OBJECTIVE: Transperineal mpMRI-targeted fusion prostate biopsies (TPFBx) are recommended for prostate cancer diagnosis, but little is known about their learning curve (LC), especially when performed under local anaesthesia (LA). We investigated how operators\' and institutions\' experience might affect biopsy results.
METHODS: Baseline, procedure and pathology data of consecutive TPFBx under LA were prospectively collected at two academic Institutions, from Sep 2016 to May 2019. Main inclusion criterion was a positive MRI. Endpoints were biopsy duration, clinically significant prostate cancer detection rate on targeted cores (csCDR-T), complications, pain and urinary function. Data were analysed per-centre and per-operator (with ≥ 50 procedures), comparing groups of consecutive patient, and subsequently through regression and CUSUM analyses. Learning curves were plotted using an adjusted lowess smoothing function.
RESULTS: We included 1014 patients, with 27.3% csCDR-T and a median duration was 15 min (IQR 12-18). A LC for biopsy duration was detected, with the steeper phase ending after around 50 procedures, in most operators. No reproducible evidence in favour of an impact of experience on csPCa detection was found at operator\'s level, whilst a possible gentle LC of limited clinical relevance emerged at Institutional level; complications, pain and IPSS variations were not related to operator experience.
CONCLUSIONS: The implementation of TPFBx under LA was feasible, safe and efficient since early phases with a relatively short learning curve for procedure time.

To investigate the effects of various prostate biopsy protocols with reduced cores on the detection of clinically significant prostate cancer (csPCa) in individuals with MRI-visible lesions (Prostate Imaging Reporting and Data System ≥ 3).
A total of 464 patients with MRI-visible lesions were recruited. All patients underwent two or more targeted biopsies (TB) and systematic biopsies (SB). Several hypothetical biopsy schemes were set-up: TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+SB of the targeted sector (TB+t-SB), and TB+SB of the non-targeted sector (TB+n-SB). A subgroup analysis of patients with multiple MRI-visible lesions was performed. The standard of reference was defined as TB+SB. McNemar test was used to compare csPCa detection rates between various sampling schemes.
The detection rates for prostate cancer and csPCa were 72.8% (338 of 464) and 62.1% (288 of 464), respectively. There were 8.0%, 0.3%, 6.3%, 1.0%, and 4.5% cases in which TB alone, TB+ipsilateral SB, TB+contralateral SB, TB+t-SB, and TB+n-SB would have missed csPCa, respectively. All hypothetical schemes, with the exception of TB+contralateral SB (p = 0.063), significantly outperformed TB alone in terms of csPCa detection (p < 0.05). As for the multi-focus cohort, which included 48 cases, none of the non-index lesions had a higher Gleason grade than the index lesions within the same patients.
TB+ipsilateral SB might be the optimal biopsy scheme for detecting csPCa. As for the multi-focus cohort, the biopsy of the non-index lesions provided limited pathological information.

OBJECTIVE: To investigate the causes of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy.
METHODS: The clinical data of 759 patients who underwent transperineal prostate biopsy from March 2021 to June 2021 at Nanjing DrumTower Hospital were retrospectively analyzed. Twenty-one patients had MRI contraindications. Ultimately, 738 patients completed mpMRI/TRUS fusion-guided targeted prostate biopsy + 12-core transperineal systematic biopsy after mpMRI and PI-RADS scoring. The pathological diagnoses from targeted and systematic biopsy were compared to evaluate and analyze the reasons for missed diagnoses in targeted biopsy.
RESULTS: A total of 388 prostate cancer patients were identified, including 37 (9%) missed diagnoses with targeted biopsy and 44 (11.34%) with systematic biopsy. Between the target biopsy missed diagnosis group and not missed diagnosis group, there was no significant difference in age (71.08 ± 7.11 vs. 71.80 ± 7.94), but PSA (13.63 ± 12.41 vs. 54.54 ± 177.25 ng/ml), prostate volume (61.82 ± 40.64 vs. 44.34 ± 25.07 cm3), PSAD (0.27 ± 0.28 vs. 1.07 ± 2.91), and ISUP grade [1(1) vs. 3(2)] were significantly different. The pathological results of the 37 targeted biopsy missed diagnoses were recompared with MRI: 21 prostate cancers were normal on MRI; 9 cancer areas were abnormal on MRI; and 7 cancer areas on MRI were PI-RADS 3.
CONCLUSIONS: Early prostate cancer, large prostate, effect of local anesthesia, doctor-patient cooperation, MRI diagnosis, and operator technology were possible factors for missed diagnosis in targeted biopsy. Improvements imaging technology, greater experience, and personalized biopsy may lead to an accurate pathological diagnosis.

