Increased Optical Magnification From 2.5× to 4.3× With Technical Modification Lowers the Positive Margin Rate in Open Radical Retropubic Prostatectomy
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No AccessJournal of UrologyAdult urology1 Jan 2008Increased Optical Magnification From 2.5× to 4.3× With Technical Modification Lowers the Positive Margin Rate in Open Radical Retropubic Prostatectomy James S. Magera, Brant A. Inman, Jeffrey M. Slezak, Stephanie M. Bagniewski, Thomas J. Sebo, and Robert P. Myers James S. MageraJames S. Magera Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Brant A. InmanBrant A. Inman Department of Urologic Research, Mayo Clinic, Rochester, Minnesota More articles by this author , Jeffrey M. SlezakJeffrey M. Slezak Division of Biostatistics, Mayo Clinic, Rochester, Minnesota More articles by this author , Stephanie M. BagniewskiStephanie M. Bagniewski Division of Biostatistics, Mayo Clinic, Rochester, Minnesota More articles by this author , Thomas J. SeboThomas J. Sebo Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota. More articles by this author , and Robert P. MyersRobert P. Myers Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.08.128AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared the positive surgical margin rate of 2.5× and 4.3× optical loupe magnification with associated technical improvement during open radical retropubic prostatectomy. Materials and Methods: From January 2, 2004 to September 16, 2005, 511 consecutive patients underwent open radical retropubic prostatectomy, as performed by 1 surgeon. Because 10 patients refused authorization for a retrospective chart review, 501 were evaluable. For the first 265 patients 2.5× power loupes were used and for the subsequent 236 we used 4.3× power loupes. We used the chi-square test for univariate analysis, followed by multivariate logistic regression analysis adjusted for commonly recognized predictors of positive surgical margins in the 2 successive cohorts. Focusing on the apex, which was the most commonly reported site of positive surgical margins, we include operative video segments mimicking 4.3× magnification to demonstrate the surgical precision possible at 4.3× for managing the periurethral fascial bands of Walsh and urethral transection at the prostato-urethral junction. Results: Positive surgical margins were identified in 39 of 265 patients (14.7%) at 2.5× and in 12 of 236 (5.1%) at 4.3×. Apical positive surgical margins were identified in 25 of 265 patients (9.4%) at 2.5× and in 5 of 236 (2.1%) at 4.3×. On multivariate analysis 4.3× magnification was independently associated with a 75% decrease in the odds of a positive surgical margin overall and in the apex alone (p <0.001 and 0.003, respectively). Conclusions: This exploratory retrospective study suggests that, compared with 2.5× magnification, the use of 4.3× magnification with technical refinements that are not possible or deemed safe at 2.5× resulted in a substantial decrease in the positive surgical margin rate. References 1 : An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series. J Urol2004; 171: 23. Link, Google Scholar 2 : Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi-institutional assessment of 5831 patients. Urology2005; 66: 1245. Google Scholar 3 : Correlation of margin status and extraprostatic extension with progression of prostate carcinoma. Cancer1999; 86: 1775. Google Scholar 4 : Impact of positive surgical margins on prostate cancer recurrence and the use of secondary cancer treatment: data from the CaPSURE database. J Urol2000; 163: 1171. 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Abstract, Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 1January 2008Page: 130-135Supplementary Materials Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsprostatectomyprostatic neoplasmsequipment and suppliesoutcome assessment (health care)prostateAcknowledgmentsEric J. Bergstralh, Division of Biostatistics provided advice.MetricsAuthor Information James S. Magera Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Brant A. Inman Department of Urologic Research, Mayo Clinic, Rochester, Minnesota More articles by this author Jeffrey M. Slezak Division of Biostatistics, Mayo Clinic, Rochester, Minnesota More articles by this author Stephanie M. Bagniewski Division of Biostatistics, Mayo Clinic, Rochester, Minnesota More articles by this author Thomas J. Sebo Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota. More articles by this author Robert P. Myers Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ...Keywords:
Radical retropubic prostatectomy
No AccessJournal of UrologyEditorial1 Aug 2006Radical Prostatectomy—Which Patients Benefit Most From Surgery?is companion ofBlack Race Does Not Independently Predict Adverse Outcome Following Radical Retropubic Prostatectomy at a Tertiary Referral CenterPathological Outcomes and Biochemical Progression in Men With T1c Prostate Cancer Undergoing Radical Prostatectomy With Prostate Specific Antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/mlLong-Term Outcome Following Radical Prostatectomy in Men With Clinical Stage T3 Prostate Cancer25-Year Prostate Cancer Control and Survival Outcomes: A 40-Year Radical Prostatectomy Single Institution Series Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2006.05.019AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Radical Prostatectomy—Which Patients Benefit Most From Surgery?." The Journal of Urology, 176(2), p. 437 Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee© 2006 by American Urological AssociationFiguresReferencesRelatedDetailsRelated articlesJournal of Urology9 Nov 2018Black Race Does Not Independently Predict Adverse Outcome Following Radical Retropubic Prostatectomy at a Tertiary Referral CenterJournal of Urology9 Nov 2018Pathological Outcomes and Biochemical Progression in Men With T1c Prostate Cancer Undergoing Radical Prostatectomy With Prostate Specific Antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/mlJournal of Urology9 Nov 2018Long-Term Outcome Following Radical Prostatectomy in Men With Clinical Stage T3 Prostate CancerJournal of Urology9 Nov 201825-Year Prostate Cancer Control and Survival Outcomes: A 40-Year Radical Prostatectomy Single Institution Series Volume 176Issue 2August 2006Page: 437 Advertisement Copyright & Permissions© 2006 by American Urological AssociationMetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...
