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#AUA15 - 3D printed physical models of renal malignancies for operative ... - UroToday |
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NEW ORLEANS, LA USA (UroToday.com) - Given the significance of training tools for physician education, the authors created three-dimensionally printed physical kidney models of renal malignancies. These models may aid trainees as well as patients by serving as a visual tool as well as for surgical simulation prior to a patient operation. Previous studies have demonstrated the use of three-dimensional printing technologies for developing anatomically correct models to be used as an education tool for training and skills acquisition.
 The authors constructed high-fidelity physical 3D models of renal units with enhancing renal lesions using various 3D-printing techniques. Although each 3D-printing technique differed, all techniques used a similar process where successful layers of a material are cured, one atop another, until a final model was created.
The first technique used was colorjet printing. This process uses a core layer of plaster like powder to form a rigid, opaque model. The second technique used stereolithograph. This technique uses a liquid polymer that is cured by a UV laser to create a semi-translucent, rigid model. The last two techniques involved multijet printing. In this process various photopolymers are jetted through a print head in small droplets. This technique was also used to create a mold that could be used to make a kidney model using agarose gel.
The authors conclude that “pre-operative physical 3-D models using readily available printing techniques can be constructed and may potentially influence both the patients’ and trainees’ understanding of renal malignancies.” Further studies must be done to validate these models as a training tool and to determine whether they may improve patient outcomes.
Presented by Jonathan Silberstein at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Tulane University, New Orleans, LA USA
Reported by Renai Yoon (University of California-Irvine), medical writer for UroToday.com
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#AUA15 - The current and emerging role of renal biopsy for the renal mass ... - UroToday |
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NEW ORLEANS, LA USA (UroToday.com) - Percutaneous renal biopsy (PRB) under real-time ultrasound guidance is a routine procedure performed to diagnose renal mass histopathology. The indications for PRB have expanded, as there has been a substantial increase in the number of small renal masses (SRM) that are being diagnosed, and the acceptance of pre-treatment biopsy for SRM continues to expand. Additionally, imaging technologies continue to improve with higher quality ultrasound devices routinely being introduced into clinical practice.
Due to the percent of incidental renal tumors and localized tumors increasing, management of small renal masses (SRM) (renal cortical tumors ? 4 cm) is a frequent clinical problem. By traditional treatment strategies, which were designed to treat larger renal masses, all SRMs were managed as if they were malignant. Typically, management included ablative, open radical, or extirpative surgery. With technological advancement, urologists have several treatment modalities now available for management of SRMs, ranging from active surveillance to ablative techniques.
Dr. Landman emphasized that according to the AUA guidelines, 24% of histopathological staging of removed tumors are indicated as benign, thus indicating that the surgery was unnecessary.
Biopsy can be performed with sedation, but it can be successfully performed under local anesthesia. Dr. Landman’s technique has been described in the recent articles published in British Journal of Urology. Generally, access is obtained under the 12th rib and a spinal needle is used to anesthetize the tract. He recommends to work with the patient. Since the patient is awake, you have him breath normally up until you’re ready to do the biopsy, then request to have him hold his breath. In his series of 62 biopsied patients, there was a 19% benign tumor rate from partials, and cryoablation was reduced to a staggering 1.6%, meaning 12 patients avoided surgery.
He demonstrated a new ultrasound probe that has been developed by Hitachi-Aloka, and was tested in his lab, using a gel model with an olive inserted. Retrieving a green-red-green pattern, from the olive and a pimento center, indicated a successful biopsy.