BACKGROUND: Prostate cancer is a common disease in men and has a relatively high mortality rate. However, the interventional medical equipment used for prostate biopsy and brachytherapy has always been a social concern.
METHODS: To understand interventional medical equipment for prostate cancer, the structure of manual, semi-automatic and automatic medical equipment were considered as the mainline, while the corresponding research on these structures were the auxiliary lines. The characteristics and corresponding research status have been discussed.
RESULTS: Interventional medical equipment for prostate cancer with different degrees of automation and its characteristics were determined, and the imaging principles and characteristics of computed tomography, transrectal ultrasound and magnetic resonance imaging have been briefly described.
CONCLUSIONS: Certain feasible research suggestions have been proposed for future development from the perspective of structure, accuracy and safety. These include flexible and compact robot structures, high-precision image recognition and guidance, accurate dose planning and monitoring, real-time imaging monitoring without delay, high-precision needle insertion strategy, master-slave control, virtual reality and remote control.

BACKGROUND: Percutaneous magnetic resonance-guided (MR-guided) MWA procedures have traditionally been performed under local anesthesia (LA) and sedation. However, pain control is often difficult to manage, especially in some cases when the tumor is large or in a specific location, such as near the abdominal wall or close to the hepatic dome. This study retrospectively compared the results of general anesthesia (GA) and local anesthesia (LA) for MR-guided microwave ablation (MWA) in patients with hepatocellular carcinoma (HCC ≤ 5.0 cm) to investigate whether different anesthesia methods lead to different clinical outcomes.
METHODS: The results of the analysis include procedure-related complications, imaging response, and the time to complete two sets of procedures. According to the type of anesthesia, the Kaplan-Meier method was used to compare the local tumor progression (LTP) of the two groups who underwent MR-guided MWA.
RESULTS: All patients achieved technical success. The mean ablation duration of each patient in the GA group and LA group was remarkably different (P = 0.012). Both groups had no difference in complications or LTP (both P > 0.05). Notably, the tumor location (challenging locations) and the number of lesions (2-3 lesions) could be the main factors affecting LTP (p = 0.000, p = 0.015). Univariate Cox proportional hazard regression indicated that using different anesthesia methods (GA and LA) was not associated with longer LTP (P = 0.237), while tumor location (challenging locations) and the number of lesions (2-3 lesions) were both related to shorter LTP (P = 0.000, P = 0.020, respectively). Additionally, multivariate Cox regression further revealed that the tumor location (regular locations) and the number of lesions (single) could independently predict better LTP (P = 0.000, P = 0.005, respectively).
CONCLUSIONS: No correlation was observed between GA and LA for LTP after MR-guided MWA. However, tumors in challenging locations and the number of lesions (2-3 lesions) appear to be the main factors affecting LTP.

