– XXIII CONGRESSO

costante guida ecografica. La procedura ha previsto lo studio accurato dei parametri emocoagulativi, la somministrazione preventiva di desmopressina e l’anestesia locale. Sono stati effettuati 1-3 affondamenti al polo inferiore del rene sinistro per il prelievo di una quantità congrua di tessuto renale con ago semiautomatico 15 o 17 G, in anestesia locale. I campioni sono stati conservati e inviati presso il Laboratorio di Istopatologia Renale del Policlinico di Bari per lo studio in microscopia ottica, immunofluorescenza e microscopia elettronica ove indicato. Il tempo di osservazione del paziente dopo biopsia renale è stato di almeno 24 ore.

Risultati. Nel periodo considerato sono state effettuate 100 BRP, con una media annuale di 20 procedure. Si sono registrate 23 complicanze, delle quali 1 maggiore e 22 minore (Tabella 1). Nel complesso, il tasso di complicanze era del 23%, di cui 95% minori e il 5% maggiori. Le diagnosi ottenute sono indicate in Tabella 2, Figura 1.

L’unica complicanza maggiore è stata un’emorragia incoercibile che ha richiesto multiple trasfusioni di emocomponenti e una procedura in urgenza di radiologia interventistica. Non sono stati osservati decessi o nefrectomie dopo BRP.

Fra le complicanze minori, si sono verificati 15 casi di ematomi subcapsulari (15%), 2 fistole artero-venose di piccole dimensioni e a risoluzione spontanea e 5 episodi di macroematuria in altrettanti pazienti (15%). Osservazione e riposo per le 24-36 ore seguenti hanno permesso la remissione del quadro.

Conclusioni. La nostra casistica di complicanze è in linea con le serie europee e americane, che hanno descritto complicanze minori nel 10-20% e maggiori nell’1,2–6,6% dei pazienti. La continua guida ecografica e l’esperienza degli operatori, ottenuta centralizzando le BRP in una struttura con disponibilità immediata di procedure interventistiche, ha consentito di ridurre drasticamente il tasso di complicanze, in particolare di quelle maggiori. La BRP si conferma procedura efficace e sicura, anche sotto il profilo medico-legale, quando effettuata secondo precisa indicazione clinica e dopo attenta valutazione del rapporto rischi/benefici.

Letture consigliate.

- Kisrani A, KasiskeB. Laboratory assessment of kidney disease: clearance, urinalysis and kidneybiopsy In The Kidney, Brenner and Rector Editors, Saunders Company Philadelphia. 2008; (1)23:747-756.

- Whitter W, Korbes S. Indications and complications of renal biopsy UpToDate 2022 www. UpToDate.com

- Fuiano G, Mazza G, Comi N, et al. Current indications for renal biopsy: a questionnaire-based survey Am J Kidney Dis. 2000; 35: 448-457.

ASSESSING THE ROLE OF HIGHRESOLUTION MICRO-ULTRASOUND AMONG NAÏVE PATIENTS WITH A NEGATIVE MULTIPARAMETRIC MRI AND PERSISTENT SUSPICION OF PROSTATE CANCER

Avolio PP1,2, Lughezzani G1,2, Fasulo V1,2, Sanchez-Salas R3, Maffei D1,2, Paciotti M1,2, Saitta C1,2, De Carne F1,2, Saita A2, Hurle R2, Lazzeri M2, Guazzoni G1,2, Buffi NM1,2, Casale P2.

1 Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy;

2 Department of Urology, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy;

3 Department of Surgery, Division of Urology. McGill University. Montréal, Canada.

Background. Multiparametric magnetic resonance imaging (mpMRI) is an invaluable diagnostic tool in prostate biopsies (PBx) decision making. However, a non-negligible proportion of patients with a negative MRI (nMRI) may still harbour prostate cancer (PCa).

Objective. To assess whether micro-UltraSound (microUS) can help in sub-stratifying the presence of PCa and clinically significant PCa (i.e., any Gleason score ≥7 PCa; csPCa) in those patients with a nMRI despite a persistent clinical suspicion of PCa.

Design, Setting, and Participants. A total of 125 biop- sy-naïve patients who underwent microUS-guided prostate biopsy (PBx) with ExactVu system, for persistent suspicion of PCa despite nMRI were prospectively enrolled.

Intervention. The Prostate Risk Identification using microUS (PRI-MUS) protocol was used to identify suspicious areas; PBx included targeted sampling of PRI-MUS≥3 areas and systematic sampling.

Outcome Measurements and Statistical Analysis. The primary endpoint was the assessment of microUS diagnostic accuracy in detecting csPCa. Secondary endpoints included determining: the proportion of patients with nMRI who may avoid PBx after microUS TRUS; presence of cribriform pattern on biopsy core examination; predictors of csPCa in patients presenting with nMRI; and comparing microUS-targeted and systematic PBx in identifying csPCa.

Results and Limitations. Considering csPCa detection rate, microUS showed optimal sensitivity and negative predictive value (respectively 97.1% and 96.4%), while specificity and positive predictive value were 29.7 % and 34.0%, respectively. 28 (22.4%) patients with negative microUS examination could have avoided PBx with 1 (2.9%) missed csPCa. Cribriform pattern was found in 14 (41.2%) of csPCa patients.In multivariable logistic regression models (MLRMs), positive microUS, age, digital rectal examination, and PSA density ≥0.15 emerged as independent predictors of PCa. Targeted and systematic sampling identified 33 (97.1%) and 26 (76.5%) csPCa, respectively. The main limitation of the current study is represented by its retrospective single-center nature on an operatordependent technology.

Conclusions. MicroUS represent a valuable tool to rule out the presence of csPCa among subjects with persistent clinical suspicion despite a nMRI.

DIAGNOSTIC PERFORMANCE OF MICRO-ULTRASOUND AT MRIGUIDED RECLASSIFICATION

BIOPSY IN PATIENTS UNDER ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER

Maffei D1,2, Fasulo V1,2, Avolio PP1,2, Saitta C1,2, Paciotti M1,2, De Carne F1,2, Colombo P1,3, Pasini L2, De Zorzi SZ2, Saita A2, Hurle R2, Lazzeri M2, Guazzoni GF1,2, Casale P2, Buffi NM1,2, Lughezzani G1,2

1 Department of Biomedical Sciences, Humanitas University, Milan - Italy;

2 IRCCS Humanitas Research Hospital, Department of Urology, Rozzano (Mi) - Italy;

3 IRCCS Humanitas Research Hospital, Department of Pathology, Rozzano (Mi) – Italy.

Background. Active surveillance (AS) represents the standard of care of low-risk prostate cancer (PCa). However, identification and monitoring of AS candidates remains challenging.

Micro-ultrasound (microUS) is a novel high-resolution imaging modality for transrectal ultrasonography (TRUS). We explored the impact of microUS TRUS and targeted biopsies in mpMRI-guided reclassification biopsies. Methods. Between October 2017 and September 2021