Dr. Landman concluded that while surgical excision is preferred and the superior treatment option for aggressive RCC subtypes, some histopathological subtypes are successfully managed with alternative treatment options. Knowledge of tumor histopathology on preoperative evaluation allows for a more selective treatment approach, avoiding unnecessary surgery, and minimizing the need for aggressive surgical procedures. These factors have stimulated surgeons to look for preoperative factors and techniques to evaluate tumor histopathology. In terms of cost, although no surgical approach was taken, there is a significant level of savings,
Presented by Jaime Landman at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of California, Irvine, CA USA
Reported by Victor Huynh (University of California-Irvine), medical writer for UroToday.com
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Socioeconomic Predictors of Clear-Cell Renal Cell Carcinoma Identified - Cancer Therapy Advisor |
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May 16, 2015
Older age, unmarried status, or white race are independent risk factors for metastatic clear-cell renal cell carcinoma at time of diagnosis.
NEW ORLEANS—Older age, unmarried status, or white race are independent risk factors for metastatic clear-cell renal cell carcinoma (ccRCC) at the time of diagnosis, researchers revealed at the 2015 American Urological Association meeting in New Orleans.
For the study, the team led by Zachary Klaassen, MD, of the Medical College of Georgia-Georgia Regents University in Augusta, analyzed data for more than 63,589 ccRCC patients from the Surveillance, Epidemiology, and End Results (SEER) database 2004–2010. Metastatic disease was present at diagnosis in 9,623 patients (15%).
The researchers examined the effect of age, gender, race, marital status, health insurance status, and county wealth (i.e., median income, percentage of residents living in poverty, percentage unemployed, and percentage with less than a 9th-grade education).
Patients with metastatic cancer at diagnosis were more frequently older (age 65 vs. 63), male, and single, divorced, or widowed. They were also more likely to lack health insurance and to live in a neighborhood with more residents who were poorly educated and living in poverty.
These results coincide with research findings for other cancers, including non-urological malignancies and urothelial carcinoma of the bladder.
RELATED: 16-Gene Assay Validated As Outcome Predictor in Clear Cell Renal Cell Carcinoma
As advanced ccRCC is associated with poor prognosis, “there needs to be a heightened level of suspicion on the part of clinicians when suspecting metastasis in certain high risk patients,” Dr. Klaassen told Cancer Therapy Advisor.
“Clinicians should be aware of the correlation between these risk factors and presentation of advanced disease at diagnosis, highlighting potential health care disparities and providing an opportunity to involve social services and other support mechanisms in an effort to improve early care.”
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Socioeconomic Predictors of Metastatic Clear-Cell RCC Identified - Renal and Urology News |
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May 16, 2015
It is important to assess factors that may put patients at higher risk of metastatic disease, according to researchers.
NEW ORLEANS—Older age, unmarried status, or white race are independent risk factors for metastatic clear-cell renal cell carcinoma(ccRCC) at the time of diagnosis, researchers revealed at the 2015 American Urological Association meeting in New Orleans.
For the study, the team led by Zachary Klaassen, MD, of the Medical College of Georgia-Georgia Regents University in Augusta, analyzed data for more than 63,589 ccRCC patients from the Surveillance, Epidemiology, and End Results (SEER) database 2004–2010. Metastatic disease was present at diagnosis in 9,623 patients (15%).
The researchers examined the effect of age, gender, race, marital status, health insurance status, and county wealth (i.e., median income, percentage of residents living in poverty, percentage unemployed, and percentage with less than a 9th-grade education).
Patients with metastatic cancer at diagnosis were more frequently older (age 65 vs. 63), male, and single, divorced, or widowed. They were also more likely to lack health insurance and to live in a neighborhood with more residents who were poorly educated and living in poverty.
These results coincide with research findings for other cancers, including non-urological malignancies and urothelial carcinoma of the bladder.
As advanced ccRCC is associated with poor prognosis, “there needs to be a heightened level of suspicion on the part of clinicians when suspecting metastasis in certain high risk patients,” Dr. Klaassen told Renal & Urology News. “Clinicians should be aware of the correlation between these risk factors and presentation of advanced disease at diagnosis, highlighting potential health care disparities and providing an opportunity to involve social services and other support mechanisms in an effort to improve early care.”
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