In this study, a novel intelligent nanoplatform to integrate multiple imaging and therapeutic functions for targeted cancer theranostics. The nanoplatform, DOX@Gd-MFe3O4 NPs, was constructed Gd-doped mesoporous Fe3O4 nanoparticles following with the doxorubicin (DOX) loading in the mesopores of the NPs. The DOX@Gd-MFe3O4 NPs exhibited good properties in colloidal dispersity, photothermal conversion, NIR triggered drug release, and high T1/T2 relaxicity rate (r1=9.64 mM-1s-1, r2= 177.71 mM-1s-1). Benefiting from the high MR contrast, DOX@Gd-MFe3O4 NPs enabled simultaneous T1/T2 dual-modal MR imagining on 4T1 bearing mice in vivo and the MR contrast effect was further strengthened by external magnetic field. In addition, the DOX@Gd-MFe3O4 NPs revealed the strongest inhibition to the growth of 4T1 in vitro and in vivo under NIR irradiation and guidance of external magnetic field. Moreover, biosafety was also validated by in vitro and in vivo tests. Thus, the prepared DOX@Gd-MFe3O4 NPs would provide a promising intelligent nanoplatform for dual-modal MR imagining guided synergistic therapy in cancer theranostics.

UNASSIGNED: To evaluate targeted magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion prostate biopsy versus systematic prostate biopsy and the two approaches combined for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in our center.
UNASSIGNED: From September 2018 to June 2020, a total of 161 patients with PI-RADS ≥3 were enrolled in this study. They were randomly to undergo either systematic prostate biopsy (systematic group) or targeted MRI/TRUS fusion prostate biopsy + systematic prostate biopsy (combined group). The clinical data and pathological results of biopsies were analyzed.
UNASSIGNED: The detection rate of PCa by targeted MRI/TRUS fusion prostate biopsy was higher than systematic prostate biopsy (38/81 vs. 33/81) in combinated group, but there was no significantly difference. The PCa detection rate in combinated group was significantly higher than systematic group (47/81 vs. 34/80, P = 0.049). There were 40 patients in combinated group and 22 patients in systematic group diagnosed as csPCa, respectively. The ratio of detected csPCa was much higher in combinated group (P = 0.032). In Gleason score no more than 6, the detected ratio of targeted MRI/TRUS fusion prostate biopsy was significantly lower than systematic biopsies in combinated group (P = 0.044). While, in Gleason score higher than 6, the detected ratios of targeted MRI/TRUS fusion prostate biopsy were all higher than systematic biopsies.
UNASSIGNED: Among patients with PI-RADS ≥ 3, targeted MRI/TRUS fusion prostate biopsy is superior to systematic prostate biopsy in the detection rate of PCa and csPCa, but it still misses some PCa patients, including csPCa. Combining targeted MRI/TRUS fusion prostate biopsy and systematic prostate biopsy can led to more detection of all PCas, especially csPCa.

UNASSIGNED: The objective of our study was to prospectively evaluate the feasibility, effectiveness, and safety of 1.0T open multiparametric magnetic resonance (MR)-guided and monitored microwave ablation (MWA) of liver cancer.
UNASSIGNED: Fifty-six liver lesions (12 - initial hepatocellular carcinoma, 34 - recurrent hepatocellular carcinoma, and 10 - metastatic liver cancers) in 45 patients were treated with MWA ablation using MR guidance and monitoring. The mean diameter of the liver lesions was 1.7 ± 0.9 cm (range, 0.5-4.6 cm). The 56 liver lesions were divided into 3 groups according to diameter: the <1.0 cm group (17 lesions), the 1.0-2.0 cm group (19 lesions), and the >2.0 cm group (20 lesions). Technical success, technical effectiveness, local tumor progression, procedure duration, and complications were assessed. Primary technical effectiveness was assessed 3 months after the MWA, while local tumor progression was assessed more than 3 months after the MWA. The follow-up time for assessment of treatment response ranged from 12 to 30 months (median, 23 months).
UNASSIGNED: The technical success rate was 100%. Primary technical effectiveness was achieved in 52/56 (92.8%) lesions. Local tumor progression was detected in three tumors after initial technical effectiveness. The median duration of the intervention per tumor was 66 min (range, 40-156 min). There were no significant differences between lesion groups in the technical success rate, primary technical effectiveness rate, or local tumor progression rate. There were no major complications following the ablation therapy.
UNASSIGNED: 1.0T open multiparametric MR-guided and MR-monitored MWA for liver cancer is safe and feasible and decreases the risk of local tumor progression; it also provides good primary technique effectiveness rates and is especially suitable when ultrasound and CT facilitated treatments are inappropriate.

