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The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT.We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months' mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage.Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months' mortality (OR 0.407, 95% CI 0.171-0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months' mortality (aOR 0.430, 95% CI 0.187-0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121-3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263-4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173-7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141-0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099-3.942, p = 0.024) after adjustment for variables associated with 3 months' mortality and successful recanalization, respectively.Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months' mortality.

RIASSUNTO: La diagnosi differenziale preoperatoria delle lesioni testicolari non palpabili mediante le metodiche di imaging, specie con l'ecografia, è cruciale poiché consente, nei casi di negatività dei marker biochimici tumorali, un approccio chirurgico conservativo. Lo scopo dello studio è stato quello di valutare il ruolo dell'ecografia con mezzo di contrasto nella caratterizzazione delle piccole lesioni didimarie.

This Report intends to estimate the total number of people still alive in 2010 after cancer diagnosis in Italy, regardless of the time since diagnosis, and to project these estimates to 2015. This study is also aimed to estimate the number of already cured cancer patients, whose mortality rates have become undistinguishable from that of the general population of the same age and sex.The study took advantage of the information from the AIRTUM database, which included 29 Cancer Registries (covering 21 million people, 35% of the Italian population). A total of 1,624,533 cancer cases diagnosed between 1976 and 2009 contributed to the study. For each registry, the observed prevalence was calculated. Prevalence for lengths of time exceeding the maximum duration of the registration and of the complete prevalence were derived by applying an estimated correction factor, the completeness index. This index was estimated by means of statistical regression models using cancer incidence and survival data available in registries with 18 years of observation or more. For 50 types or combinations of neoplasms, complete prevalence was estimated at 1.1.2010 as an absolute number and as a proportion per 100,000 inhabitants by sex, age group, area of residence, and years since diagnosis. Projections of complete prevalence for 1.1.2015 were computed under the assumption of a linear trend of the complete prevalence observed until 2010. Validated mixture cure models were used to estimate: the cure fraction, that is the proportion of patients who, starting from the time of diagnosis, are expected to reach the same mortality rate of the general population; the conditional relative survival (CRS), that is the cumulative probability of surviving some additional years, given that patients already survived a certain number of years; the time to cure, that is the number of years necessary so that conditional survival in the following five years (5-year CRS) exceeds the conventional threshold of 95% (i.e., mortality rates in cancer patients become undistinguishable compared to those of the general population); the proportion of patients already cured, i.e., people alive since a number of years exceeding time to cure.As of 1.1.2010, it was estimated that 2,587,347 people were alive after a cancer diagnosis, corresponding to 4.4% of the Italian population. A relevant geographical heterogeneity emerged, with a prevalence above 5% in northern registries and below 4% in southern areas. Men were 45% of the total (1,154,289) and women 55% (1,433,058). In the population aged 75 years or more, the proportions of prevalent cases were 20% in males and 13% in females, 11% between 60 and 74 years of age in both sexes. Nearly 600,000 Italian women were alive after a breast cancer diagnosis (41% of all women with this neoplasm), followed by women with cancers of the colon rectum (12%), corpus uteri (7%), and thyroid (6%). In men, 26% of prevalent cases (295,624) were patients with prostate cancer, 16% with either bladder or colon rectum cancer. The projections for 1.1.2015 are of three million (3,036,741) people alive after a cancer diagnosis, 4.9% of the Italian population; with a 20% increase for males and 15% for females, compared to 2010. The cure fractions were heterogeneous according to cancer type and age. Estimates obtained as the sum of cure fractions for all cancer types showed that more than 60% of patients diagnosed below the age of 45 years will reach the same mortality rate of the general population. This proportion decreased with increasing age and it was30% for cancer diagnosed after the age of 74 years. It was observed that 60% of all prevalent cases (1,543,531 people or 2.6% of overall Italian population) had been diagnosed5 years earlier (long-term survivors). Time to cure (5-year CRS95%) was reached in10 years by patients with cancers of the stomach, colon rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. Mortality rates similar to the ones reported by the general population were reached after approximately 20 years for breast and prostate cancer patients. Five-year CRS remained95% for25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Time to cure was reached by 27% (20% in men and 33% in women) of all people living after a cancer diagnosis, defined as already cured.The study showed a steady increase over time (nearly +3% per year) of prevalent cases in Italy. A quarter of Italian cancer patients alive in 2010 can be considered as already cured. The AIRTUM Report 2014 describes characteristics of cancer patients and former-patients for 50 cancer types or combinations by sex and age. This detailed information promotes the conduction of studies aimed at expanding the current knowledge on the quality of life of these patients during and after the active phase of treatments (prevalence according to health status), on the long-term effects of treatments (in particular for paediatric patients), on the cost profile of cancer patients, and on rare tumours. All these observations have a high potential impact on health planning, clinical practice, and, most of all, patients' perspective.

