Halushka Marc K, Kahane Hillel, Epstein Jonathan I
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21231, USA.
Hum Pathol. 2004 Jan;35(1):43-6. doi: 10.1016/j.humpath.2003.08.013.
Atypical glands on prostate needle biopsy with a negative 34betaE12 (cytokeratin 903; CK903) immunostain, indicating a lack of a basal cell layer, are typically diagnostic of prostate cancer. However, in certain cases a negative 34betaE12 immunostain in a small focus of atypical glands is still not convincing enough to make the diagnosis of cancer. This study is the first report to evaluate the incidence of prostate cancer on follow-up biopsy in individuals with this diagnosis. A total of 543 men who had prostate core biopsy specimens diagnosed as a small focus of atypical-appearing glands with a negative 34betaE12 immunostain between January 1, 1997 and December 31, 2000 were selected for study. Some 61% of these 543 individuals (n = 332) had undergone at least one follow-up biopsy procedure. Of these, 43% of repeat biopsy cases (n = 142) were diagnostic of prostate cancer. A total of 46 individuals had at least 2 follow-up biopsy procedures, with 48% of these (n = 22) being diagnosed as cancer. The Gleason grades of the detected carcinomas were broken down as follows: Gleason grade 3 + 2 = 5, 6%; grade 3 + 3 = 6, 86%; grade 3 + 4 = 7, 1%; grade 4 + 3 = 7, 4%; and grade 4 + 4 = 8, 3%. The median amount of time to the first follow-up biopsy was 79 days, with 52% of follow-up biopsies performed within 90 days. A negative 34betaE12 immunohistochemical stain in a small focus of atypical glands is not associated with an increased prediction of prostate cancer on follow-up biopsy (43%), compared with previously published data for "small focus of atypical glands" alone (approximately 45%). Because 48% of men with an initial negative biopsy and multiple follow-up biopsy procedures were found to have cancer, more than one repeat biopsy session or more extensive sampling on the first repeat biopsy procedure may be necessary to maximize the identification of cancer. This finding is similar to that found in men with atypical diagnoses in general, without a negative 34betaE12 immunohistochemical stain. Only half of all individuals with a diagnosis of 34betaE12-negative focus of atypical glands underwent repeat biopsy within 3 months. Urologists need to be educated as to the significance of an atypical diagnosis and the need for repeat biopsy. In a small focus of atypical glands on prostate biopsy, negative staining for 34betaE12 should not necessarily lead to a definitive malignant diagnosis in all cases, because almost half of these biopsies on follow-up sampling are benign.
前列腺穿刺活检中出现的非典型腺体，若34βE12（细胞角蛋白903；CK903）免疫染色为阴性，提示缺乏基底细胞层，通常可诊断为前列腺癌。然而，在某些情况下，一小灶非典型腺体的34βE12免疫染色阴性仍不足以确诊癌症。本研究是首篇评估此类诊断患者后续活检中前列腺癌发生率的报告。选取了1997年1月1日至2000年12月31日期间前列腺穿刺活检标本被诊断为一小灶非典型外观腺体且34βE12免疫染色阴性的543名男性进行研究。这543名个体中约61%（n = 332）接受了至少一次后续活检。其中，重复活检病例的43%（n = 142）被诊断为前列腺癌。共有46名个体接受了至少2次后续活检，其中48%（n = 22）被诊断为癌症。检测到的癌灶的Gleason分级如下：Gleason 3 + 2 = 5级，占6%；3 + 3 = 6级，占86%；3 + 4 = 7级，占1%；4 + 3 = 7级，占4%；4 + 4 = 8级，占3%。首次后续活检的中位时间为79天，52%的后续活检在90天内进行。一小灶非典型腺体中34βE12免疫组化染色阴性与后续活检中前列腺癌预测增加无关（43%），与之前单独发表的“一小灶非典型腺体”数据（约45%）相比。由于初始活检阴性且接受多次后续活检的男性中有48%被发现患有癌症，可能需要不止一次重复活检或在首次重复活检时进行更广泛的采样，以最大程度地识别癌症。这一发现与一般非典型诊断的男性相似，无论34βE12免疫组化染色是否阴性。所有诊断为34βE12阴性的非典型腺体检出灶个体中，只有一半在3个月内接受了重复活检。泌尿科医生需要了解非典型诊断的意义以及重复活检的必要性。在前列腺活检中一小灶非典型腺体，34βE12染色阴性不一定在所有病例中都能确诊为恶性，因为这些活检后续采样中几乎一半是良性的。
