AIMTo evaluate the performance of FibroMeter<sup>Virus3G</sup> combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis...AIMTo evaluate the performance of FibroMeter<sup>Virus3G</sup> combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis in chronic hepatitis C (CHC). METHODSFirst generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis. FibroMeter<sup>Virus3G</sup> was sequentially applied to unclassified cases from APRI or Forns. Accuracy of non-invasive combination of tests, APRI plus FibroMeter<sup>Virus3G</sup> and Forns plus FibroMeter<sup>Virus3G</sup> was evaluated in the Brazilian derivation population. APRI plus FibroMeter<sup>Virus3G</sup> combination was validated in a population of CHC patients from Angers in France. All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists. Significant fibrosis was considered as METAVIR F ≥ 2. The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests. Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at -70 °C. RESULTSSeven hundred and sixty CHC patients were included (222 in the derivation population and 538 in the validation group). In the derivation population, the FibroMeter<sup>Virus3G</sup> AUROC was similar to APRI AUROC (0.855 vs 0.815, P = 0.06) but higher than Forns AUROC (0.769, P Virus3G</sup> cut-off to discriminate significant fibrosis was 0.61 (80% diagnostic accuracy; 75% in the validation population, P = 0.134). The sequential combination of APRI or Forns with FibroMeter<sup>Virus3G</sup> in derivation population presented similar performance compared to FibroMeter<sup>Virus3G</sup> used alone (79% vs 78% vs 80%, respectively, P = 0.791). Unclassified cases of significant fibrosis after applying APRI and Forns corresponded to 49% and 54%, respectively, of the total sample. However, the combination of APRI or Forns with FibroMeter<sup>Virus3G</sup> allowed 73% and 77%, respectively, of these unclassified cases to be correctly evaluated. Moreover, this combination resulted in a reduction of FibroMeter<sup>Virus3G</sup> requirement in approximately 50% of the entire sample. The stepwise combination of APRI and FibroMeter<sup>Virus3G</sup> applied to the validation population correctly identified 74% of patients with severe fibrosis (F ≥ 3). CONCLUSIONThe stepwise combination of APRI or Forns with FibroMeter<sup>Virus3G</sup> may represent an accurate lower cost alternative when evaluating significant fibrosis, with no need for liver biopsy.展开更多
AIM： Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in...AIM： Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in interventional liver studies. METHODS： Thirty lesions each of hyperdense, isodense and hypodense attenuation compared to normal liver parenchyma were injected into 15 ex-vivo pig livers. All lesions were composed of the same amounts of gelatine containing 0.5 MBq of ^18F-FDG. Following lesion insertion, an interventional needle was placed in each lesion under CT-guidance solely. After that, a PET/CT study was performed. The localization of the needle within the lesion was assessed for CT alone and PET/CT and the root mean square （RMS） was calculated. Results were compared with macroscopic measurements after lesion dissection serving as the standard of reference. RESULTS： In hypo- and isodense lesions PET/CT proved more accurate in defining the position of the interventional device when compared with CT alone. The mean RMS for CT and PET/CT differed significantly in isodense and hypodense lesions. No significant difference was found for hyperdense lesions. CONCLUSION： Combined FDG-PET/CT imaging provides more accurate information than CT alone concerning the needle position in FDG-PET positive liver lesions. Therefore combined PET/CT might be potentially beneficial not only for localization of an interventional device, but may also be beneficial for guidance in interventional liver procedures.展开更多
Systematic prostate biopsy has limitations,such as overdiagnosis of clinically insignificant prostate cancer and underdiagnosis of clinically significant prostate cancer.Magnetic resonance imaging(MRI)-guided biopsy,a...Systematic prostate biopsy has limitations,such as overdiagnosis of clinically insignificant prostate cancer and underdiagnosis of clinically significant prostate cancer.Magnetic resonance imaging(MRI)-guided biopsy,a promising alternative,might improve diagnostic accuracy.To compare the cancer detection rates of systematic biopsy and combined biopsy(systematic biopsy plus MRI-targeted biopsy)in Asian men,we conducted a retrospective cohort study of men who underwent either systematic biopsy or combined biopsy at two medical centers(Queen Mary Hospital and Tung Wah Hospital,Hong Kong,China)from July 2015 to December 2022.Descriptive statistics were calculated,and univariate and multivariate logistic regression analyses were performed.The primary and secondary outcomes were prostate cancer and clinically significant prostate cancer.A total of 1391 participants were enrolled.The overall prostate cancer detection rates did not significantly differ between the two groups(36.3%vs 36.6%,odds ratio[OR]=1.01,95%confidence interval[CI]:0.81-1.26,P=0.92).However,combined biopsy showed a significant advantage in detecting clinically significant prostate cancer(Gleason score≥3+4)in patients with a total serum prostate-specific antigen(tPSA)concentration of 2-10 ng ml−1(systematic vs combined:11.9%vs 17.5%,OR=1.58,95%CI:1.08-2.31,P=0.02).Specifically,in the transperineal biopsy subgroup,combined biopsy significantly outperformed systematic biopsy in the detection of clinically significant prostate cancer(systematic vs combined:12.6%vs 24.0%,OR=2.19,95%CI:1.21-3.97,P=0.01).These findings suggest that in patients with a tPSA concentration of 2-10 ng ml−1,MRI-targeted biopsy may be of greater predictive value than systematic biopsy in the detection of clinically significant prostate cancer.展开更多
