Emiliozzi P, Maymone S, Paterno A, Scarpone P, Amini M, Proietti G, Cordahi M, Pansadoro V
San Giovanni Hospital and Vincenzo Pansadoro Foundation, Rome, Italy.
J Urol. 2004 Dec;172(6 Pt 1):2224-6. doi: 10.1097/01.ju.0000144456.67352.63.
Accurate tumor grading is critical for adequate prostate cancer treatment. Nonetheless, the Gleason score of standard sextant biopsy correctly predicts the Gleason score of the radical prostatectomy specimen in about 50% of cases. We investigated if extended needle biopsy could improve biopsy Gleason score accuracy.
Laparoscopic transperitoneal radical prostatectomy was performed in 135 patients. Prostate cancer was diagnosed in 89 cases by standard sextant transrectal (6 to 8 cores) biopsy and in 46 by extended needle (12 core transperineal under transrectal guidance) biopsy. Preoperative evaluation included digital rectal examination, prostatic specific antigen measurement, transrectal ultrasonography and endorectal coil magnetic resonance imaging in all patients. All biopsy and prostatectomy specimens were reviewed by a single pathologist.
Clinical characteristics were similar in the 2 groups. The concordance between prostate biopsy and radical prostatectomy Gleason score was 32 of 46 cases (70%) and 44 of 89 (49%) for 12 core and standard transrectal biopsy, respectively (z test p = 0.0127). Biopsy under grading was found in 11 of 46 cases (24%) and 35 of 89 (39%) (z test p = 0.0366), and biopsy over grading was found in 3 of 46 (6%) and 10 of 89 (11%) (z test p = 0.1894) with 12 core and standard transrectal biopsy, respectively. Primary Gleason pattern was predicted exactly by biopsy in 40 of 46 cases (87%) and 56 of 89 (63%) with 12 core and standard sextant biopsy, respectively (z test p = 0.0018).
Extended needle biopsy significantly increases the accuracy of biopsy Gleason score for assessing final prostate cancer grade.
准确的肿瘤分级对于前列腺癌的充分治疗至关重要。然而，标准六分区活检的Gleason评分在约50%的病例中能正确预测根治性前列腺切除术标本的Gleason评分。我们研究了扩展穿刺活检是否能提高活检Gleason评分的准确性。
对135例患者进行了腹腔镜经腹根治性前列腺切除术。89例患者通过标准经直肠六分区（6至8针）活检诊断为前列腺癌，46例通过扩展穿刺活检（在经直肠引导下经会阴12针）诊断为前列腺癌。所有患者术前评估均包括直肠指检、前列腺特异性抗原测量、经直肠超声检查及直肠内线圈磁共振成像。所有活检和前列腺切除术标本均由一名病理学家复查。
两组临床特征相似。12针活检和标准经直肠活检的前列腺活检与根治性前列腺切除术Gleason评分的一致性分别为46例中的32例（70%）和89例中的44例（49%）（z检验p = 0.0127）。12针活检和标准经直肠活检的病例中，活检分级过低分别为46例中的11例（24%）和89例中的35例（39%）（z检验p = 0.0366），活检分级过高分别为46例中的3例（6%）和89例中的10例（11%）（z检验p = 0.1894）。12针活检和标准六分区活检分别在46例中的40例（87%）和89例中的56例（63%）中准确预测了主要Gleason模式（z检验p = 0.0018）。
扩展穿刺活检显著提高了评估最终前列腺癌分级的活检Gleason评分的准确性。
