Helpap B, Egevad L
Konsultationsdienst für Uropathologie, Institut für Pathologie, Singen.
Urologe A. 2007 Jan;46(1):59-62. doi: 10.1007/s00120-006-1238-9.
In several consensus conferences of the International Society of Urological Pathology (ISUP), the Gleason grading system of prostatic carcinomas was modified and adapted to the routine histological diagnostics of specimens of core needle biopsies and radical prostatectomies. The main results are the documentation of all histological patterns (primary, secondary, tertiary) and a shifting of the maximal Gleason score of biopsies from 6 to 7a (3+4) and of radical prostatectomies from 6 and 7 to 7a and 7b (4+3). Score 2 to 4 carcinomas do not exist in the peripheral prostate. pT2 prostatic carcinomas with good prognosis have a maximal score of 7a; pT3 carcinomas with poor prognosis have a most frequent score of 7b. The agreement of the Gleason scores of core needle biopsies and radical prostatectomy specimens is more than 80%. Inter- and intraobserver reproducibility is better than after the conventional Gleason grading. The prognostic value of scores 6 and 7a may be similar. The border between low- and high-grade prostatic carcinoma may be probably Gleason score 7a and 7b. The prognostic value of score 6 should be changed to score 7a in the different therapeutic options for prostatic carcinomas.
在国际泌尿病理学会（ISUP）的几次共识会议上，前列腺癌的Gleason分级系统进行了修改，以适应经皮穿刺活检和根治性前列腺切除术标本的常规组织学诊断。主要结果是记录了所有组织学模式（主要、次要、三级），活检的最大Gleason评分从6改为7a（3+4），根治性前列腺切除术的最大Gleason评分从6和7改为7a和7b（4+3）。外周前列腺不存在2至4分的癌。预后良好的pT2前列腺癌的最大评分为7a；预后不良的pT3癌最常见的评分为7b。经皮穿刺活检和根治性前列腺切除术标本的Gleason评分一致性超过80%。观察者间和观察者内的可重复性优于传统Gleason分级。6分和7a分的预后价值可能相似。低级别和高级别前列腺癌之间的界限可能是Gleason评分7a和7b。在前列腺癌的不同治疗选择中，6分的预后价值应改为7a分。
