Perineural invasion detected in prostate biopsy is a predictor of positive surgical margin of radical prostatectomy specimen: A meta‐analysis

Li, Hui; Chang, Xuefeng; Du, Yongqiang

doi:10.1111/and.14395

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…Two systemic reviews concluded that biopsy PNI is associated with positive surgical margins at RP as well as biochemical recurrence after operation and radiotherapy. 26,27 In a large multicentre study, Celik et al showed that biopsy PNI was also significantly associated with a posterolateral margin status and nervesparing surgery, although surgical procedures were not standardised as in the current study. 28 It is not clear whether the risk of positive surgical margins is increasing when PNI is observed in more biopsies.…”

Section: Discussionmentioning

confidence: 71%

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Biopsy prostate cancer perineural invasion and tumour load are associated with positive posterolateral margins at radical prostatectomy: implications for planning of nerve‐sparing surgery

et al. 2023

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AimsRadical prostatectomy (RP) for prostate cancer is frequently complicated by erectile dysfunction and urinary incontinence. However, sparing of the nerve bundles adjacent to the posterolateral sides of the prostate reduces the number of complications at the risk of positive surgical margins. Preoperative selection of men eligible for safe, nerve‐sparing surgery is therefore needed. Our aim was to identify pathological factors associated with positive posterolateral surgical margins in men undergoing bilateral nerve‐sparing RP.Methods and resultsProstate cancer patients undergoing RP with standardised intra‐operative surgical margin assessment according to the NeuroSAFE technique were included. Preoperative biopsies were reviewed for grade group (GG), cribriform and/or intraductal carcinoma (CR/IDC), perineural invasion (PNI), cumulative tumour length and extraprostatic extension (EPE). Of 624 included patients, 573 (91.8%) received NeuroSAFE bilaterally and 51 (8.2%) unilaterally, resulting in a total of 1197 intraoperative posterolateral surgical margin assessments. Side‐specific biopsy findings were correlated to ipsilateral NeuroSAFE outcome. Higher biopsy GG, CR/IDC, PNI, EPE, number of positive biopsies and cumulative tumour length were all associated with positive posterolateral margins. In multivariable bivariate logistic regression, ipsilateral PNI [odds ratio (OR) = 2.98, 95% confidence interval (CI) = 1.62–5.48; P < 0.001] and percentage of positive cores (OR = 1.18, 95% CI = 1.08–1.29; P < 0.001) were significant predictors for a positive posterolateral margin, while GG and CR/IDC were not.ConclusionsIpsilateral PNI and percentage of positive cores were significant predictors for a positive posterolateral surgical margin at RP. Biopsy PNI and tumour volume can therefore support clinical decision‐making on the level of nerve‐sparing surgery in prostate cancer patients.

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Section: Discussionmentioning

confidence: 71%

“…Biopsy PNI has been investigated extensively as a prognostic marker with variable outcomes. Two systemic reviews concluded that biopsy PNI is associated with positive surgical margins at RP as well as biochemical recurrence after operation and radiotherapy 26,27 . In a large multicentre study, Celik et al .…”

Section: Discussionmentioning

confidence: 99%

Biopsy prostate cancer perineural invasion and tumour load are associated with positive posterolateral margins at radical prostatectomy: implications for planning of nerve‐sparing surgery

et al. 2023

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“…Some preoperative clinicopathological factors, such as clinical T stage, Gleason score, percentage of positive biopsy cores, and perineural invasion detected in prostate biopsy, have been reported to correlate with the risk of PSM [ 3 , 9 – 11 ]. In addition, pelvic anatomy is associated with PSM [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

An MRI-based grading system for preoperative risk estimation of positive surgical margin after radical prostatectomy

Xu,

Zhang,

Zhang

et al. 2023

Insights Imaging

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Objective To construct a simplified grading system based on MRI features to predict positive surgical margin (PSM) after radical prostatectomy (RP). Methods Patients who had undergone prostate MRI followed by RP between January 2017 and January 2021 were retrospectively enrolled as the derivation group, and those between February 2021 and November 2022 were enrolled as the validation group. One radiologist evaluated tumor-related MRI features, including the capsule contact length (CCL) of lesions, frank extraprostatic extension (EPE), apex abutting, etc. Binary logistic regression and decision tree analysis were used to select risk features for PSM. The area under the curve (AUC), sensitivity, and specificity of different systems were calculated. The interreader agreement of the scoring systems was evaluated using the kappa statistic. Results There were 29.8% (42/141) and 36.4% (32/88) of patients who had PSM in the derivation and validation cohorts, respectively. The first grading system was proposed (mrPSM1) using two imaging features, namely, CCL ≥ 20 mm and apex abutting, and then updated by adding frank EPE (mrPSM2). In the derivation group, the AUC was 0.705 for mrPSM1 and 0.713 for mrPSM2. In the validation group, our grading systems showed comparable AUC with Park et al.’s model (0.672–0.686 vs. 0.646, p > 0.05) and significantly higher specificity (0.732–0.750 vs. 0.411, p < 0.001). The kappa value was 0.764 for mrPSM1 and 0.776 for mrPSM2. Decision curve analysis showed a higher net benefit for mrPSM2. Conclusion The proposed grading systems based on MRI could benefit the risk stratification of PSM and are easily interpretable. Critical relevance statement The proposed mrPSM grading systems for preoperative prediction of surgical margin status after radical prostatectomy are simplified compared to a previous model and show high specificity for identifying the risk of positive surgical margin, which might benefit the management of prostate cancer. Key points • CCL ≥ 20 mm, apex abutting, and EPE were important MRI features for PSM. • Our proposed MRI-based grading systems showed the possibility to predict PSM with high specificity. • The MRI-based grading systems might facilitate a structured risk evaluation of PSM. Graphical Abstract

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Development and Validation of a Biparametric MRI Deep Learning Radiomics Model with Clinical Characteristics for Predicting Perineural Invasion in Patients with Prostate Cancer

Zhang,

Mao,

Wei

et al. 2024

Academic Radiology

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Perineural invasion detected in prostate biopsy is a predictor of positive surgical margin of radical prostatectomy specimen: A meta‐analysis

Cited by 5 publications

References 37 publications

Biopsy prostate cancer perineural invasion and tumour load are associated with positive posterolateral margins at radical prostatectomy: implications for planning of nerve‐sparing surgery

Biopsy prostate cancer perineural invasion and tumour load are associated with positive posterolateral margins at radical prostatectomy: implications for planning of nerve‐sparing surgery

An MRI-based grading system for preoperative risk estimation of positive surgical margin after radical prostatectomy

Development and Validation of a Biparametric MRI Deep Learning Radiomics Model with Clinical Characteristics for Predicting Perineural Invasion in Patients with Prostate Cancer

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