GIULIANO BETONI GUGLIELMETTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
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- Value of 3-Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance(2017) PESSOA, Rodrigo R.; VIANA, Publio C.; MATTEDI, Romulo L.; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio D.; COELHO, Rafael F.; NAHAS, William C.; SROUGI, MiguelObjective To evaluate the role of multiparametric magnetic resonance imaging (mpMRI) of the prostate and transrectal ultrasonography guided biopsy (TRUS-Bx) with visual estimation in early risk stratification of patients with prostate cancer on active surveillance (AS). Patients and Methods Patients with low-risk, low-grade, localised prostate cancer were prospectively enrolled and submitted to a 3-T 16-channel cardiac surface coil mpMRI of the prostate and confirmatory biopsy (CBx), which included a standard biopsy (SBx) and visual estimation-guided TRUS-Bx. Cancersuspicious regions were defined using Prostate Imaging Reporting and Data System (PI-RADS) scores. Reclassification occurred if CBx confirmed the presence of a Gleason score >= 7, greater than three positive fragments, or >= 50% involvement of any core. The performance of mpMRI for the prediction of CBx results was assessed. Univariate and multivariate logistic regressions were performed to study relationships between age, prostate-specific antigen (PSA) level, PSA density (PSAD), number of positive cores in the initial biopsy, and mpMRI grade on CBx reclassification. Our report is consistent with the Standards of Reporting for MRItargeted Biopsy Studies (START) guidelines. Results In all, 105 patients were available for analysis in the study. From this cohort, 42 (40%) had PI-RADS 1, 2, or 3 lesions and 63 (60%) had only grade 4 or 5 lesions. Overall, 87 patients underwent visual estimation TRUS-Bx. Reclassification among patients with PI-RADS 1, 2, 3, 4, and 5 was 0%, 23.1%, 9.1%, 74.5%, and 100%, respectively. Overall, mpMRI sensitivity, specificity, positive predictive value, and negative predictive value for disease reclassification were 92.5%, 76%, 81%, and 90.5%, respectively. In the multivariate analysis, only PSAD and mpMRI remained significant for reclassification (P < 0.05). In the crosstabulation, SBx would have missed 15 significant cases detected by targeted biopsy, but SBx did detect five cases of significant cancer not detected by targeted biopsy alone. Conclusion Multiparametric magnetic resonance imaging is a significant tool for predicting cancer severity reclassification on CBx among AS candidates. The reclassification rate on CBx is particularly high in the group of patients who have PI-RADS grades 4 or 5 lesions. Despite the usefulness of visual-guided biopsy, it still remains highly recommended to retrieve standard fragments during CBx in order to avoid missing significant tumours.
bookPart Disfunção erétil(2017) GUGLIELMETTI, Giuliano Betoni; CURY, José; CORDEIRO, Mauricio Dener- Extended versus limited pelvic lymphadenectomy during radical prostatectomy for intermediate- and high-risk prostate cancer: Early outcomes from a randomized controlled phase III study.(2017) LESTINGI, Jean Felipe Prodocimo; GUGLIELMETTI, Giuliano; PONTES JR., Jose; MITRE, Anuar Ibrahim; SARKIS, Alvaro; BASTOS, Diogo Assed; RIECHELMANN, Rachel; MATTEDI, Romulo Loss; CORDEIRO, Mauricio; COELHO, Rafael; SROUGI, Miguel; NAHAS, William Carlos
- The accuracy of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS v2 in disease upgrading on re-biopsy among patients with low-risk prostate cancer (PCa) on active surveillance (AS): A Brazilian perspective.(2017) VIANA, Pablio C. C.; HORVAT, Natally; GUGLIELMETTI, Giuliano; COELHO, Rafael; NAHAS, William Carlos; PARK, Rubens; BEZERRA, Regis; BASTOS, Diogo Assed; RODRIGUES, Thiana; VARGAS, Hebert Alberto
conferenceObject CONVENTIONAL LAPAROSCOPIC RADICAL NEPHRECTOMY WITH INFERIOR VENA CAVA THROMBECTOMY(2017) GUGLIELMETTI, Giuliano; NONEMACHER, Henrique; ALBUQUERQUE, George Lins de; COELHO, Rafael; CORDEIRO, Mauricio; NAHAS, Willian- Robot - assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor(2017) TORRICELLI, Fabio C. M.; JARDIM, Denis; GUGLIELMETTI, Giuliano B.; PATEL, Vipul; COELHO, Rafael F.
- Oncological outcomes of positive surgical margins in partial nephrectomy for renal cell carcinoma.(2017) NONEMACHER, Henrique T. S.; CORDEIRO, Mauricio; ALBUQUERQUE, George Lins De; GALUCCI, Fabio; CARVALHO, Paulo Afonso de; BORGES, Leonardo; GUGLIELMETTI, Giuliano Betuni; BASTOS, Diogo Assed; COELHO, Rafael; SARKIS, Alvaro; DZIK, Carlos; NAHAS, William Carlos
conferenceObject THE ACCURACY AND VALIDATION OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING (MPMRI) USING PI-RADS V2 IN DISEASE UPGRADING ON RE-BIOPSY AMONG PATIENTS WITH LOW-RISK PROSTATE CANCER ON ACTIVE SURVEILLANCE (AS) - A BRAZILIAN PERSPECTIVE.(2017) VIANA, Publio; HORVAT, Natally; PESSOA, Rodrigo; RODRIGUES, Thiana; GUGLIELMETTI, Giuliano; COELHO, Rafael; PARK, Rubens; VARGAS, Herbert Alberto; NAHAS, WillianconferenceObject NEPHROMETRY SCORES ARE USELESS FOR EXPERIENCED UROLOGISTS IN CLINICAL PRACTICE(2017) NONEMACHER, Henrique; GUGLIELMETTI, Giuliano; ALBUQUERQUE, George Lins de; COELHO, Rafael; CORDEIRO, Mauricio; FAZOLI, Arnaldo; CARVALHO, Paulo Afonso; FREIRE, Tiago Magalhaes; HAYEK, Kayann Kaled R. el; PAGOTTO, Vitor; ALBUQUERQUE, George Lins de; ROCHA, Bruno Aragao; RODRIGUES, Diego Parga; KANAS, Alexandre Fligelman; VIANA, Publio Cesar Cavalcanti; NAHAS, Willian- Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing(2017) ALBUQUERQUE, George Augusto Monteiro Lins de; GUGLIELMETTI, Giuliano Betoni; CORDEIRO, Mauricio Dener; NAHAS, William Carlos; COELHO, Rafael FerreiraIntroduction: Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods: A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results: The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion: This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.