Radical retropubic prostatectomy
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From the computer simulation study of blood vessel imaging in cerebral angiography it is found that, with proper choice of the focal-spot size and magnification ratio, radiographic magnification in conjunction with fast screens can give blood vessel images "equivalent" to or better than those from slower screens without magnification. However, this result is highly dependent on blood vessel diameter. If a sufficiently small focal spot is not available so that the proper choice of focal-spot size and magnification cannot be made, then the vessel image from slower screens without magnification can be better than that from fast screens with magnification.
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Radical retropubic prostatectomy
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An x-ray unit designed for conventional nonmagnification and magnification mammography has been evaluated in terms of image quality and corresponding radiation exposure levels. The technical advantages of the radiographic magnification technique can result in improved image quality and reduction of the recording-system noise. The microfocal spot allows 1.5 x magnification mammograms with minimal geometric unsharpness. However, the magnification technique requires an increased radiation dose to the breast, compared to conventional nonmagnification techniques. An additional radiation dose may be required for screen-film magnification views because of reciprocity law failure due to long exposure times. The increased-dose limitation and the small dimensions of the recording-system cassettes have precluded the use of magnification in place of nonmagnified images for routine mammographic examination. The magnification technique has proved to be beneficial in selected cases.
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Magnification selective renal arteriograms were performed on 24 patients, 12 of whom were hypertensive, and compared with non-magnification arteriograms by two observers independently. The magnification angiograms were performed on a Siemens Microfocus Bi 125/3/50 RG tube with a 0.1 mm focal spot. Of the 24 patients examined, information crucial to the diagnosis was found only on the magnification films in three patients (12.5%). Extra information compared with the nonmagnification films was found in the magnification films in 12 patients (50%). No additional information was discovered in the remaining nine patients (37.5%). The magnification angiograms enabled the interlobular vessels to be visualized—this was not possible on the non-magnification films. Against the additional information gained must be weighed the disadvantages of magnification arteriography which include increased radiation dose and lengthening of procedure time plus additional injections of contrast. In conclusion, there is a place for magnification renal arteriography and the advantages seem to outweigh the disadvantages.
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It has been shown that the quality of blood vessel images in cerebral angiograms can be improved either by employing radiographic magnification in conjunction with fast screens or by using slower screens and fast film without magnification. It is not known which of these methods results in better images, and under what conditions magnification used with slow screens might result in further improvement. By means of a computer, the dependence of image contrast and sharpness on magnification with various screen-film systems has been studied. One result indicates that, for blood vessel diameters less than 100 mu m and focal spot sizes of 0.3 mm or larger, the use of slow screens without magnification results in better images than those obtained with fast screens and magnification. For blood vessels larger than 300 mu m in diameter and focal spot sizes of 0.3 mm or less, fast screens with magnification can give better images than those obtained using slow screens without magnification.
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Two techniques of direct-magnification radiography are compared : (a) standard magnification using a 40 cm air gap to reduce scatter, and (b) short-target-film (STF) magnification using a 55 cm target-film distance and a rotating grid to reduce scatter. Both techniques provide nearly equal resolution, although STF magnification is slightly superior in this respect. The advantages and disadvantages of STF magnification are discussed.
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