Department of Pathology, The Johns Hopkins Hospital Medical Institutions, Baltimore, Maryland, USA.
J Urol. 2010 Jul;184(1):126-30. doi: 10.1016/j.juro.2010.03.021. Epub 2010 May 15.
We determined the value of mandatory second opinion pathology review to interpret prostate needle biopsy before radical prostatectomy.
In all cases referred to our institution for radical prostatectomy in 1 year we compared pathological parameters in original and reviewed pathology reports, including benign, atypical or malignant diagnosis, final Gleason score, positive core number, core highest cancer percent and perineural invasion or extraprostatic extension. A major Gleason score discrepancy was defined as a change to a different risk category (6, 7 and 8-10). We defined a significant difference in the highest percent of cancer in a core as 30% or greater.
Of the 855 cases originally diagnosed as prostatic adenocarcinoma cancer was confirmed in 844 (98.8%) by needle biopsy and prostatectomy, of which 9 (1%) were atypical and 2 (0.2%) were benign upon review. A major discrepancy in Gleason score was present in 124 cases (14.7%), of which 57 (46.0%) were upgraded and 67 (54%) were downgraded. Of cases with a final Gleason score of 6, 8.4% were originally diagnosed as 7 (7.8%) or 8-10 (0.6%), 21% with a final score of 7 had an original score of 6 (13.2%) or 8-10 (7.8%) and 21 of 61 (34%) with a score of 8-10 were originally diagnosed as 7 or less. There were 80 cases (64.5%) of disagreement between scores 6 and 7. Of the 777 cases with the positive core number in each report 71 (9.1%) had discrepancies. After review the positive core number was higher in 45 cases (63.4%) and lower in 26 (36.6%). We noted a significant difference in the highest cancer percent in a core in 76 of 844 evaluable cases (9%) in which cancer was originally underestimated. In 60 of 76 cases (78.9%) cancer discontinuously involved the core on review. Review revealed perineural invasion in 138 of 844 cases (16.3%) that was not originally reported in 37 of 138 (26.8%). In 4 cases review showed extraprostatic extension on needle biopsy.
Compared to a smaller study more than 10 years ago at our institution the rate of unconfirmed cancer was identical (1.2%). To our knowledge this is the first study to analyze concordance upon review of the number of positive cores and maximum percent positive in a core (each discrepancy 9%). In a few cases mandatory second opinion on prostate needle biopsy results in significant differences that may affect therapy.
我们旨在确定在根治性前列腺切除术之前进行强制性的第二意见病理检查对前列腺针吸活检的解读价值。
在所有这一年被转诊到我们机构进行根治性前列腺切除术的病例中，我们比较了原始和复查的病理报告中的病理参数，包括良性、非典型或恶性诊断、最终 Gleason 评分、阳性核心数量、核心最高癌症百分比和神经周围侵犯或前列腺外延伸。主要的 Gleason 评分差异被定义为改变为不同的风险类别（6、7 和 8-10）。我们将核心中癌症最高百分比的显著差异定义为 30%或更高。
在最初诊断为前列腺腺癌的 855 例中，844 例（98.8%）通过针吸活检和前列腺切除术得到证实，其中 9 例（1%）为非典型，2 例（0.2%）为良性。124 例（14.7%）出现主要的 Gleason 评分差异，其中 57 例（46.0%）为升级，67 例（54%）为降级。在最终 Gleason 评分为 6 的病例中，8.4%最初被诊断为 7（7.8%）或 8-10（0.6%），21%最终评分为 7 的病例最初评分为 6（13.2%）或 8-10（7.8%），而 21 例 8-10 病例中有 132%最初被诊断为 7 或更低。6 分和 7 分之间有 80 例（64.5%）的评分不一致。在每个报告中，777 例中有阳性核心数的病例中有 71 例（9.1%）存在差异。复查后，阳性核心数增加了 45 例（63.4%），减少了 26 例（36.6%）。在 844 例可评估病例中，76 例（9%）的核心中最高癌症百分比存在显著差异，其中癌症最初被低估。在 60 例 76 例（78.9%）中，癌症在复查时不连续累及核心。复查发现 844 例中有 138 例（16.3%）存在神经周围侵犯，而在 138 例中有 37 例（26.8%）未报告。在 4 例中，复查显示针吸活检中有前列腺外延伸。
与我们机构 10 多年前的一项较小研究相比，未证实癌症的发生率相同（1.2%）。据我们所知，这是第一个分析复查时阳性核心数量和核心中最高阳性百分比差异（每个差异为 9%）的研究。在少数情况下，对前列腺针吸活检结果进行强制性的第二意见可能会导致显著差异，从而影响治疗。