Dalla Prefazione: La Diagnostica per Immagini è oggi al primo posto fra le indagini strumentali indispensabili a supporto della prima diagnosi clinica ed è il filo conduttore del monitoraggio del decorso clinico di diverse patologie. Nei dieci anni intercorsi dalla prima edizione, l’imaging ha subito tumultuose evoluzioni tecnologiche in termini di digitalizzazione delle immagini, con straordinari risultati applicativi, tanto da introdurre nuove metodiche e ridurne l’indicazione o farne scomparire altre. L’acquisizione delle immagini in TC ed RM è divenuta più veloce e i pixel delle immagini digitali più piccoli. Ciò ha consentito nuove applicazioni cliniche quali la cardio-TC, l’entero-TC e la colonscopia virtuale, l’angio-TC di tutti gli apparati fino a livello dei piccoli vasi: quest’ultima ha completamente sostituito l’angiografia convenzionale. I sistemi CAD (Computed Aided Detection) stanno sempre più affiancando la diagnosi radiologica come strumento di seconda lettura in settori quale il torace, la mammografia e la colonscopia virtuale, specie negli esami di screening. Inoltre, la digitalizzazione delle immagini insieme alla diffusione dei sistemi RIS-PACS ha radicalmente mutato l’attività del radiologo, che oggi si svolge su workstation capaci di visualizzare velocemente migliaia di immagini, facilitandone così la lettura, e di eseguire su queste ricostruzioni tridimensionali in tempo reale; per di più essa può essere svolta in sedi distanti. Contemporaneamente, negli ultimi anni si è osservato in tutto il mondo uno smisurato incremento di richieste delle indagini radiologiche, che ha indotto la necessità di strumenti per promuovere l’appropriatezza e l’efficacia degli interventi ed un uso più razionale delle risorse: da qui la nascita di numerose linee guida per le indicazioni alle varie metodiche di imaging e di algoritmi decisionali condivisi dalle varie società scientifiche per le diverse patologie, che devono essere conosciuti. I radiologi in formazione, come anche gli specialisti di altre discipline, debbono dunque rendersi edotti delle numerose problematiche di ordine tecnico- metodologico e interpretativo che emergono nelle applicazioni cliniche delle tante e complesse apparecchiature, con l’imperativo del più razionale e accurato utilizzo di esse. Essi sentono profondamente questo loro dovere ed è infatti molto frequente da parte loro la richiesta di testi che forniscano chiare e complete informazioni sull’ottimale impiego delle varie tecniche d’indagine, specie se trattano nel loro insieme e con criterio d’integrazione tutte le tecniche di diagnostica per immagini. Con questo nostro lavoro abbiamo dunque inteso concorrere a soddisfare tale domanda, proponendoci di fornire ai radiologi un testo di approfondimento ed una guida ragionata nella scelta della tecnica di elezione e di quelle complementari nello studio morfologico e funzionale delle patologie dei diversi apparati e di illustrarne i principali reperti morfologici. Abbiamo cercato di redigere questo testo con modalità e terminologia tali da poterlo rendere anche un manuale di facile consultazione per tutti i medici operanti nel campo della medicina generale e nelle branche specialistiche, che vogliano orientarsi nel complesso settore della diagnostica per immagini, vogliano acquisire le informazioni necessarie per valutare in ciascuna patologia l’utilità delle varie tecniche, desiderino conoscerne le potenzialità e anche i limiti e vogliano rendersi edotti dei risultati che si possono ottenere mediante l’integrazione delle diverse tecniche. Negli ultimi dieci anni si sono inoltre sviluppate la genomica e la proteomica e, per lo studio di questi fenomeni, si sono sviluppate le nanotecnologie (quali i sistemi meccanici di microelettronica, o MEMS), in grado di identificare a livello molecolare le variazioni della composizione dei costituenti del corpo umano e l’imaging molecolare (la micro-PET o tomografia ad emissione di positroni, la micro-SPECT o tomografia ad emissione di un singolo fotone, la micro-TC, la micro-RM, la micro-ecografia e l’optical imaging), alcune delle quali vengono applicate solamente in campo pre-clinico su modelli animali da laboratorio (come l’optical imaging), altre già trovano analoga e routinaria applicazione sia preclinica che clinica. Tali argomenti, che probabilmente troveranno applicazione umana negli anni a venire, sono anch’essi stati oggetto di trattazione. L’opera si compone di due volumi ed è organizzata in cinque parti. La Parte Prima (capitoli 1-3) tratta dei principi fisici delle metodiche computerizzate (TC ed RM) e dei relativi mezzi di contrasto. La Parte Seconda (capitoli 4-26) è dedicata a tutti i settori di applicazione delle metodiche TC ed RM nei diversi distretti anatomici, passando in rassegna tutte le principali patologie d’organo; è la più ampia in quanto in essa è contenuta la maggior parte delle informazioni (dati epidemiologici e anatomopatologici, classificazioni nosologiche, algoritmi diagnostici, classificazioni in stadi della patologia neoplastica, ecc.) che servono anche come riferimento nell’esporre le applicazioni cliniche delle altre tecniche. La Parte Terza (capitoli 27-29) presenta tre metodiche innovative (spettroscopia RM, RM funzionale, ed imaging molecolare). La Parte Quarta (II volume) esamina le applicazioni dell’US nei diversi distretti anatomici. La Parte Quinta (II volume) è dedicata alle applicazioni della Medicina Nucleare. ANTONINO LENTINI, RITA GOLFIERI

