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Introduction and Objective Recent advances in magnetic resonance (MR) technology have allowed for high-resolution ex vivo spectroscopy on small, intact tissue samples. We examined the capability of 1 H magnetic resonance magic angle spinning (MR-MAS) to correctly characterize post–radiofrequency ablation (RFA) renal biopsies from human samples, compared with standard histology and cross-sectional imaging. Methods A minimum of two, 18G, percutaneous renal biopsies were obtained from ten biopsy-confirmed renal tumors at a mean 26.6 mo (range, 15–48) post-RFA. All patients were considered free of disease by computed tomography criteria. A portion of each sample was immediately frozen at −80°C for spectroscopy and the remainder used for pathological analysis. 1 H MR-MAS was performed blinded with a 14.1-tesla field strength. Prior renal biopsies from nonablated tissue were used as positive controls for the spectral analysis. Concordance between, computed tomography, histology, and MR-MAS was analyzed. All spectroscopy was processed with VNMR software. Results Histological analysis of all ten post-RFA biopsies demonstrated no cancer or viable tissue. All MR-MAS spectral peaks for each biopsy were consistent with necrosis and, more importantly, indicated an absence of small molecule metabolites characteristic of both normal and malignant renal tissue. Both MR-MAS and histology confirmed, in each case, the conventional computed tomography determination of complete ablation. Conclusions MR spectroscopy can correctly diagnose the molecular absence of disease in post-RFA tissue biopsies. This proof of principle study warrants in vivo evaluation to confirm the clinical correlates of this modality.

Objectives Optical reflectance spectrophotometry (ORS) is part of a group of novel techniques that have demonstrated promise for the assessment and differentiation of various solid tumors. In this study, we evaluated the ability of ORS to differentiate malignant from benign kidney tumors at surgery. Methods From January to April 2007, we completed optical spectroscopy measurements (OSM) at several standardized tumoral and normal parenchymal locations immediately after specimen removal during radical or partial nephrectomy. The depth of tissue penetration with our specific probe was 1 mm. We compared the slopes of the optical reflectance curves between 630- and 900-nm wavelengths and assessed the correlation between benign and malignant tumors. Results There were 8 partial and 13 radical nephrectomies for 6 benign (oncocytomas) and 15 malignant (14 clear cell and 1 papillary) tumors. Overall, benign and malignant OSM slopes were significantly different ( P = .005). In the near-infrared region, there was excellent correlation among benign ( r = .99) and malignant OSM ( r = .97). On the contrary, there was a poor correlation coefficient when we compared benign and malignant tumors ( r = .49). Conclusions Optical reflectance spectrophotometry may be a novel real-time method to distinguish malignant from benign tumors in vivo. However, we performed these pilot study measurements immediately after specimen removal, and therefore expansion to in situ assessments is necessary.

There have been improvements in the outcome of patients with clinically localized prostate cancer treated by radical prostatectomy. However, some patients treated with radical prostatectomy will have clinical or biochemical progression. These men are at increased risk of dying of their disease. Identification of patients with adverse features at the time of radical prostatectomy may permit the use of additional multimodality therapies to improve outcomes. Whether this additional multimodality therapy should be administered in the neoadjuvant or adjuvant setting remains controversial. Further, whether a patient at increased risk for progression after radical prostatectomy requires additional therapy before the development of documented progression remains controversial. This article reviews the potential multimodality approaches to prevent or delay recurrence of prostate cancer in patients undergoing surgical treatment for prostate cancer.

We report a rare case of a strangulated internal hernia behind the common iliac artery after robot-assisted pelvic lymph node dissection. Internal hernias involving the retroperitoneal vascular axis have been reported four times in medical literature. This is the first time it has been seen after robotic surgery.