Department of Pathology, Singapore General Hospital, Singapore.
Pathology. 2010 Jan;42(1):6-14. doi: 10.3109/00313020903434330.
The increase in early detection of prostate cancer in the Asian population has bolstered second opinion consultations in prostate pathology in this region. In this review, we aimed to identify the spectrum of lesions and queries submitted to a pathologist with uropathology interest at the Singapore General Hospital.
Request forms for second opinion prostate consultations from pathologists and clinicians were retrieved from central laboratory records and a specialist's correspondence files within 2004-2007. Histomorphological queries raised in the referrals, and comparison of original diagnosis and Gleason scoring with the review diagnoses were collated.
Discordant diagnoses (183/323, 57%) were more common than concordant diagnoses (143/326, 44%) between original diagnosis and subspecialist review. The majority of discordances comprised initial undergrading of Gleason scores (132/183, 72%; p < 0.01) especially in needle core biopsies. Among the significantly altered pathological diagnoses, 24 cases (13%; p < 0.01) were changed from benign to malignant (n = 9, 5%; p < 0.01), and malignant to benign (n = 11, 6%; p < 0.01) or high grade prostatic intraepithelial neoplasia (n = 4, 2%; p < 0.01). Benign mimics of malignancy such as atypical adenomatous hyperplasia and atrophy, and small foci of adenocarcinoma, were some examples of morphological pitfalls.
Prostate biopsy review is important because of management and prognostic implications that vary among Gleason scores, and predictive parameters that are detailed in prostate pathology reports.
在亚洲人群中，前列腺癌的早期检出率有所增加，这促使该地区的前列腺病理学家进行了更多的二次诊断咨询。本研究旨在确定在新加坡总医院具有尿路病理学家兴趣的病理学家收到的病变和查询的范围。
从 2004 年至 2007 年的中央实验室记录和专家通信文件中检索了病理学家和临床医生的二次诊断前列腺咨询请求表。整理了转介中提出的组织形态学查询，并比较了原始诊断和 Gleason 评分与复查诊断。
在原始诊断与专科复查之间，不一致的诊断（183/323，57%）比一致的诊断（143/326，44%）更为常见。大多数不一致包括初始 Gleason 评分的低估（132/183，72%；p<0.01），尤其是在针芯活检中。在明显改变的病理诊断中，24 例（13%；p<0.01）从良性变为恶性（n=9，5%；p<0.01），恶性变为良性（n=11，6%；p<0.01）或高级前列腺上皮内瘤变（n=4，2%；p<0.01）。良性肿瘤的恶性类似物，如非典型腺瘤性增生和萎缩，以及小灶腺癌，是形态学陷阱的一些例子。
由于 Gleason 评分之间的治疗和预后意义不同，以及前列腺病理报告中详细描述的预测参数，前列腺活检复查很重要。