Scopo: Valutare l'accuratezza delle sequenze FIESTA nella rilevazione e quantificazione di stenosi dell'arteria renale in confronto con l'arteriografia digitale (DSA).

The study of the alleles of the delta-globin gene is relevant to the prevention of beta-thalassemia homozygosis; in fact, the increase of the HbA2 is an invaluable hematological marker of the beta-thalassemia heterozygosis and the double heterozygosis for alleles of delta- and beta-globin genes can cause the decrease of the HbA2 up to normal or borderline values. We carried out the characterization of alleles of the delta- and beta-globin genes, restriction fragment length polymorphism (RFLP) haplotype background, and hematologic phenotype in 23 double heterozygotes belonging to 18 unrelated families. A wide heterogeneity of the delta-globin alleles was detected; seven known alleles in trans to the beta-globin gene defects were revealed in 17 out of 18 families, while a new allele in cis to a beta-thalassemia allele was detected in one family. Moreover, the relative frequency of the delta-mutants was quite different from that found among heterozygotes. The new allele delta-cod 5 CCT>ACT, in cis to the allele beta+ thal IVS-I-110 G>A, was found in five carriers of a Sicilian family. The new variant delta5(A2)Pro>Thr, named HbA2-Partinico upon the origin of the family, was detected with high-performance liquid chromatography; it overlapped the HbA2 peak which was partially split. The double in cis heterozygotes had increased percentage of normal and variant HbA2 of comparable size. The variant originated most likely from a new mutational event because it was associated with RFLP haplotype I, commonly found with the beta+ thal IVS-I-110 G>A, even if crossing over or gene conversion cannot be excluded.

