apresentação do powerpoint€¦ · positive surgical margins 1. 15% incidence (6-30%) 2. similar...
TRANSCRIPT
![Page 1: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/1.jpg)
Antonio Lopez-Beltran
![Page 2: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/2.jpg)
Radical prostatectomy
specimens
EPE+? M+?
![Page 3: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/3.jpg)
![Page 4: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/4.jpg)
Sung, Montironi, Lopez-Beltran Current Diagn Pathol, 2014
Direito Esquerdo
Base
Apex
Base
Apex
1ª Fatia
2ª Fatia
3ª Fatia
5ª Fatia
6ª Fatia
7ª Fatia
8ª Fatia
4ª Fatia
![Page 5: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/5.jpg)
22-36
![Page 6: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/6.jpg)
Positive surgical margins in RPs
ODefinition: ink on tumor cells
![Page 7: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/7.jpg)
M+?
![Page 8: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/8.jpg)
Positive surgical margins 1. 15% incidence (6-30%)
2. Similar in Robotic than in open/laparoscopic RP
3. Increasing incidence with higher grade, volume, and stage of
Pca
4. Strong dependent of surgeon “Experience”
Eur Urol 2014
![Page 9: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/9.jpg)
pT2 with + margin (intra-prostatic) pT2
pT3a with + margin (extra-prostatic) pT3a
![Page 10: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/10.jpg)
pT3a
M-
![Page 11: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/11.jpg)
A B
Unifocal
intraprostatic +SM
![Page 12: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/12.jpg)
Normal benign tissue at SM
![Page 13: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/13.jpg)
EPE+
SM+
![Page 14: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/14.jpg)
![Page 15: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/15.jpg)
Swindle P et al, J Urol 174, 903, 2005
Biochemical
recurrence
![Page 16: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/16.jpg)
Surgical margins
O Extent: OFocal vs. extensive
1. number of blocks involved
2. mm of involvement
≤ 3mm vs. > 3 mm
![Page 17: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/17.jpg)
carcinoma
sampled area
False positive margin
![Page 18: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/18.jpg)
Missing Margin
![Page 19: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/19.jpg)
False M+
![Page 20: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/20.jpg)
Positive surgical margin in areas of capsular incision>>Biochem.
recurrence
![Page 21: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/21.jpg)
Izard JP et al, AJSP 38, 333, 2014 Close: < 0.1 mm from tumor cells
![Page 22: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/22.jpg)
Gleason at M+
![Page 23: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/23.jpg)
![Page 24: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/24.jpg)
![Page 25: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/25.jpg)
![Page 26: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/26.jpg)
![Page 27: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/27.jpg)
![Page 28: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/28.jpg)
![Page 29: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/29.jpg)
![Page 30: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/30.jpg)
EPE LM vs DIG
![Page 31: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/31.jpg)
EPE LM (mm)
p value EPE LM single
(mm)
p value
EPE DIG (mm)
p value EPE DIG single p value EPE DIG R (mm) p value
pT2 vs pT3; (n)
median±SD
0.485*
0.663*
0.130*
0.156*
0.034*
pT2 (2)
3.500±0.7071
(2)
3.500±0.707
(2) 2.240±1.456
(2)
1.890±0.961
(2) 0.240±0.135
pT3 (39)
7.071±6.434
(39)
5.123±3.986
(39)
18.895±19.867
(39)
9.157±10.048
(39)
2.152 ± 2.137
LN status;
(n) median ± SD
0.418#
0.383#
0.330#
0.167#
0.138#
N0 (26)
6.730±6.115
(26)
4.538±3.373
(26)
18.274±21.541
(26)
7.353±6.310
(26)
1.815±2.031
N1
(8) 9.487±8.278
(8)
7.362±5.333
(8)
18.865±13.339
(8)
11.577±10.464
(8) 3.178±2.554
Nx
(7) 4.557±3.882
(7)
4.271±3.466
(7)
16.481±21.052
(7)
11.018±18.373
(7) 1.688±1.789
Biochemical
recurrence; (n)
median±SD
0.221*
0.383*
0.239*
0.461*
0.042*
No (26)
5.992±5.592
(26)
4.415±3.031
(26)
14.123±14.510
(26)
8.016±9.977
(26)
1.429±1.155
Yes (15)
8.466±7.356
(15)
6.133±5.012
(15)
24.948±25.565
(15)
10.167±10.019
(15)
3.151±2.915
Grade Group; (n)
median±SD 0.036#
0.069#
0.211#
0.205#
0.022#
GG 2 (22)
4.900±4.409
(22)
4.036±3.325
(22)
15.502±20.955
(22)
7.712±11.037
(22)
1.799±2.261
GG 3 (14)
6.857±4.671
(14)
4.785±2.636
(14)
17.243±17.243
(14)
8.289±6.202
(14)
1.577±0.951
GG 4 (5)
15.800±10.183
(5)
10.200±5.718
(5)
32.390±17.722
(5)
15.042±12.797
(5) 4.554±2.525
# Kruskal Wallis test; * U de Mann Whitney test; † ANOVA test
Legend: EPE LM - cumulative length of extraprostatic extension in mm, determined by light microscopy; EPE LM single - greatest single extraprostatic
extension in mm, determined by light microscopy, EPE DIG - cumulative length of extraprostatic extension in mm, determined digitally on whole slide
images; EPE DIG single - single greatest extraprostatic extension in mm, determined digitally on whole slide images; EPE DIG R - greatest single radial
length of extraprostatic extension in mm, determined digitally on whole slide images; LN status -lymph node status; GG - grade group
Table 3. Quantification of extraprostatic extension based on linear extent of positivity and disease characteristics.
![Page 32: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/32.jpg)
Impact of New Imaging methods
Any Role for Artificial
Intelligence?
M+?
EPE+?
![Page 33: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/33.jpg)
Conclusion
O En general, las mediciones totales (agregado
longitudinal) tienen mejor poder discriminante
que las mediciones del foco mayor individual.
O Patologia digital mejora el reconocimiento y
medición del M+ lo que tiene implicaciones
clinicas.
O Patologia digital mejora el reconocimento y
medición de la EPE, en particular del EPE radial,
lo que tiene implicaciones clínicas.
![Page 34: Apresentação do PowerPoint€¦ · Positive surgical margins 1. 15% incidence (6-30%) 2. Similar in Robotic than in open/laparoscopic RP 3. Increasing incidence with higher grade,](https://reader033.vdocuments.mx/reader033/viewer/2022050308/5f6ff9a96729037b512b9342/html5/thumbnails/34.jpg)
GRACIAS