Divrik Rauf Taner, Eroglu Aşkin, Sahin Ali, Zorlu Ferruh, Ozen Haluk
Department of Urology, SB Tepecik Research and Teaching Hospital, Izmir, Turkey.
Urol Oncol. 2007 Sep-Oct;25(5):376-82. doi: 10.1016/j.urolonc.2006.08.028.
To determine the importance of increasing the number of biopsy cores to decrease the discrepancy of Gleason scores of needle biopsy and radical prostatectomy specimens.
Between May 1998 and July 2005, 392 patients with clinically localized prostate cancer diagnosed by 18-gauge transrectal needle biopsy underwent radical prostatectomy. We categorized the cohort into 2 groups according to the number of the cores. Group 1 consisted of 206 patients diagnosed by extended biopsies (> or =10 cores, range 10-14, median 11). The remaining 186 patients who were diagnosed by sextant biopsies were categorized as being in group 2. Preoperative clinical variables, including patient age, digital rectal examination findings, serum prostate-specific antigen, and the number of cores positive for cancer the parameters, were assessed in both groups. The concordance of Gleason scores in both groups were analyzed by both individual Gleason scores and clinical subgroups of Gleason scores: 2-4 (well differentiated), 5-6 (moderately differentiated), 7 (intermediate), and 8-10 (poorly differentiated).
Needle biopsies revealed moderately differentiated tumors (Gleason 5-6) for the 2 groups (55.3% and 60.2%). Gleason scores of the needle biopsies were identical to that of the prostatectomy specimen in 116 (56.31%) and 76 cases (40.86%) for each group (kappa: 0.432 and 0.216 for each group, respectively). Gleason score of the needle biopsy differed by 1 grade in 56 (27.18%) and 84 cases (45.16%), and by > or =2 units in 34 (16.50%) and 26 cases (15.05%) for each group, respectively. Of the specimens, 34% were undergraded, and 10% were overgraded in group 1. These rates were 38% and 22% in group 2, respectively. A total of 70% in group 1 and 56% in group 2 remained in the same categorical group, 28% and 32% of the specimens were undergraded, and 4% and 12% were overgraded in groups 1 and 2, respectively. In group 1, the number of patients with Gleason scores of 2-4, 5-6, 7, and 8 were 9.7%, 55.3%, 21.4%, 13.6%, and 1.9%, 47.6%, 32%, 18.4%, graded by needle biopsies and radical prostatectomy specimens, respectively. However, in the sextant group, the change was the number of patients with Gleason scores of 2-4, 5-6, 7, and 8-10 was 5.4% 60.2%, 24.7%, and 9.7%, detected by needle biopsies, respectively. Radical prostatectomy specimens revealed the same Gleason categories in 4.3%, 41.9%, 38.7%, and 15.1%, respectively. There was no correlation between categorized prostate-specific antigen levels and concordance of the Gleason grade. Age and digital rectal examination results did not affect Gleason correlation.
We have shown that an extended biopsy scheme beyond its superior diagnostic capability also improves the concordance of Gleason scores of needle biopsies and radical prostatectomy specimens.
确定增加活检针数对于减少穿刺活检与根治性前列腺切除术标本Gleason评分差异的重要性。
1998年5月至2005年7月，392例经18G经直肠穿刺活检诊断为临床局限性前列腺癌的患者接受了根治性前列腺切除术。我们根据活检针数将该队列分为两组。第1组由206例经扩展活检（≥10针，范围10 - 14针，中位数11针）诊断的患者组成。其余186例经六分区活检诊断的患者被归类为第2组。对两组患者术前的临床变量进行评估，包括患者年龄、直肠指检结果、血清前列腺特异性抗原以及癌症阳性针数等参数。通过个体Gleason评分以及Gleason评分的临床亚组：2 - 4分（高分化）、5 - 6分（中分化）、7分（中间型）和8 - 10分（低分化），分析两组Gleason评分的一致性。
两组穿刺活检均显示为中分化肿瘤（Gleason 5 - 6分）（分别为55.3%和60.2%）。第1组和第2组穿刺活检的Gleason评分与前列腺切除术标本的Gleason评分相同的分别有116例（56.31%）和76例（40.86%）（kappa值：每组分别为0.432和0.216）。第1组和第2组穿刺活检的Gleason评分相差1级的分别有56例（27.18%）和84例（45.16%），相差≥2级的分别有34例（16.50%）和26例（15.05%）。在第1组标本中，34%为分级过低，10%为分级过高。在第2组中，这些比例分别为38%和22%。第1组中70%和第2组中56%的标本Gleason分级相同，第1组和第2组中分别有28%和32%的标本分级过低，4%和12%的标本分级过高。在第1组中，穿刺活检和前列腺切除术标本分级为Gleason 2 - 4分、5 - 6分、7分和8分的患者比例分别为9.7%、55.3%、21.4%、13.6%和1.9%、47.6%、32%、18.4%。然而，在六分区活检组中，穿刺活检检测到的Gleason评分2 - 4分、5 - 6分、7分和8 - 10分的患者比例分别为5.4%、60.2%、24.7%和9.7%。前列腺切除术标本显示相同Gleason分级的比例分别为4.3%、41.9%、38.7%和15.1%。分类后的前列腺特异性抗原水平与Gleason分级的一致性之间无相关性。年龄和直肠指检结果不影响Gleason分级的相关性。
我们已经表明，扩展活检方案除了具有更高的诊断能力外，还能提高穿刺活检与前列腺切除术标本Gleason评分的一致性。
