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- Borkmann, Simon, et al.
(author)
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Frequency and radiological characteristics of previously overlooked renal cell carcinoma
- 2019
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In: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 60:10, s. 1348-1359
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Journal article (peer-reviewed)abstract
- Background: A majority of renal tumors are incidentally detected and may therefore have been previously radiologically overlooked. Purpose: To investigate the frequency of previously radiologically overlooked renal cell carcinoma (RCC), identify tumor characteristics and imaging factors that contribute to misdiagnoses and to investigate its consequences. Material and Methods: All RCCs identified in a regional cancer registry over one year were retrieved (n = 87). All preceding radiological examinations were re-analyzed for overlooked RCCs. Results: RCCs had been previously overlooked in 18 (21%) of the 87 patients (on 26 examinations: computed tomography [CT] = 16, magnetic resonance imaging [MRI] = 5, urography = 3, ultrasound = 2) or 18 (43%) of the 42 patients who had earlier radiological examinations. Overlooked RCCs were smaller than non-overlooked RCCs (median = 23 mm; range = 10–45 mm vs. 65 mm; range = 13–207 mm) (P < 0.0001), more frequently located in upper pole, 50% vs. 26% (P = 0.0836), and more frequently homogenous, 50% vs. 9% (P = 0.0003). There was no difference in exophytic growth (60% vs. 60%) (P = 0.74). Overlooked RCCs displayed poorer visualization on CT/MRI in all image planes (axial, coronal, sagittal) compared to non-overlooked tumors (P = 0.004, P = 0.001, P < 0.0001, respectively). Overlooked tumors had interval size progression of median 12 mm (range = 0–65 mm) to clinical detection (median = 1033 days). Conclusions: RCCs are frequently overlooked at imaging in the clinical routine. Overlooked tumors were smaller and displayed poorer visualization in all image planes compared to non-overlooked tumors. Substantial delay to clinical diagnosis and variable size progression was noted. Careful attention to the kidneys in multiple image planes seems warranted, irrespective of clinical indication. © The Foundation Acta Radiologica 2019.
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| 4. |
- Hugosson, Jonas, 1955, et al.
(author)
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Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only.
- 2022
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In: The New England journal of medicine. - 1533-4406. ; 387:23, s. 2126-2137
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Journal article (peer-reviewed)abstract
- Screening for prostate cancer is burdened by a high rate of overdiagnosis. The most appropriate algorithm for population-based screening is unknown.We invited 37,887 men who were 50 to 60 years of age to undergo regular prostate-specific antigen (PSA) screening. Participants with a PSA level of 3 ng per milliliter or higher underwent magnetic resonance imaging (MRI) of the prostate; one third of the participants were randomly assigned to a reference group that underwent systematic biopsy as well as targeted biopsy of suspicious lesions shown on MRI. The remaining participants were assigned to the experimental group and underwent MRI-targeted biopsy only. The primary outcome was clinically insignificant prostate cancer, defined as a Gleason score of 3+3. The secondary outcome was clinically significant prostate cancer, defined as a Gleason score of at least 3+4. Safety was also assessed.Of the men who were invited to undergo screening, 17,980 (47%) participated in the trial. A total of 66 of the 11,986 participants in the experimental group (0.6%) received a diagnosis of clinically insignificant prostate cancer, as compared with 72 of 5994 participants (1.2%) in the reference group, a difference of -0.7 percentage points (95% confidence interval [CI], -1.0 to -0.4; relative risk, 0.46; 95% CI, 0.33 to 0.64; P<0.001). The relative risk of clinically significant prostate cancer in the experimental group as compared with the reference group was 0.81 (95% CI, 0.60 to 1.1). Clinically significant cancer that was detected only by systematic biopsy was diagnosed in 10 participants in the reference group; all cases were of intermediate risk and involved mainly low-volume disease that was managed with active surveillance. Serious adverse events were rare (<0.1%) in the two groups.The avoidance of systematic biopsy in favor of MRI-directed targeted biopsy for screening and early detection in persons with elevated PSA levels reduced the risk of overdiagnosis by half at the cost of delaying detection of intermediate-risk tumors in a small proportion of patients. (Funded by Karin and Christer Johansson's Foundation and others; GÖTEBORG-2 ISRCTN Registry number, ISRCTN94604465.).
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| 5. |
- Lönn, Lars, 1956, et al.
(author)
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Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms
- 2004
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In: J Endovasc Ther. - 1526-6028. ; 11:5, s. 570-6
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Journal article (peer-reviewed)abstract
- PURPOSE: To compare in a randomized prospective study the treatment of femoral pseudoaneurysms with ultrasound-guided thrombin injection versus ultrasound-guided compression. METHODS: Thirty consecutive patients (22 men; mean age 67+/-8 years, range 53-82) with iatrogenic femoral pseudoaneurysms were randomized to treatment with either ultrasound-guided compression (n=15) or injection of bovine thrombin (n=15). The primary outcome measure was thrombosis of the pseudoaneurysm within 24 hours. Secondary outcome measures were complications and hospitalization time (LOS). RESULTS: Thrombosis within 24 hours was achieved in 15 (100%) patients given thrombin versus 2 (13%) in the compression group (p<0.001). Of 13 pseudoaneurysms failing the initial compression treatment, 7 were retreated, 4 successfully. Thus, only 6 (40%) lesions were thrombosed within 48 hours after 1 or 2 compression sessions. The other 9 cases were successfully treated with thrombin injection. LOS was 2.8+/-1.5 days and 3.5+/-2.4 days in the thrombin and compression groups, respectively (p>0.05). No complications were noted in either group. CONCLUSIONS: Ultrasound-guided thrombin injection induces a fast, effective, and safe thrombosis of postcatheterization pseudoaneurysms. The technique is clearly superior to compression treatment and is recommended as the therapy of choice.
