetic resonance imaging would consistently ensure treatment of the entire histological tumor volume during focal ablative therapy. References 1 : the role of focal therapy in the management of localised prostate cancer: a systematic review. Eur Urol2014; 66: 732. 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Volume 194Issue 2August 2015Page: 364-370 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsimage processingriskcomputer-assistedprostatic neoplasmspathologymagnetic resonance imagingMetricsAuthor Information Julien Le Nobin Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York Departments of Urology, University Hospital of Lille, Lille and Unités Mixtes de Recherche 6301-CERVOxy Group, University Hospital of Caen, Caen, France More articles by this author Andrew B. Rosenkrantz Department of Radiology, New York University Langone Medical Center, New York, New York More articles by this author Arnauld Villers Departments of Urology, University Hospital of Lille, Lille and Unités Mixtes de Recherche 6301-CERVOxy Group, University Hospital of Caen, Caen, France More articles by this author Clément Orczyk Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York More articles by this author Fang-Ming Deng Department of Pathology, New York University Langone Medical Center, New York, New York More articles by this author Jonathan Melamed Department of Pathology, New York University Langone Medical Center, New York, New York More articles by this author Artem Mikheev Department of Radiology, New York University Langone Medical Center, New York, New York More articles by this author Henry Rusinek Department of Radiology, New York University Langone Medical Center, New York, New York More articles by this author Samir S. Taneja Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York Financial interest and/or other relationship with Hitachi-Aloka, Biobot, Healthtronics, Elsevier and Trod. More articles by this author Expand All Advertisement PDF downloadLoading ...