Gliomas are one of the most common types of primary brain tumors. Despite recent advances in the combination of surgery, radiotherapy, systemic therapy (chemotherapy, targeted therapy) and supportive therapy in the multimodal treatment of gliomas, the overall prognosis remains poor and the long‑term survival rate is low. Thus, it is crucial to develop a novel glioma management method. Due to its relatively non‑invasive, selective and repeatable characteristics, photodynamic therapy (PDT) has been investigated for glioma therapy in the past decade, exhibiting higher selectivity and lower side effects compared with those of conventional therapy. However, most of the photosensitizers (PSs) are highly hydrophobic, leading to poor water solubility, rapid degradation with clearance in blood circulation and ultimately, low bioavailability. In the present study, hydrophilic polyethylene glycol (PEG)‑chlorin e6 (Ce6) chelated gadolinium ion (Gd3+) nanoparticles (PEG‑Ce6‑Gd NPs) were synthesized via a chelation and self‑assembly process. Initially, the cell cytotoxicity of PEG‑Ce6‑Gd NPs was evaluated with or without laser irradiation. The in vitro study demonstrated the lack of toxicity of PEG‑Ce6‑Gd NPs to tumor cells in the absence of laser irradiation. However, its toxicity was enhanced under laser irradiation. Moreover, the size and weight of brain tumors were significantly decreased in mice with glioma xenografts, which was further confirmed via histological analysis. Subsequently, the results indicated that the PEG‑Ce6‑Gd NPs had a favorable T1‑weighted contrast performance (0.43 mg ml‑1 s‑1) and were observed to have significant contrast enhancement at the tumor site from 0.25 to 1 h post‑injection in vivo. The favorable MRI, as well as the synergetic photodynamic antitumor effect and antineoplastic ability of PEG‑Ce6‑Gd NPs was identified. It was suggested that PEG‑Ce6‑Gd NPs had great potential in the diagnosis and PDT treatment of gliomas, and possibly other cancer types, with prospects of clinical application in the near future.

UNASSIGNED: This study aimed to assess the dosimetric effect of intestinal gas of stereotactic magnetic resonance (MR)-guided adaptive radiation therapy (SMART) on target and critical organs for pancreatic cancer without online electron density correction (EDC).
UNASSIGNED: Thirty pancreatic cancer patients who underwent online SMART were selected for this study. The treatment time of each stage and the total treatment time were recorded and analyzed. The concerned dose-volume parameters of target and organs-at-risk (OAR) were compared with and without an intestinal gas EDC using the Wilcoxon-signed rank test. Analysis items with p value < 0.05 were considered statistically significant. The relationships between dosimetric differences and intestinal gas volume variations were investigated using the Spearman test.
UNASSIGNED: The average treatment time was 82 min, and the average EDC time was 8 min, which accounted for 10% of the overall treatment time. There were no significant differences in CTV (GTV), PTV, bowel, stomach, duodenum, and skin (p > 0.05) with respect to dose volume parameters. For the Dmax of gastrointestinal organs (p = 0.03), the mean dose of the liver (p = 0.002) and kidneys (p = 0.03 and p = 0.04 for the left and right kidneys, respectively), there may be a risk of slight overestimation compared with EDC, and for the Dmax of the spinal cord (p = 0.02), there may be a risk of slight underestimation compared with EDC. A weak correlation for D95 in the PTV and D0.5 cc in the duodenum was observed.
UNASSIGNED: For patients with similar inter-fractional intestinal gas distribution, EDC had little dosimetric effects on the D0.5 cc of all GI organs and dose volume parameters of target in most plans.
UNASSIGNED: By omitting the EDC of intestinal gas, the online SMART treatment time can be shortened.