Delatour Nicolas L D Roustan, Mai Kien T
Department of Pathology and Laboratory Medicine, Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
Urology. 2008 Sep;72(3):623-7. doi: 10.1016/j.urology.2007.11.082. Epub 2008 Feb 15.
High-grade prostatic intraepithelial neoplasia (HGPIN) is a putative premalignant lesion of prostate adenocarcinoma (PCa). The significance of isolated HGPIN in initial biopsy cores as a marker of PCa in repeat biopsies has been extensively investigated, but little is known of the true occurrence of PCa in this setting, because repeat biopsies can miss the focus of cancer. In this study, a hemi-prostate model was used to define the true positive predictive value of HGPIN in core biopsies in predicting PCa.
From 132 consecutive resected prostate specimens, 70 hemi-prostates with all corresponding biopsy cores negative for PCa were thoroughly examined.
Of the 70 hemi-prostates, 38 had PCa (including 8 with clinically significant PCa), and 11 had HGPIN. In the group of 38 hemi-prostate with PCa, 7 were associated with HGPIN-positive biopsies. No statistically significant difference was found between the hemi-prostates with or without PCa, regarding the presence, microscopic pattern, or multiple core involvement of HGPIN in the biopsies. The positive predictive value of HGPIN in predicting for clinically significant PCa was 27%, the negative predictive value was 87%, the sensitivity was 38%, and the specificity was 91% (P = 0.04, statistically significant). In addition, the positive predictive value of multiple cores with HGPIN in predicting for clinically significant PCa was 75% (negative predictive value 92%).
The results of the present study have failed to support HGPIN as a statistically significant predictor for the occurrence of PCa. More importantly, however, HGPIN and multiple core involvement did seem to be a useful marker for clinically significant PCa.
高级别前列腺上皮内瘤变（HGPIN）被认为是前列腺腺癌（PCa）的一种潜在癌前病变。孤立性HGPIN在初次活检组织中作为重复活检时PCa标志物的意义已得到广泛研究，但在此情况下PCa的真实发生率却鲜为人知，因为重复活检可能会遗漏癌灶。在本研究中，采用半前列腺模型来确定HGPIN在穿刺活检中预测PCa的真正阳性预测值。
对132例连续切除的前列腺标本进行研究，对其中70个半前列腺及其所有对应的PCa穿刺活检结果均为阴性的标本进行全面检查。
70个半前列腺中，38个存在PCa（包括8个具有临床意义的PCa），11个存在HGPIN。在38个存在PCa的半前列腺组中，7个与HGPIN阳性活检相关。在穿刺活检中，有无PCa的半前列腺在HGPIN的存在、显微镜下形态或多个组织受累情况方面均未发现统计学显著差异。HGPIN预测具有临床意义的PCa的阳性预测值为27%，阴性预测值为87%，敏感性为38%，特异性为91%（P = 0.04，具有统计学意义）。此外，多个组织存在HGPIN预测具有临床意义的PCa的阳性预测值为75%（阴性预测值为92%）。
本研究结果未能支持HGPIN作为PCa发生的统计学显著预测指标。然而，更重要的是，HGPIN和多个组织受累似乎是具有临床意义的PCa的有用标志物。
