Diagnostic efficiency of systemic immune-inflammation index in fusion prostate biopsy.

OBJECTIVE: To investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA < 10 ng/mL undergoing fusion prostate biopsy. METHODS: The prospective study included patients who were planned for fusion prostate biopsy and had PSA < 10 ng/mL and a PI-RADS ≥ 3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII = platelet × neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity + specificity - 1). RESULTS: The study included 508 patients with a mean age of 62.49 ±â€¯6.86 years and a median PSA level of 7.28 (5.69-8.70) ng/mL. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC = 0.487, P = 0.622), it was revealed as a significant marker in PCa patients with an ISUP grade ≥ 3 (AUC = 0.811, P < 0.001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3-5 PCa, though not as effective as SII. CONCLUSION: SII and SII combination with PI-RADS score appear to be a significant diagnostic marker in patients with high-grade PCa (ISUP grade 3-5). These values were found to be higher compared to those of patients with a benign pathology and patients with lower ISUP scores.

Preoperative evaluation of hilar vessel anatomy with 3-D computerized tomography in living kidney donors.

OBJECTIVES: Digital subtract angiography is the gold standard for anatomic assessment of renal vasculature for living renal donors. However, multidetector-row computerized tomography (MDCT) is less invasive than digital subtract angiography and provides information of kidney stones and other intra-abdominal organs. In this study, preoperative MDCT angiography results were compared with the peroperative findings to evaluate the accuracy of MDCT for the evaluation of renal anatomy. METHODS: From December 2002 to May 2007, all 60 consecutive living kidney donors were evaluated with MDCT angiography preoperatively. We reported the number and origin of renal arteries, presence of early branching arteries, and any intrinsic renal artery disease. Renal venous anatomy was evaluated for the presence of accessory, retroaortic, and circumaortic veins using venous phase axial images. The calyces and ureters were assessed with delayed topograms. The results of the MDCT angiography were compared with the peroperative findings. RESULTS: A total of 67 renal arteries were seen peroperatively in 60 renal units. Preoperative MDCT angiography detected 64 of them. The two arteries not detected by MDCT had diameters less than 3 mm. Anatomic variations were present in nine veins, five of which were detected by CT angiography. Sensitivity of MDCT angiography for arteries and veins was 95% and 93%, respectively. Positive predictive values were 100% for both arteries and veins. CONCLUSION: MDCT angiography offers a less invasive, rapid, and accurate preoperative investigation modality for vascular anatomy in living kidney donors. It also provides sufficient information about extrarenal anatomy important for donor surgery.

Eficacia diagnóstica del índice de inmunidad-inflamación sistémica en la biopsia de próstata por fusión / Diagnostic efficiency of systemic immune-inflammation index in fusion prostate biopsy

Objetivo: Evaluar la eficacia diagnóstica del índice de inmunidad-inflamación sistémica (IIS) en el cáncer de próstata (CaP) en pacientes con PSA<10ng/ml sometidos a una biopsia de próstata por fusión.MétodosEl estudio prospectivo incluyó a pacientes con una biopsia de próstata por fusión planificada, con un PSA<10ng/ml y un PI-RADS≥3. Todos los pacientes se sometieron a una biopsia prostática transrectal estándar de 12 cilindros, seguida de una biopsia dirigida (biopsia combinada). Con base en los parámetros del recuento sanguíneo completo preoperatorio, el IIS se calculó mediante la siguiente fórmula: IIS=plaquetas×índice neutrófilo-linfocito. Las correlaciones entre la puntuación PI-RADS, las plaquetas, el índice neutrófilo-linfocito, el PSA, la densidad de PSA, el IIS y el CaP se determinaron utilizando el análisis de curvas ROC. Los valores de corte óptimos se determinaron utilizando el máximo del índice de Youden (definido como: sensibilidad+especificidad−1).ResultadosEl estudio incluyó 508 pacientes con una media de edad de 62,49±6,86 años y un nivel medio de PSA de 7,28 (5,69-8,70) ng/ml. La tasa global de CaP clínicamente significativo fue del 39,4%. Aunque el IIS no tenía un valor diagnóstico significativo en los pacientes con CaP de bajo grado ISUP (grado 1 y 2) (AUC=0,487, p=0,622), se reveló como un marcador significativo en los pacientes con CaP con un grado de ISUP≥3 (AUC=0,811, p<0,001). El valor de corte del IIS fue de 533,0. Aunque la combinación de IIS con la puntuación PI-RADS conforman el marcador más efectivo, el índice neutrófilo-linfocito y las plaquetas también se mostraron como marcadores efectivos en la predicción del CaP de grado ISUP 3-5, aunque no tanto como el IIS. (AU)

Objective: To investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA<10ng/ml undergoing fusion prostate biopsy.MethodsThe prospective study included patients who were planned for fusion prostate biopsy and had PSA<10ng/ml and a PI-RADS≥3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII=platelet×neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity+specificity−1).ResultsThe study included 508 patients with a mean age of 62.49±6.86 years and a median PSA level of 7.28 (5.69-8.70) ng/ml. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC=0.487, P=.622), it was revealed as a significant marker in PCa patients with an ISUP grade≥3 (AUC=0.811, P<.001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3-5 PCa, though not as effective as SII. (AU)