title: Analysis of topographical distribution of prostate cancer and related pathological findings in prostatectomy specimens using cMDX document architecture.
abstract: BACKGROUND
  Understanding the topographical distribution of prostate cancer (PCa) foci is necessary to optimize the biopsy strategy. This study was done to develop a technical approach that facilitates the analysis of the topographical distribution of PCa foci and related pathological findings (i.e., Gleason score and foci dimensions) in prostatectomy specimens.
  
  
  METHODS
  The topographical distribution of PCa foci and related pathologic evaluations were documented using the cMDX documentation system. The project was performed in three steps. First, we analyzed the document architecture of cMDX, including textual and graphical information. Second, we developed a data model supporting the topographic analysis of PCa foci and related pathologic parameters. Finally, we retrospectively evaluated the analysis model in 168 consecutive prostatectomy specimens of men diagnosed with PCa who underwent total prostate removal. The distribution of PCa foci were analyzed and visualized in a heat map. The color depth of the heat map was reduced to 6 colors representing the PCa foci frequencies, using an image posterization effect. We randomly defined 9 regions in which the frequency of PCa foci and related pathologic findings were estimated.
  
  
  RESULTS
  Evaluation of the spatial distribution of tumor foci according to Gleason score was enabled by using a filter function for the score, as defined by the user. PCa foci with Gleason score (Gls) 6 were identified in 67.3% of the patients, of which 55 (48.2%) also had PCa foci with Gls between 7 and 10. Of 1173 PCa foci, 557 had Gls 6, whereas 616 PCa foci had Gls>6. PCa foci with Gls 6 were mostly concentrated in the posterior part of the peripheral zone of the prostate, whereas PCa foci with Gls>6 extended toward the basal and anterior parts of the prostate. The mean size of PCa foci with Gls 6 was significantly lower than that of PCa with Gls>6 (P<0.0001).
  
  
  CONCLUSIONS
  The cMDX-based technical approach facilitates analysis of the topographical distribution of PCa foci and related pathologic findings in prostatectomy specimens.
authors.affiliation: Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany. Electronic address: okyaz.eminaga@uk-koeln.de.
authors.forename: Okyaz
authors.initials: O
authors.lastname: Eminaga
authors.affiliation: Prostate Center, Dept. of Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149 Muenster, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Semjonow
authors.affiliation: Institute for Pathology Saarbrücken-Rastpfuhl, Rheinstrasse 2, D-66113 Saarbrücken, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Eltze
authors.affiliation: Institute of Pathology and Cytology, Technikerstrasse 14, D-48465 Schüttorf, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Bettendorf
authors.affiliation: Institute for Pathology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Schultheis
authors.affiliation: Department for Visceral Surgery, University Hospital Cologne, Kerpener Straße 62, D-50937 Cologne, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Warnecke-Eberz
authors.affiliation: Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany.
authors.forename: Ilgar
authors.initials: I
authors.lastname: Akbarov
authors.affiliation: Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wille
authors.affiliation: Dept. of Urology, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Engelmann
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Biopsy; CMDX; Diagnostic tools; Prostate cancer; Spatial distribution; Zonal anatomy