Department of Pathology, The Johns Hopkins University School of Medicine, The James Brady Urological Institute, The Johns Hospital, Baltimore, Maryland 21231, USA.
J Urol. 2010 Feb;183(2):433-40. doi: 10.1016/j.juro.2009.10.046. Epub 2009 Dec 14.
An update is provided of the Gleason grading system, which has evolved significantly since its initial description.
A search was performed using the MEDLINE(R) database and referenced lists of relevant studies to obtain articles concerning changes to the Gleason grading system.
Since the introduction of the Gleason grading system more than 40 years ago many aspects of prostate cancer have changed, including prostate specific antigen testing, transrectal ultrasound guided prostate needle biopsy with greater sampling, immunohistochemistry for basal cells that changed the classification of prostate cancer and new prostate cancer variants. The system was updated at a 2005 consensus conference of international experts in urological pathology, under the auspices of the International Society of Urological Pathology. Gleason score 2-4 should rarely if ever be diagnosed on needle biopsy, certain patterns (ie poorly formed glands) originally considered Gleason pattern 3 are now considered Gleason pattern 4 and all cribriform cancer should be graded pattern 4. The grading of variants and subtypes of acinar adenocarcinoma of the prostate, including cancer with vacuoles, foamy gland carcinoma, ductal adenocarcinoma, pseudohyperplastic carcinoma and small cell carcinoma have also been modified. Other recent issues include reporting secondary patterns of lower and higher grades when present to a limited extent, and commenting on tertiary grade patterns which differ depending on whether the specimen is from needle biopsy or radical prostatectomy. Whereas there is little debate on the definition of tertiary pattern on needle biopsy, this issue is controversial in radical prostatectomy specimens. Although tertiary Gleason patterns are typically added to pathology reports, they are routinely omitted in practice since there is no simple way to incorporate them in predictive nomograms/tables, research studies and patient counseling. Thus, a modified radical prostatectomy Gleason scoring system was recently proposed to incorporate tertiary Gleason patterns in an intuitive fashion. For needle biopsy with different cores showing different grades, the current recommendation is to report the grades of each core separately, whereby the highest grade tumor is selected as the grade of the entire case to determine treatment, regardless of the percent involvement. After the 2005 consensus conference several studies confirmed the superiority of the modified Gleason system as well as its impact on urological practice.
It is remarkable that nearly 40 years after its inception the Gleason grading system remains one of the most powerful prognostic factors for prostate cancer. This system has remained timely because of gradual adaptations by urological pathologists to accommodate the changing practice of medicine.
对格里森分级系统进行了更新，自最初描述以来，该系统发生了重大变化。
使用 MEDLINE（R）数据库和相关研究的参考文献列表进行了搜索，以获得有关格里森分级系统变化的文章。
自 40 多年前引入格里森分级系统以来，前列腺癌的许多方面都发生了变化，包括前列腺特异性抗原检测、经直肠超声引导的前列腺针活检，具有更大的采样量、基底细胞的免疫组织化学改变了前列腺癌的分类，以及新的前列腺癌变体。该系统在 2005 年由国际泌尿病理学会主办的国际泌尿病理专家共识会议上进行了更新。格里森评分 2-4 在针活检中很少出现，如果出现，某些模式（即形态不规则的腺体）最初被认为是格里森 3 型，现在被认为是格里森 4 型，所有筛状癌都应分级为 4 型。前列腺腺癌的变体和亚型的分级，包括有空泡的癌、泡沫状腺泡癌、导管腺癌、假增生性癌和小细胞癌也已修改。其他最近的问题包括报告次要模式的低级别和高级别，如果存在有限程度，以及评论三级模式，这取决于标本是来自针活检还是根治性前列腺切除术。虽然关于针活检中三级模式的定义几乎没有争议，但在根治性前列腺切除术标本中，这个问题存在争议。虽然三级格里森模式通常被添加到病理报告中，但由于没有简单的方法将其纳入预测诺莫图/表、研究和患者咨询中，因此在实践中通常会省略它们。因此，最近提出了一种改良的根治性前列腺切除术格里森评分系统，以直观的方式纳入三级格里森模式。对于显示不同分级的不同核心的针活检，目前的建议是分别报告每个核心的分级，其中选择最高分级的肿瘤作为整个病例的分级，以确定治疗方法，而不考虑参与的百分比。在 2005 年共识会议之后，几项研究证实了改良的格里森系统的优越性及其对泌尿外科实践的影响。
令人惊讶的是，在其诞生近 40 年后，格里森分级系统仍然是前列腺癌最强大的预后因素之一。该系统之所以保持时效性，是因为泌尿科病理学家逐渐适应了医学实践的变化。