L'identificazione delle mutazioni del gene delta-globinico è importante sia per la prevenzione della beta thalassemia omozigote sia per la conoscenza della variabilità genetica in studi popolazionistici. Centoquarantasei famiglie sono state selezionate mediante dosaggio dell'HB A2 TAG) o per l'alterazione del consenso del sito di poliadenilazione (AATAAA>AATTAA). Negli altri 3 casi la mutazione porta ad una sostituzione aminocidica; tuttavia in nessun caso la nuova variante attesa è presente sul cromatogramma HPLC. Il confronto con il fenotipo delle mutazioni beta-globiniche suggerisce che nel caso delle mutazioni Hb A2-Catania ed Hb A2-Scarano l'assenza dell'Hb A2 variante potrebbe essere dovuta ad una comigrazione con la normale HbA; infatti, la variante beta con la stessa sostituzione da origine ad una "fast-mooving-band". Pertanto, i valori bassi di Hb A2 nei rispettivi portatori potrebbero essere dovuti soltanto a problemi tecnici di detection dell'Hb A2 variante. Nel caso della mutazione Hb A2-Foggia, invece, l'assenza della variante dovrebbe essere dovuta alla sua instabilità considerato che la variante beta corrispondente è associata ad un fenotipo di anemia emolitica (corpi di Heinz e riduzione della percentuale di variante circolante al 24%).

Clinical and biopsy study of nine patients on statin therapy suffering from various myopathic syndromes is reported. Biopsy findings showed non specific myopathic signs and mitochondrial changes, such as subsarcolemmal accumulation, morphological alterations, lipid increase and Cox-negative fibers. These findings confirm that statins may cause muscle damage and impair oxidative metabolism.

We characterized mutations and haplotypes of the delta-globin gene (HBD, MIM# 142000) in two regions of southern Italy. Mutations were discovered by screening for individuals with Hb A2A), Hb A2-Campania (g.302C>A), Hb A2-Lucania (g.393C>G), and Hb A2-Capri (g.443G>T)]. Hb A2-Lucania was not inherited but had arisen in the propositus. Two were novel mutations in the noncoding regions: the substitutions IVS2+6T>A, presumably affecting the splicing, and g.-126A>T in the GATA motif presumably affecting transcription. All novel alleles were found associated with haplotypes common in the Mediterranean area. The remaining six were alleles already described. The Hb A2-Yialousa (g.82G>T) was the most prevalent (42/63 families). Recurrent homologous crossing-over events have, most likely, linked this allele to Haplotypes IX (24 families), IV (10 families), or III (seven families). The ratio of Haplotypes IX:IV:III was about the same in the two regions. The rare allele Hb A2-NYU (g.39T>A) was found in 11 families from Basilicata associated with Haplotype I. All the 11 families lived in a restricted area extending from the Ionian Coast for 15 km along the Angri and Sinni Rivers. A founder effect most probably gave origin to this isolated group. The remaining four alleles were rare: the 7.2-kb deletion Corfu type (HBD g.-5946_1262del), Hb A2-Mitsero (g.14C>T), Hb A2-Etolia (g.385T>C), Hb A2-Coburg (g.1376G>A). Correlation between genotype and phenotype was established in 103 carriers.

In this study, purified P-glycoprotein molecules, a membrane drug pump responsible for the multidrug resistance phenomenon, were incorporated in model membranes deposited onto solid supports, according to the method described by Puu and Gustafson (1997). The insertion of proteins into planar supported model membranes is of interest, as the films are fundamental in biosensor applications and for the investigation of how proteins conform and aggregate in a lipid environment. In our investigation, two model membranes were prepared by transferring liposomes containing P-glycoprotein to different hydrophobic supports: (a) thin amorphous carbon films; (b) Langmuir-Blodgett lipid monolayers on mica. After the labelling of P-glycoprotein with two well-characterised monoclonal antibodies, MM4.17 and MRK-16, samples (a) were observed by transmission electron microscopy (TEM) and samples (b) by atomic force microscopy (AFM). The comparative analysis performed by TEM and AFM allowed us to demonstrate the successful insertion of P-glycoprotein in the model membranes and their stability under different environmental conditions (vacuum, air and water). P-glycoprotein appeared to maintain, after purification and insertion in lipid bilayers, a good part of its conformational features as shown by the P-glycoprotein segments bearing the specific monoclonal antibody epitopes.

