Automated prostate cancer detection in magnetic resonance imaging(MRI)scans is of significant importance for cancer patient management.Most existing computer-aided diagnosis systems adopt segmentation methods while ob...Automated prostate cancer detection in magnetic resonance imaging(MRI)scans is of significant importance for cancer patient management.Most existing computer-aided diagnosis systems adopt segmentation methods while object detection approaches recently show promising results.The authors have(1)carefully compared performances of most-developed segmentation and object detection methods in localising prostate imaging reporting and data system(PIRADS)-labelled prostate lesions on MRI scans;(2)proposed an additional customised set of lesion-level localisation sensitivity and precision;(3)proposed efficient ways to ensemble the segmentation and object detection methods for improved performances.The ground-truth(GT)perspective lesion-level sensitivity and prediction-perspective lesion-level precision are reported,to quantify the ratios of true positive voxels being detected by algorithms over the number of voxels in the GT labelled regions and predicted regions.The two networks are trained independently on 549 clinical patients data with PIRADS-V2 as GT labels,and tested on 161 internal and 100 external MRI scans.At the lesion level,nnDetection outperforms nnUNet for detecting both PIRADS≥3 and PIRADS≥4 lesions in majority cases.For example,at the average false positive prediction per patient being 3,nnDetection achieves a greater Intersection-of-Union(IoU)-based sensitivity than nnUNet for detecting PIRADS≥3 lesions,being 80.78%�1.50%versus 60.40%�1.64%(p<0.01).At the voxel level,nnUnet is in general superior or comparable to nnDetection.The proposed ensemble methods achieve improved or comparable lesion-level accuracy,in all tested clinical scenarios.For example,at 3 false positives,the lesion-wise ensemble method achieves 82.24%�1.43%sensitivity versus 80.78%�1.50%(nnDetection)and 60.40%�1.64%(nnUNet)for detecting PIRADS≥3 lesions.Consistent conclusions are also drawn from results on the external data set.展开更多
Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) u...Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.展开更多
基金National Natural Science Foundation of China,Grant/Award Number:62303275International Alliance for Cancer Early Detection,Grant/Award Numbers:C28070/A30912,C73666/A31378Wellcome/EPSRC Centre for Interventional and Surgical Sciences,Grant/Award Number:203145Z/16/Z。
文摘Automated prostate cancer detection in magnetic resonance imaging(MRI)scans is of significant importance for cancer patient management.Most existing computer-aided diagnosis systems adopt segmentation methods while object detection approaches recently show promising results.The authors have(1)carefully compared performances of most-developed segmentation and object detection methods in localising prostate imaging reporting and data system(PIRADS)-labelled prostate lesions on MRI scans;(2)proposed an additional customised set of lesion-level localisation sensitivity and precision;(3)proposed efficient ways to ensemble the segmentation and object detection methods for improved performances.The ground-truth(GT)perspective lesion-level sensitivity and prediction-perspective lesion-level precision are reported,to quantify the ratios of true positive voxels being detected by algorithms over the number of voxels in the GT labelled regions and predicted regions.The two networks are trained independently on 549 clinical patients data with PIRADS-V2 as GT labels,and tested on 161 internal and 100 external MRI scans.At the lesion level,nnDetection outperforms nnUNet for detecting both PIRADS≥3 and PIRADS≥4 lesions in majority cases.For example,at the average false positive prediction per patient being 3,nnDetection achieves a greater Intersection-of-Union(IoU)-based sensitivity than nnUNet for detecting PIRADS≥3 lesions,being 80.78%�1.50%versus 60.40%�1.64%(p<0.01).At the voxel level,nnUnet is in general superior or comparable to nnDetection.The proposed ensemble methods achieve improved or comparable lesion-level accuracy,in all tested clinical scenarios.For example,at 3 false positives,the lesion-wise ensemble method achieves 82.24%�1.43%sensitivity versus 80.78%�1.50%(nnDetection)and 60.40%�1.64%(nnUNet)for detecting PIRADS≥3 lesions.Consistent conclusions are also drawn from results on the external data set.
文摘Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.
