Epstein Jonathan I, Sanderson Harriete, Carter H Ballentine, Scharfstein Daniel O
Department of Pathology, Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Urology. 2005 Aug;66(2):356-60. doi: 10.1016/j.urology.2005.03.002.
To determine whether potential candidates for watchful waiting have undersampling of more substantial cancer.
A total of 103 men were studied, who were predicted to have insignificant cancer in their radical prostatectomy (RP) specimen. All had limited cancer on routine needle biopsy (no core with more than 50% involvement; Gleason score less than 7, and fewer than 3 cores involved) with a serum prostate-specific antigen density of 0.15 or less. Insignificant tumor at RP was considered organ-confined tumor, no Gleason pattern 4 or 5, and a tumor volume of less than 0.5 cm3. Saturation biopsy (average 44 cores) and an alternate biopsy saturation scheme with one half the number of cores using an 18-gauge Biopty gun was performed in the pathology laboratory on totally embedded and serially sectioned RP specimens.
Of the tumors, 97% were organ confined. The RP Gleason score was less than 7 in 84% of the cases. The RP tumor volume was 0.01 to 2.39 cm3 (median 0.14). Of the cancer specimens, 71% were insignificant and 29% had been incorrectly classified before surgery using standard biopsy schemes. Using the full saturation biopsy scheme, if we predicted significant cancer, the probability of having insignificant cancer was only 11.5% (false-positive rate). If the model predicted insignificant cancer, the probability of significant cancer was also only 11.5% (false-negative rate; sensitivity 71.9% and specificity 95.8%). Using the alternate biopsy sampling scheme, the false-positive rate was 8% and the false-negative rate was 11.4% (sensitivity 71.9% and specificity 97.1%).
Saturation biopsy provides accurate predictability of prostate tumor volume and grade to select suitable candidates for watchful waiting therapy.
确定进行观察等待的潜在候选者是否对更严重的癌症采样不足。
共研究了103名男性，他们在根治性前列腺切除术（RP）标本中被预测患有不显著的癌症。所有人在常规穿刺活检时癌症范围有限（无任何一个穿刺核心的受累程度超过50%；Gleason评分小于7，且受累穿刺核心少于3个），血清前列腺特异性抗原密度为0.15或更低。RP时不显著的肿瘤被认为是器官局限性肿瘤，无Gleason 4或5级模式，肿瘤体积小于0.5 cm³。在病理实验室对完全包埋并连续切片的RP标本进行饱和活检（平均44个穿刺核心）以及使用18号Biopty枪的核心数量减半的替代活检饱和方案。
在这些肿瘤中，97%为器官局限性。84%的病例RP Gleason评分小于7。RP肿瘤体积为0.01至2.39 cm³（中位数0.14）。在癌症标本中，71%为不显著的，29%在术前使用标准活检方案时被错误分类。使用完整的饱和活检方案，如果我们预测为显著癌症，实际为不显著癌症的概率仅为11.5%（假阳性率）。如果模型预测为不显著癌症，显著癌症的概率也仅为11.5%（假阴性率；敏感性71.9%，特异性95.8%）。使用替代活检采样方案，假阳性率为8%，假阴性率为11.4%（敏感性71.9%，特异性97.1%）。
饱和活检可为前列腺肿瘤体积和分级提供准确的预测性，以选择适合观察等待治疗的候选者。