Uretero-caval fistula after radical cystectomy with bricker ileal conduit: a case report

Objectives: This study investigates the diagnostic performance of a new T1 imaging series, generated by the digital subtraction of the opposed phase from in phase T 1 weighted images, in MRI for renal angiomyolipoma (AML) evaluation. Methods: This retrospective study involved 96 patients, 63 (65.6%) with at least one renal AML and 33 (34.4%) healthy patients. Two radiologists having different experience retrospectively reviewed two MR imaging series, starting with in and out-phase T 1 weighted images and then the new subtracted T1 images, in which AML appeared white on black background. The presence, number, location, and dimensions of the AMLs, and reading time were collected separately for the two kidneys. Statistical analysis was carried out using the appropriate tests. Results: The number of lesions identified and the evaluation of lesion dimension did not statistically differ between the different MR imaging series evaluated, without interobserver variability. Both percentage agreement of the total number of observations and the κ coefficient showed very good agreement between the radiologists. The median time for the diagnosis was statistically lower when using the subtracted T1 imaging series for both observers with a median gain from 6.5 to 15 s per identified lesion, resulting in a total time-saving of more than half (52.9%), in both patients with and without AMLs, and in patients with a single or with more than one AML (p < 0.001). Conclusions: The new subtracted T1 imaging series proved to be reliable in identifying fat-containing renal lesions, by both expert and non-expert radiologists, resulting in a saving of both time and money. Moreover, this new subtracted T1 imaging series could be an effective tool in non-dedicated kidney examinations in which a faster reading is advisable. Advances in knowledge: The opportunity of using a single set of MRI images in kidney evaluation for identifying fat-containing lesions, considerably reducing reading time, resulting in cost-effectiveness.

Background Multiparametric magnetic resonance imaging (mpMRI) can guide the surgical plan during robot-assisted radical prostatectomy (RARP), and intraoperative frozen section (IFS) can facilitate real-time surgical margin assessment. Objective To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP). Design, setting, and participants Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI. Surgical procedure In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance. Measurements Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups. Results and limitations Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01). Conclusions The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion. Patient summary Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.

Background: Testicular adrenal rest tumors (TARTs) are benign neoplasms affecting patients with congenital adrenal hyperplasia (CAH). The prevalence of TART in adult patients with CAH is not well known. Ultrasonography (US) is the main tool for diagnosing TART and the role of contrast-enhanced US (CEUS) is never investigated. The aim of this study was to evaluate the TART prevalence in adults with CAH, by stratifying patients according to disease phenotype and assessing the diagnostic performance of US, color Doppler (CD) US and CEUS. Methods: Male patients >16 years old with certain diagnosis of CAH who underwent US for TARTs, between December 2015 and September 2019 were prospectively enrolled. The control group included patients without CAH affected by testicular lesions at US other than TARTs. Results: TARTs were identified in 16 of 52 patients (31%), of whom 15 (93.8%) displayed the salt-wasting (SW) form (P

Introduction The purpose of this study was to evaluate the impact of 3-dimensional (3D) digital reconstructions of renal models on the arterial clamping approach during partial nephrectomy (PN). Patients and Methods Fifty-seven patients with T1 renal mass, referred for PN, were prospectively enrolled in 2 groups: Group 1 (n = 32) with revision of both 2-dimensional (2D) computed tomography (CT) imaging and 3D virtual model before surgery; Group 2 (n = 25) with revision of 2D CT imaging. Segmentation of the 3D models from preoperative high-quality CT scan was achieved using D2P software. In a sub-analysis of patients treated with PN with the on-clamp approach (n = 36), the effective intraoperative level of arterial clamping was compared with the preoperative planning. Results In the sub-group of patients referred to PN with the on-clamp approach, the intraoperative selective clamping was performed in 12 (57.1%) patients of Group 1 and in 2 (13.3%) cases of Group 2 (P = .01). The intraoperative management of the renal pedicle was done as preoperatively planned in 61.9% of patients in Group 1 and in 86.6% of cases in Group 2 (P = .1). Conclusion The 3D-guided plan of PN allows to perform selective clamping in higher proportion of patients compared with the standard 2D-guided approach without increasing intraoperative and postoperative complications.

