Contrast-enhanced ultrasound (CEUS) as a follow-up method after the focal treatment of renal tumors: systematic review and meta-analysis.

CONTEXT: Contrast-enhanced ultrasound (CEUS) is a cost-effective radiation-free diagnostic method that can be used for renal tumor postoperative visualization after ablative treatment. OBJECTIVE: To assess CEUS diagnostic accuracy comparing with CT and MRI as a follow-up method in short-term and long-term postoperative periods after renal tumor ablation. MATERIALS AND METHODS: A systematic review and meta-analysis were performed in Scopus and Medline databases using the query "(kidney OR rena* OR RCC) AND (ablation OR RFA OR MWA OR cryo*) AND CEUS". The endpoint of the study was the evaluation of the overall accuracy of CEUS. RESULTS: Twelve trials were included in the review. With CT or MRI as a reference, for a short-term group (< 6 weeks after ablation) pooled sensitivity was 90.2%, I2 = 0%; pooled specificity was 99.3%, I2 = 0%; pooled NPV was 98.6%, I2 = 0%; pooled PPV was 94.6%, I2 = 0%; the AUC on the SROC curve was 0.971. For the long-term group (> 6 weeks after ablation), pooled sensitivity was 95.3%, I2 = 0%; pooled specificity was 97.6%, I2 = 0%; PPV was 74.2%, I2 = 4%; NPV was 99.4%, I2 = 5%; AUC = 0.93. CONCLUSION: CEUS has high sensitivity and specificity in ruling out the presence of local recurrence after renal tumor ablation with a higher risk of false-positive results within follow-up > 6 weeks compared with that for CT or MRI. Further studies with a unified protocol and morphological control of local renal tumor recurrence after ablation are needed.

Role of monocarboxylate transporters and glucose transporters in prostate cancer.

OBJECTIVES: Currently, research of new diagnostic approaches to detect clinically significant prostate cancer is relevant because of the importance of early detection of aggressive forms of the disease, often challenging, even when using modern diagnostic tools. The aim of this review is to present the current knowledge regarding monocarboxylate transporters' and glucose transporters' expression as a component of glycolytic phenotype definition in prostate cancer cells. METHODS: We searched PubMed and Scopus databases. Twenty-six articles from 2003 to 2022 were included. Literature research and selection were carried out based on the recommendations of the PRISMA statement. RESULTS: The presence of "lactate shuttle" in the tumor tissue is associated with a worse prognosis. Increased expression of MCT2, MCT4, GLUT1, and down-regulation of GLUT3 are associated with prostate adenocarcinoma. MCT4 expression level correlates with the grade of tumor malignancy and disease prognosis. Up-regulation of GLUT1 and MCT4 is typical for hormone-resistant prostate cancer. Inhibition of MCT1 and MCT4 and GLUT1 in prostate cancer cells reduces their metabolic activity and growth rate, a suitable novel approach for targeted therapy. CONCLUSION: Review of the current studies showed that expression of certain MCTs and GLUTs types are associated with prostate cancer and some of them correlate with high malignancy and poor prognosis. Detection by immunohistochemistry of these transporters could represent a new diagnostic tool to identify aggressive forms of prostate cancer, and a novel therapeutic target for selective drugs.

3D modeling in adherent perinephric fat prediction in nephron-sparing surgery planning in patients with localized renal neoplasms.

STUDY OBJECTIVE: To develop a 3D-image based morphometry scoring system for Adherent Perinephric Fat (APF) prediction in nephron-sparing surgery in renal neoplasm patients. MATERIALS AND METHODS: The retrospective study involved 391 patients who underwent a laparoscopic partial nephrectomy performed by five surgeons from January 2014 till December 2018. The surgery involved the 3D virtual operation planning with «Amira¼ 3D modeling software. With the multivariate logistic regression models, we developed a scoring system based on 3D-models. We tested the significance and sensitivity of new scoring system in a comparative ROC analysis with Mayo Adhesive Probability Score (MAP). RESULTS: We found APF in 111 patients (28.4%). The univariate analysis revealed that significant indicators included mean age 59.88 (55-67) (p < 0.001), male sex (p < 0.001), Body Mass Index (BMI) >30 (21.47-35.08) kg/m2 (p < 0.001), arterial hypertension (p < 0.001), coronary heart disease (p = 0.019), diabetes mellitus (p = 0.005), urolithiasis (p = 0.002). The multivariate regression analysis identified three most significant indicators in 3D models evaluation: additional >5 mm shadows in perirenal space OR = 7.3 (3.6-15.3) (p < 0.001), the number of shadows >5 OR = 3.8 (2.1-6.8) (p < 0.001), the wide shadow base at the renal parenchymal level OR = 0.293 (0.146-0.588) (p = 0.001). The scoring of these indicators comprises a new prediction scale (0-5). The ROC analysis revealed AUC 0.816 (95% CI 0.772-0.861) p < 0.001 of the MAP score, and AUC = 0.803 (95% CI 0.758-0.848) p < 0.001 of the scoring system developed in the present study. CONCLUSIONS: The statistical findings comparison of the scoring system that we developed with those of MAP scale suggests that the scoring system is efficient and applicable.

Three-dimensionally printed non-biological simulator for percutaneous nephrolithotomy training.

Objective: We sought to improve the educational and pre-operative training on various stages of percutaneous nephrolithotomy (PCNL) under fluoroscopic and ultrasound guidance. We developed a three-dimensional (3D) printed simulator (3D-printed PCNL model) for urological trainees.Methods: 40 s year urology residents were randomly assigned into two groups, completing PCNL surgical steps on a URO Mentor™ surgical simulator (Group A) or on our new 3D-printed PCNL model (Group B). Following the training, both groups completed a standardized questionnaire (Likert scale from 0 to 10) which we used to asses the learning curve associated with PCNL training.Results: The mean score of Group A was 65.2/80 while Group B was 76.1/80. Mann-Whitney U-test showed no significant difference between the groups (U = 16, p < 0.05).Conclusion: The 3D-printed PCNL model developed is a novel and highly effective tool that can facilitate enhanced endourological education and personalized pre-operative planning for urolithiasis cases. According to the criteria tested, residents who used our 3D-printed PCNL models performed better under all metrics.