SAR Prostate DFP – Teaching Case of the Week 5/21/18 QUALITY … · 2019-04-02 · Rajan T....

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QUALITY IMPROVEMENT: IS THE BIOPSY PATHOLOGY REFLECTIVE OF DISEASE GRADE? Rajan T. Gupta, M.D. Sitharthan Sekar, B.S. SAR Prostate DFP – Teaching Case of the Week 5/21/18

Transcript of SAR Prostate DFP – Teaching Case of the Week 5/21/18 QUALITY … · 2019-04-02 · Rajan T....

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,

QUALITYIMPROVEMENT:ISTHEBIOPSYPATHOLOGY

REFLECTIVEOFDISEASEGRADE?

RajanT.Gupta,M.D.

SitharthanSekar,B.S.

SARProstateDFP–TeachingCaseoftheWeek5/21/18

Page 2: 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,

�  56yearoldM�  PSA-4.4ng/mL�  PSADensity-0.20ng/mL2

�  NegaJvepriorTRUS-guidedbiopsy�  PresentstoDukeformpMRIand

evaluaJonofpossibleprostatecancer

History

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

Page 3: 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,

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,

�  AxialT2W-lesioninrightanteriorPZatlevelofthemid-gland/apex�  Lesionmeasured1.6cminmaximalaxialdimension

�  CorrespondingareaofmarkedrestricJondiffusiononADCandb1400images

MRIInterpretaJon

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

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�  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,

�  TargetedMRI-USfusionbiopsyàG3+3=6PCa�  MulJdisciplinaryteammettoreviewresults�  Lowgradetumorfelttobediscordantwith

imagingfindings�  PaJentunderwentradicalprostatectomydue

tohighsuspicionofclinicallysignificantcanceranddiscordancewithfusionbiopsy�  FinalsurgicalpathologyrevealedG3+4=7PCa

FollowUp

CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter

Page 7: 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,

�  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,

THANKYOU

RajanT.Gupta,M.D.AssociateProfessorofRadiology

AssistantProfessorofSurgeryDirector,AbdominalImagingFellowshipProgram

DukeUniversityMedicalCenter&[email protected]

@RajanTGuptaMD

SARProstateDFP–TeachingCaseoftheWeek5/21/18


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