BERKELEY, CA (UroToday.com) - The pathology report of radical prostatectomy specimens plays an important role in clinical decisions and the prognostic evaluation in prostate cancer (PCa).
The anatomical schema is a helpful tool to document PCa extension for clinical and research purposes. To achieve electronic documentation and analysis, an appropriate documentation model for anatomical schemas is needed. For this purpose we developed an open source document architecture called clinical map document based on XML "cMDX."
The document architecture of cMDX was designed according to Open Packaging Conventions by separating the whole data into template data and patient data. Analogue custom XML elements were considered to harmonize the graphical representation (e.g. tumor extension, PIN 3° and positive surgical margins) with the textual data (e.g. histological patterns). The graphical documentation was based on the four-layer visualization model that forms the interaction between different custom XML elements. Sensitive personal data were encrypted with a 256-bit cryptographic algorithm to avoid misuse. Standard documents like HL7 CDA can also be integrated into cMDX.
These specifications of cMDX facilitate the generation of pathology reports that can represent pathological findings of the prostate in schematic styles. Such reports can be integrated into the hospital information system because “cMDX” documents can be converted into different data formats like text, graphics and PDF supported by the Hospital information system. Supplementary tools like cMDX Editor and an analyzer tool were successfully implemented and have been applied in our department since 2009. Up to now, over 1200 cMDX reports have been generated for different purposes.
cMDX Editor assists the user by generating cMDX reports with help of functions and tools. We intend to develop cMDX Editor in two versions (commercial & non-commercial) and make them available in summer 2011. In Addition, the analysis tool can analyze PCa foci and detect multifocal PCa with 90.3% sensitivity. Results including mapping, tumor volume, multifocality and incidence of PCa in each slice can be exported as CSV files supported by diverse statistical software. In order to assess the clinical value and data consistency, we retrospectively analyzed the tumor extension in 255 patients after radical prostatectomy. The graphical analysis of 255 prostatectomy specimens showed that PCa was mostly localized in the peripheral zone (Mean: 73% ± 25). 54% of PCa showed a multifocal growth pattern. These findings confirm the results of resent studies. Another important finding is that eye judgment underestimates the tumor volume in comparison to the computational estimation of tumor volume (p < 0.0001). The computerized estimation of tumor volume showed that the mean tumor volume was 17 ± 16.4 cm3. In comparison, the mean tumor volume estimated by eyeball judgment was 10 ± 10.3 cm3.
cMDX can be applied to store clinical data in schematic styles for reporting and analyzing pathological parameters in radical prostatectomy specimens. cMDX provides a single source concept that facilitates to evaluate routine data for scientific purposes.
NOTE: Figures about the data model, the supplementary tools and the cumulative diagram of PCa foci are available in the article “Eminaga et al. BMC Medical Informatics and Decision Making 2010, 10:71”
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