Egevad Lars, Allsbrook William C, Epstein Jonathan I
Department of Pathology and Cytology, Karolinska Hospital, Stockholm, Sweden.
Hum Pathol. 2006 Mar;37(3):292-7. doi: 10.1016/j.humpath.2005.10.011.
As there is a lack of hard data in the literature about many of the issues relating to diagnosing and reporting prostate cancer, we sought to survey current practices. A questionnaire was sent to 93 genitourinary pathologists with a response rate of 69%. Almost all respondents (95%) used formalin as fixative for needle biopsies. Unstained intervening sections were retained by 47%. Three levels of needle biopsies were used routinely by 63%. For verification of a diagnosis of cancer, high-molecular-weight cytokeratin was still the most commonly used immunohistochemical marker (91%), followed by p63 (58%) and alpha-methylacyl-CoA-racemase (50%). Features considered pathognomonic for cancer were glomeruloid bodies (58%), collagenous micronodules (64%), circumferential perineural invasion (84%), and growth in fat (36%). With none of these present, 39% required a minimum of 2 to 10 glands (median, 3) to diagnose cancer, whereas the others had no lower limit. A Gleason score was always given to even minute cancer foci by 86% and typically a Gleason score 6 was assigned (77%). Perineural invasion was mentioned by 86%. The extent of cancer on needle biopsies was quantified by all respondents with number of involved cores (80%) being the most commonly used measure. Linear extent was estimated by almost all, either as a percentage (80%) or millimeters of cancer length (41%) or both (22%). Measuring cancer from end to end or subtracting intervening benign tissue were almost equally common. For those general pathologists who would like to be in the mainstream of most urological pathologists, our survey data provide a guideline on how to diagnose and report prostate cancer.
由于文献中缺乏许多与前列腺癌诊断和报告相关问题的确切数据，我们试图调查当前的实践情况。我们向93名泌尿生殖病理学家发送了调查问卷，回复率为69%。几乎所有受访者（95%）都使用福尔马林作为针吸活检的固定剂。47%的人保留了未染色的间隔切片。63%的人常规使用三层针吸活检。在癌症诊断的验证方面，高分子量细胞角蛋白仍然是最常用的免疫组化标志物（91%），其次是p6３（58%）和α-甲基酰基辅酶A消旋酶（50%）。被认为是癌症特征性表现的有肾小球样小体（58%）、胶原性微小结节（64%）、环形神经周围浸润（84%）和脂肪内生长（36%）。如果这些特征都不存在，39%的人诊断癌症至少需要2至10个腺体（中位数为3个），而其他人则没有下限。86%的人即使对微小癌灶也总是给出Gleason评分，通常给出的是Gleason评分6分（77%）。86%的人提到了神经周围浸润。所有受访者都对针吸活检中癌症的范围进行了量化，其中受累核心数量（80%）是最常用的测量方法。几乎所有人都估计了线性范围，要么以百分比（80%），要么以癌症长度的毫米数（41%），或者两者都用（22%）。从一端到另一端测量癌症或减去中间的良性组织几乎同样常见。对于那些希望跟上大多数泌尿病理学家主流做法的普通病理学家来说，我们的调查数据为如何诊断和报告前列腺癌提供了一个指导。