文摘AIMTo evaluate the performance of FibroMeter<sup>Virus3G</sup> combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis in chronic hepatitis C (CHC). METHODSFirst generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis. FibroMeter<sup>Virus3G</sup> was sequentially applied to unclassified cases from APRI or Forns. Accuracy of non-invasive combination of tests, APRI plus FibroMeter<sup>Virus3G</sup> and Forns plus FibroMeter<sup>Virus3G</sup> was evaluated in the Brazilian derivation population. APRI plus FibroMeter<sup>Virus3G</sup> combination was validated in a population of CHC patients from Angers in France. All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists. Significant fibrosis was considered as METAVIR F ≥ 2. The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests. Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at -70 °C. RESULTSSeven hundred and sixty CHC patients were included (222 in the derivation population and 538 in the validation group). In the derivation population, the FibroMeter<sup>Virus3G</sup> AUROC was similar to APRI AUROC (0.855 vs 0.815, P = 0.06) but higher than Forns AUROC (0.769, P Virus3G</sup> cut-off to discriminate significant fibrosis was 0.61 (80% diagnostic accuracy; 75% in the validation population, P = 0.134). The sequential combination of APRI or Forns with FibroMeter<sup>Virus3G</sup> in derivation population presented similar performance compared to FibroMeter<sup>Virus3G</sup> used alone (79% vs 78% vs 80%, respectively, P = 0.791). Unclassified cases of significant fibrosis after applying APRI and Forns corresponded to 49% and 54%, respectively, of the total sample. However, the combination of APRI or Forns with FibroMeter<sup>Virus3G</sup> allowed 73% and 77%, respectively, of these unclassified cases to be correctly evaluated. Moreover, this combination resulted in a reduction of FibroMeter<sup>Virus3G</sup> requirement in approximately 50% of the entire sample. The stepwise combination of APRI and FibroMeter<sup>Virus3G</sup> applied to the validation population correctly identified 74% of patients with severe fibrosis (F ≥ 3). CONCLUSIONThe stepwise combination of APRI or Forns with FibroMeter<sup>Virus3G</sup> may represent an accurate lower cost alternative when evaluating significant fibrosis, with no need for liver biopsy.
文摘AIM： Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in interventional liver studies. METHODS： Thirty lesions each of hyperdense, isodense and hypodense attenuation compared to normal liver parenchyma were injected into 15 ex-vivo pig livers. All lesions were composed of the same amounts of gelatine containing 0.5 MBq of ^18F-FDG. Following lesion insertion, an interventional needle was placed in each lesion under CT-guidance solely. After that, a PET/CT study was performed. The localization of the needle within the lesion was assessed for CT alone and PET/CT and the root mean square （RMS） was calculated. Results were compared with macroscopic measurements after lesion dissection serving as the standard of reference. RESULTS： In hypo- and isodense lesions PET/CT proved more accurate in defining the position of the interventional device when compared with CT alone. The mean RMS for CT and PET/CT differed significantly in isodense and hypodense lesions. No significant difference was found for hyperdense lesions. CONCLUSION： Combined FDG-PET/CT imaging provides more accurate information than CT alone concerning the needle position in FDG-PET positive liver lesions. Therefore combined PET/CT might be potentially beneficial not only for localization of an interventional device, but may also be beneficial for guidance in interventional liver procedures.
基金funded by grants from the National Natural Science Foundation of China(No.81972645)an Innovative research team of high-level local universities in Shanghai,the Shanghai Youth Talent Support Program,an intramural grant of The University of Hong Kong to RN,and from the Shanghai Sailing Program(No.22YF1440500)to DH.
文摘Systematic prostate biopsy has limitations,such as overdiagnosis of clinically insignificant prostate cancer and underdiagnosis of clinically significant prostate cancer.Magnetic resonance imaging(MRI)-guided biopsy,a promising alternative,might improve diagnostic accuracy.To compare the cancer detection rates of systematic biopsy and combined biopsy(systematic biopsy plus MRI-targeted biopsy)in Asian men,we conducted a retrospective cohort study of men who underwent either systematic biopsy or combined biopsy at two medical centers(Queen Mary Hospital and Tung Wah Hospital,Hong Kong,China)from July 2015 to December 2022.Descriptive statistics were calculated,and univariate and multivariate logistic regression analyses were performed.The primary and secondary outcomes were prostate cancer and clinically significant prostate cancer.A total of 1391 participants were enrolled.The overall prostate cancer detection rates did not significantly differ between the two groups(36.3%vs 36.6%,odds ratio[OR]=1.01,95%confidence interval[CI]:0.81-1.26,P=0.92).However,combined biopsy showed a significant advantage in detecting clinically significant prostate cancer(Gleason score≥3+4)in patients with a total serum prostate-specific antigen(tPSA)concentration of 2-10 ng ml−1(systematic vs combined:11.9%vs 17.5%,OR=1.58,95%CI:1.08-2.31,P=0.02).Specifically,in the transperineal biopsy subgroup,combined biopsy significantly outperformed systematic biopsy in the detection of clinically significant prostate cancer(systematic vs combined:12.6%vs 24.0%,OR=2.19,95%CI:1.21-3.97,P=0.01).These findings suggest that in patients with a tPSA concentration of 2-10 ng ml−1,MRI-targeted biopsy may be of greater predictive value than systematic biopsy in the detection of clinically significant prostate cancer.
