Laboratory of Medical Investigation, Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Int Braz J Urol. 2010 Sep-Oct;36(5):583-90. doi: 10.1590/s1677-55382010000500008.
Atypical glands (ASAP) are diagnosed in 5.0% of prostate biopsies, and cancer identification in a rebiopsy is higher than 40.0%. The use of antibodies to mark basal cells is currently a common practice, in order to avoid rebiopsies. There has been no reported study that has reviewed characteristics of radical prostatectomies (RPs) when immunohistochemistry (IHC) was necessary for definitive diagnosis.
Out of 4127 biopsies examined from 2004 to 2008, 144 (3.5%) were diagnosed with ASAP. IHC was performed using antibody anti-34ΒE12 and p63. The results of surgical specimens of 27 patients treated by RP after the diagnosis of prostate cancer (PC) was made using IHC (Group 1) were compared with 1040 patients where IHC was not necessary (Group 2).
IHC helped to diagnose PC in 103 patients (71.5%). Twenty-seven (26.2%) underwent RP. In Group 1, two (7.4%) adenocarcinomas were insignificant versus 29 (2.9%) for Group 2. Patients from Group 1 were younger (p = 0.039), had lower Gleason scores (GS) (p < 0.001), lower percentage of Gleason pattern 4 (p < 0.001), and smaller tumors (p < 0.001).
The use of IHC did not lead to diagnosis of insignificant tumors as illustrated by absence of differences in pathological stage or positive surgical margins in men submitted to RP. Therefore, our results suggest that this modality should be routinely used for a borderline biopsy and ASAP cases.
在前列腺活检中，5.0%的病例被诊断为非典型腺体（ASAP），在再次活检中，癌症的检出率高于 40.0%。目前，为了避免再次活检，标记基底细胞的抗体的使用是一种常见的做法。目前还没有报道研究回顾了在需要免疫组织化学（IHC）进行明确诊断的情况下，根治性前列腺切除术（RP）的特征。
在 2004 年至 2008 年间检查的 4127 份活检中，有 144 份（3.5%）被诊断为 ASAP。使用抗 34ΒE12 和 p63 抗体进行 IHC。比较了 27 例经 IHC 诊断为前列腺癌（PC）后接受 RP 治疗的患者（第 1 组）和 1040 例无需 IHC 的患者（第 2 组）的手术标本结果。
IHC 有助于诊断 103 例（71.5%）PC。27 例（26.2%）接受 RP。第 1 组中，有 2 例（7.4%）腺癌为非显著性，而第 2 组中为 29 例（2.9%）。第 1 组患者年龄更小（p = 0.039），Gleason 评分（GS）更低（p < 0.001），Gleason 模式 4 的比例更低（p < 0.001），肿瘤更小（p < 0.001）。
免疫组织化学的使用并未导致诊断出非显著性肿瘤，因为在接受 RP 的男性中，病理分期或阳性手术切缘无差异。因此，我们的结果表明，这种方法应常规用于边界活检和 ASAP 病例。