Simple Summary Prostate Cancer is one of the main threats to men’s health. Its accurate diagnosis is crucial to properly treat patients depending on the cancer’s level of aggressiveness. Tumor risk-stratification is still a challenging task due to the difficulties met during the reading of multi-parametric Magnetic Resonance Images. Artificial Intelligence models may help radiologists in staging the aggressiveness of the equivocal lesions, reducing inter-observer variability and evaluation time. However, these algorithms need many high-quality images to work efficiently, bringing up overfitting and lack of standardization and reproducibility as emerging issues to be addressed. This study attempts to illustrate the state of the art of current research of Artificial Intelligence methods to stratify prostate cancer for its clinical significance suggesting how widespread use of public databases could be a possible solution to these issues. Abstract Many efforts have been carried out for the standardization of multiparametric Magnetic Resonance (mp-MR) images evaluation to detect Prostate Cancer (PCa), and specifically to differentiate levels of aggressiveness, a crucial aspect for clinical decision-making. Prostate Imaging—Reporting and Data System (PI-RADS) has contributed noteworthily to this aim. Nevertheless, as pointed out by the European Association of Urology (EAU 2020), the PI-RADS still has limitations mainly due to the moderate inter-reader reproducibility of mp-MRI. In recent years, many aspects in the diagnosis of cancer have taken advantage of the use of Artificial Intelligence (AI) such as detection, segmentation of organs and/or lesions, and characterization. Here a focus on AI as a potentially important tool for the aim of standardization and reproducibility in the characterization of PCa by mp-MRI is reported. AI includes methods such as Machine Learning and Deep learning techniques that have shown to be successful in classifying mp-MR images, with similar performances obtained by radiologists. Nevertheless, they perform differently depending on the acquisition system and protocol used. Besides, these methods need a large number of samples that cover most of the variability of the lesion aspect and zone to avoid overfitting. The use of publicly available datasets could improve AI performance to achieve a higher level of generalizability, exploiting large numbers of cases and a big range of variability in the images. Here we explore the promise and the advantages, as well as emphasizing the pitfall and the warnings, outlined in some recent studies that attempted to classify clinically significant PCa and indolent lesions using AI methods. Specifically, we focus on the overfitting issue due to the scarcity of data and the lack of standardization and reproducibility in every step of the mp-MR image acquisition and the classifier implementation. In the end, we point out that a solution can be found in the use of publicly available datasets, whose usage has already been promoted by some important initiatives. Our future perspective is that AI models may become reliable tools for clinicians in PCa diagnosis, reducing inter-observer variability and evaluation time.

Introduction and Objective: ExactVuTM is a real-time micro-ultrasound system which provides, according to the Prostate Risk Identification Using Micro-Ultrasound protocol (PRI-MUS), a 300% higher resolution compared to conventional transrectal ultrasound. To evaluate the performance of ExactVuTM in the detection of Clinically significant Prostate Cancer (CsPCa). Materials and methods: Patients with Prostate Cancer diagnosed at fusion biopsy were imaged with ExactVuTM. CsPCa was defined as any Gleason Score ≥ 3+4. ExactVuTM examination was considered as positive when PRI-MUS score was ≥ 3. PRI-MUS scoring system was considered as correct when the fusion biopsy was positive for CsPCa. A transrectal fusion biopsy- proven CsPCa was considered as a gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operator characteristic (ROC) curve (AUC) were calculated. Results: 57 patients out of 68 (84%) had a csPCa. PRI-MUS score was correctly assessed in 68% of cases. Regarding the detection of CsPCa, ExactVuTM ’s sensitivity, specificity, PPV, and NPV was 68%, 73%, 93%, and 31%, respectively and the AUC was 0.7 (95% CI 0.5-0-8). For detecting CsPCa in the transition/ anterior zone the sensitivity, specificity, PPV, and NPV was 45%, 66%, 83% and 25% respectively ant the AUC was 0.5 (95% CI 0.2-0.9). Accounting only the CsPCa located in the peripheral zone, sensitivity, specificity, PPV, and NPV raised up to 74%, 75%, 94%, 33%, respectively with AUC 0.75 (95% CI 0.5-0-9). Conclusions: ExactVuTM provides high resolution of the prostatic peripheral zone and could represent a step forward in the detection of CsPCa as a triage tool. Further studies are needed to confirm these promising results.

Background No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes. Objective To evaluate the impact of time from PB to HoLEP on perioperative outcomes. Design, setting, and participants A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included. Outcome measurements and statistical analysis Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time. Results and limitations In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6–0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation. Conclusions The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time. Patient summary Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP.