sar prostate dfp – teaching case of the week 5/21/18 quality … · 2019-04-02 · rajan t....
TRANSCRIPT
![Page 1: SAR Prostate DFP – Teaching Case of the Week 5/21/18 QUALITY … · 2019-04-02 · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director,](https://reader033.vdocumenti.com/reader033/viewer/2022042403/5f177fbf4c1d8732e841e68e/html5/thumbnails/1.jpg)
QUALITYIMPROVEMENT:ISTHEBIOPSYPATHOLOGY
REFLECTIVEOFDISEASEGRADE?
RajanT.Gupta,M.D.
SitharthanSekar,B.S.
SARProstateDFP–TeachingCaseoftheWeek5/21/18
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� 56yearoldM� PSA-4.4ng/mL� PSADensity-0.20ng/mL2
� NegaJvepriorTRUS-guidedbiopsy� PresentstoDukeformpMRIand
evaluaJonofpossibleprostatecancer
History
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
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T2W ADC
b1400 CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
![Page 4: SAR Prostate DFP – Teaching Case of the Week 5/21/18 QUALITY … · 2019-04-02 · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director,](https://reader033.vdocumenti.com/reader033/viewer/2022042403/5f177fbf4c1d8732e841e68e/html5/thumbnails/4.jpg)
� AxialT2W-lesioninrightanteriorPZatlevelofthemid-gland/apex� Lesionmeasured1.6cminmaximalaxialdimension
� CorrespondingareaofmarkedrestricJondiffusiononADCandb1400images
MRIInterpretaJon
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
![Page 5: SAR Prostate DFP – Teaching Case of the Week 5/21/18 QUALITY … · 2019-04-02 · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director,](https://reader033.vdocumenti.com/reader033/viewer/2022042403/5f177fbf4c1d8732e841e68e/html5/thumbnails/5.jpg)
� OverallPI-RADSCategory5� Thelesionwasupgradedfroma4to5,duetoitssizegreaterthan1.5cm.
MRIInterpretaJon
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
![Page 6: SAR Prostate DFP – Teaching Case of the Week 5/21/18 QUALITY … · 2019-04-02 · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director,](https://reader033.vdocumenti.com/reader033/viewer/2022042403/5f177fbf4c1d8732e841e68e/html5/thumbnails/6.jpg)
� TargetedMRI-USfusionbiopsyàG3+3=6PCa� MulJdisciplinaryteammettoreviewresults� Lowgradetumorfelttobediscordantwith
imagingfindings� PaJentunderwentradicalprostatectomydue
tohighsuspicionofclinicallysignificantcanceranddiscordancewithfusionbiopsy� FinalsurgicalpathologyrevealedG3+4=7PCa
FollowUp
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
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� PI-RADS5lesionshaveveryhighlikelihoodofclinicallysignificantcancer
� Discordantbiopsyresultsrequirefollowup� Inthiscase,mulJdisciplinaryteamshould
(Radiology,Urology,andPathology)reviewpathologyanddetermineconcordance/discordanceandnextstepsinmanagement
TeachingPoints
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
![Page 8: SAR Prostate DFP – Teaching Case of the Week 5/21/18 QUALITY … · 2019-04-02 · Rajan T. Gupta, M.D. Associate Professor of Radiology Assistant Professor of Surgery Director,](https://reader033.vdocumenti.com/reader033/viewer/2022042403/5f177fbf4c1d8732e841e68e/html5/thumbnails/8.jpg)
THANKYOU
RajanT.Gupta,M.D.AssociateProfessorofRadiology
AssistantProfessorofSurgeryDirector,AbdominalImagingFellowshipProgram
DukeUniversityMedicalCenter&[email protected]
@RajanTGuptaMD
SARProstateDFP–TeachingCaseoftheWeek5/21/18