Gregori A, Vieweg J, Dahm P, Paulson D F
Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, N.C., USA.
Urol Int. 2001;66(2):66-71. doi: 10.1159/000056573.
To critically evaluate the accuracy of sextant biopsies in predicting Gleason score and the site of tumor location in patients with clinically localized prostate cancer treated by radical perineal prostatectomy.
The case records of 289 patients with clinically localized prostate cancer who underwent radical perineal prostatectomy were reviewed, comparing the Gleason score and tumor site location as determined by sextant ultrasound-guided core biopsies with the Gleason score and tumor distribution within the surgical specimens. The prostatectomy specimens were further characterized by extent of disease as organ-confined, specimen-confined or margin-positive.
The Gleason score was identical in 126 (43.5%) patients. An upgrading in the surgical specimen occurred in 118 (40.8%) cases, a downgrading in 43 (14.8%). Overall, 193 (66.7%) patients had a unilateral positive biopsy, while 96 (33.2%) patients had bilateral positive biopsies. Sixty-four (33.1%) patients with a unilateral positive biopsy had cancer confined to one side of the gland, while 127 (65.8%) showed bilateral disease; 142 (73.5%) patients had organ-confined tumors versus 51 (26.4%) patients with capsular penetration. In the 96 patients with bilateral positive biopsies, 64 (66.6%) patients had intracapsular cancer versus 32 (33.3%) patients with either specimen-confined or margin-positive disease. The overall rate of positive margins was 14%. Fifty-one (61.4%) of the 83 patients with non-organ-confined disease had posterolateral capsular penetration in the region of the superior pedicle of the neurovascular bundle, while 28 (33.7%) patients had apical capsular penetration, in the region of the inferior neurovascular pedicle.
The ability of sextant ultrasound-guided biopsies to estimate the pathological grading is satisfactory: when we consider a difference of +/- 1 in the final Gleason score, the overall correlation is 80%. In 66% of the cases, sextant biopsies predicted unilateral disease when bilateral disease existed. A unilateral positive biopsy does not predict unilateral disease.
严格评估六分区活检在预测接受根治性会阴前列腺切除术的临床局限性前列腺癌患者的Gleason评分及肿瘤位置方面的准确性。
回顾了289例接受根治性会阴前列腺切除术的临床局限性前列腺癌患者的病例记录，比较六分区超声引导下穿刺活检确定的Gleason评分和肿瘤位置与手术标本内的Gleason评分及肿瘤分布情况。前列腺切除标本根据疾病范围进一步分为器官局限性、标本局限性或切缘阳性。
126例（43.5%）患者的Gleason评分相同。手术标本中Gleason评分升级的有118例（40.8%），降级的有43例（14.8%）。总体而言，193例（66.7%）患者单侧活检阳性，而96例（33.2%）患者双侧活检阳性。64例（33.1%）单侧活检阳性的患者癌症局限于腺体一侧，而127例（65.8%）显示双侧病变；142例（73.5%）患者肿瘤局限于器官内，51例（26.4%）患者有包膜侵犯。在96例双侧活检阳性的患者中，64例（66.6%）患者为包膜内癌，32例（33.3%）患者为标本局限性或切缘阳性病变。切缘阳性的总体发生率为14%。83例非器官局限性疾病患者中，51例（61.4%）在神经血管束上蒂区域有后外侧包膜侵犯，28例（33.7%）患者在神经血管下蒂区域有尖部包膜侵犯。
六分区超声引导下活检评估病理分级的能力令人满意：当我们考虑最终Gleason评分相差±1时，总体相关性为80%。在66%的病例中，当存在双侧疾病时，六分区活检可预测单侧疾病。单侧活检阳性并不能预测单侧疾病。