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| 8. |
- Ragnarsson, Oskar, et al.
(author)
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Inadequate testosterone suppression after medical and subsequent surgical castration in a patient with prostate cancer.
- 2013
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In: BMJ Case Reports. - : BMJ. - 1757-790X. ; 2013
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Journal article (peer-reviewed)abstract
- Androgen deprivation is a cornerstone in prostate cancer management. We present a 69-year-old man, with a poorly differentiated prostate cancer with skeletal and lymph node metastases. After medical and subsequent surgical castration serum testosterone concentrations remained inappropriately high (4.9 and 4.5 nmol/L; castration range < 0.5). For cancer staging a CT was performed which showed bilateral adrenal enlargement. Endocrine workup revealed elevated levels of adrenal androgens and adrenal precursors. Mutation analysis confirmed a non-classical 21-hydroxylase deficiency, that is, a mild form of congenital adrenal hyperplasia (CAH). To suppress adrenocorticotrophic hormone and the excess adrenal androgen secretion, treatment with hydrocortisone and prednisolone was started with success. Inadequate testosterone suppression after castration due to previously undiagnosed CAH has not previously been reported. Considering the estimated prevalence of 1% in selected populations, non-classical CAH should be considered when testosterone is not adequately suppressed after castration in men with prostate cancer.
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| 9. |
- Wallström, Jonas, et al.
(author)
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Prostate Cancer Screening with Magnetic Resonance Imaging: Results from the Second Round of the Göteborg Prostate Cancer Screening 2 Trial.
- 2022
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In: European urology oncology. - : Elsevier BV. - 2588-9311. ; 5:1, s. 54-60
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Journal article (peer-reviewed)abstract
- The Göteborg 2 prostate cancer (PC) screening (G2) trial evaluates screening with prostate-specific antigen (PSA) followed by magnetic resonance imaging (MRI) in case of elevated PSA levels.To assess the safety of using a 2-yr interval in men who were previously screened positive with PSA but had negative MRI or positive MRI with a negative biopsy.A total of 61 201 men aged 50-60 yr were randomized and 38 366 were invited for screening (years 2015-2020). Men with positive MRI (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3) were scheduled for targeted biopsies. Men with negative MRI or negative biopsies were reinvited after 2yr. Round 1 and 2 MRI scans (PI-RADS ≥3) of men not diagnosed with PC in round 1 were re-read and classified according to Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) by two radiologists. Interval PCs (detected outside the program before invitation to round 2) were identified by linking to the Regional PC Registry.Tabulation of overall detection of PC was done.Between October 2017 and June 2020, 474 men with round 1 elevated PSA and MRI underwent a second screening. Of those, 19% had nonelevated PSA in round 2 and were not examined further. Of the remaining 376 men, 89% had negative MRI. Targeted biopsies yielded 14 PCs: nine grade group (GG) 1 and five GG 2-3. In men with PI-RADS ≥3 and PC diagnosed in round 2, only two (GG 1) progressed according to the PRECISE criteria and the remainder were stable. Ten interval PCs were diagnosed: seven GG 1, one GG 2, and two GG 5. The two GG 5 PCs were PI-RADS 4 and 5 with negative round 1 biopsy.A 2-yr interval seems to be safe in men with negative MRI, while men with PI-RADS 4 and 5 lesions with negative biopsies should have a closer follow-up.In prostate cancer screening, a 2-yr follow-up seems to be safe if magnetic resonance imaging did not show highly suspicious findings.
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| 11. |
- Zachrisson, Sara, et al.
(author)
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Optimisation of tube voltage for conventional urography using a Gd2O2S:Tb flat panel detector
- 2010
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In: Radiation protection dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; 139:1-3, s. 86-91
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Journal article (peer-reviewed)abstract
- With the increasing use of computed tomography (CT) for urography examinations, the indications for 'conventional' projection urography have changed and are more focused on high-contrast details. The purpose of the present study was to optimise the beam quality for urography examinations performed with a Gd(2)O(2)S:Tb flat-panel detector for the new conditions. Images of an anthropomorphic phantom were collected at different tube voltages with a CXDI-40G detector (Canon Inc., Tokyo, Japan). The images were analysed by radiologists and residents in a visual grading characteristics (VGCs) study. The tube voltage resulting in the best image quality was 55 kV, which therefore was selected for a clinical study. Images from 62 patients exposed with either 55 or 73 kV (original tube voltage) at constant effective doses were included. The 55-kV images underwent simulated dose reduction to represent images collected at 80, 64, 50, 40 and 32 % of the original dose level. All images were included in a VGC study where the observers rated the visibility of important anatomical landmarks. For images collected at 55 kV, an effective dose of approximately 85 % resulted in the same image quality as for images collected at 73 kV at 100 % dose. In conclusion, a low tube voltage should be used for conventional urography focused on high-contrast details. The study indicates that using a tube voltage of 55 kV instead of 73 kV for a Gd(2)O(2)S:Tb flat-panel detector, the effective dose can be reduced by approximately 10-20 % for normal-sized patients while maintaining image quality.
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