EURURO Vol. 72 No. 2

E37 320

Letter to the Editor
Re: Kenneth [2_TD$DIFF]A. Iczkowski’s Letter to the Editor re: Re:
Rodolfo Montironi, Silvia Gasparrini, Roberta
Mazzucchelli, et al’s Letter to the Editor re: Karim A.
Touijer, James A. Eastham. The Sentinel Lymph Node
Concept and Novel Approaches in Detecting Lymph
Node Metastasis in Prostate Cancer. Eur Urol
2016;70:738–9: Sentinel Lymph Nodes in Adipose Tissue
Surrounding the Prostate Gland and Seminal Vesicles as
Observed in Virtual Whole-mount Histologic Slides. Eur
Urol 2017;71:e73–5
Potential for Further Robotics Steps and for Information
Fusion in Prostate Cancer?
We read with interest Dr. Iczkowski’s letter and agree
with him that the frequency of lymph nodes found in
periprostatic fat ‘‘depends highly on the technique of the
surgeon(s) for the population being studied. The percentage
of prostatectomy tissue submitted probably also influences
the frequency’’.
Dr. Iczkowski’s contribution refers to a recent letter from
our group commenting on the PlatinumPriority Editorial
by Drs. Touijer and Eastham . Our letter was based on
observations made on a large series of radical prostatec-
tomy (RP) specimens examined with a complete sampling
procedure utilizing the whole-mount technique at Ancona
United Hospitals. In addition, selected slides of particular
morphological and clinical interest are processed with a
slide scanner to share digitized images of microscopy slides
(virtual slides) for discussion among ourselves and with
other colleagues. Our letter included an example of an
image of a whole-mount section of an RP specimen with a
periprostatic lymph node showing a metastatic deposit
immunostained for PSMA. A high-resolution version of this
slide for use with the Virtual Microscope is available .
Dr. Iczkowski’s letter gives us the opportunity to make
the following comments:
(1) The importance of the surgical technique adopted by
the urologists in relation to the possibility of findings
periprostatic lymph nodes was mentioned in our recent
letter and is in agreement with the observation made by
Dr. Iczkowski. Our cases of lymph nodes in periprostatic
locations were patients who had undergone a non–
nerve-sparing procedure . This means that when a
urologist opts for a nerve-sparing procedure, he/she can
discover and even treat intraoperatively lymph nodes in
the periprostatic soft tissue. This could be done, for
instance, with prostate-specific membrane antigen
(PSMA)-targeted radiotracers and therapeutic agents.
Considering the current fast pace in further develop-
ment of robot-assisted surgery, all this could lead to the
development of robot-assisted image-guided devices
with implementation of sensor or data fusion
approaches.
(2) The importance of discussing histological findings
among ourselves and with other colleagues was
highlighted by some of our group in an Editorial in
European Urology . The paramount importance of
joint evaluation of histological findings helps the
uropathologist and urologist to collect a wealth of
clinically useful information and accurately interpret
preoperative, intraoperative, and postoperative fea-
tures (see below).
(3) The importance of adopting digital technology for
microscopy slides in relation to the presence of, for
instance, lymph nodes in a periprostatic location, was
dealt with by some of our group in a contribution to
European Urology Focus Major advantages associat-
ed with digitalization of glass slides are consultation
and remote interpretation, including image analysis
, and direct integration with data derived, for
instance, from surgery and other imaging techniques
such as multiparametric magnetic resonance imaging
).
Starting from Dr. Iczkowski’s letter and according to our
comments, we can conclude that the process of merging
knowledge and multiple data derived from disparate
sources is what is known as information fusion and
ava ilable at
journal homepage:
DOIs of original articles: , ,
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0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.