Korean J Urol.  2013 Jul;54(7):437-441.

Efficacy of Using Three-Tesla Magnetic Resonance Imaging Diagnosis of Capsule Invasion for Decision-Making About Neurovascular Bundle Preservation in Robotic-Assisted Radical Prostatectomy

• Tanaka K
• Shigemura
• Muramaki M
• Takahashi
• Miyake H
• Fujisawa M

Abstract

PURPOSE
To evaluate the efficacy of using 3-tesla (T) magnetic resonance imaging (MRI) diagnosis of extracapsular extension (ECE) for decision-making about neurovascular bundle (NVB) preservation in robot-assisted radical prostatectomy (RARP) for prostate cancer (PC).
MATERIALS AND METHODS
We prospectively collected data on PC patients (n=67) who underwent preoperative 3-T MRI before RARP. The choice between nerve sparing or resection was based on 3-T MRI findings of ECE. We compared the MRI findings with the pathological data on surgical margins. Our clinical staging in this study was defined only by MRI.
RESULTS
When the data were divided by prostate lobe (right lobe or left lobe, n=134), 3-T MRI showed 28 positive cases of ECE in 134 prostate lobes, allowing NVB preservation in 42 cases (31.3%). Nerve-sparing surgery was achieved in 38.7% of cases in which clinical T2 staging by MRI was reported. The pathological data revealed that 10 of 134 prostate lobes had positive ECE. The overall sensitivity, specificity, positive predictive value, and negative predictive value for predicting stage T3 (positive ECE) by side were 60.0% (12 of 20 sides), 86.0% (98 of 114 sides), 42.9% (12 of 28 sides), and 92.5% (98 of 106 sides), respectively.
CONCLUSIONS
Three-T MRI prior to RARP enables the use of ECE diagnosis to guide decision-making about NVB preservation, with comparatively high specificity and negative predictive value. Further prospective studies are underway to reach more definitive conclusions.

Keyword

Diagnoses; Magnetic resonance imaging; Prostatectomy; Robotics

MeSH Terms

Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Prospective Studies
Prostate
Prostatectomy
Prostatic Neoplasms
Robotics
Sensitivity and Specificity

Figure

• 

  FIG. 1 Representative cases with positive (prostate cancer-positive part is shown by an arrow) (A) and negative (B) extracapsular extension magnetic resonance imaging findings are shown.

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