Institute of Pathology, Center of Uropathology, General Hospital Hegau-Bodensee-Klinikum Singen, Academic Hospital of University of Freiburg, Singen, Germany.
Int J Urol. 2012 Feb;19(2):126-33. doi: 10.1111/j.1442-2042.2011.02902.x. Epub 2011 Nov 22.
Accurate tumor grading on prostate biopsy represents the mainstay for therapy planning. Biopsy undergrading is a persistent diagnostic dilemma with therapeutic relevance. We questioned whether Gleason grading combined with an established alternative grading system incorporating cytological parameters improves grading accuracy.
Needle biopsies of 968 patients and the corresponding radical prostatectomy specimens were graded according to the Gleason grading system. In addition, all biopsies were graded according to the histo- and cytological grading system of Helpap. Biopsy Gleason grade, as well as the combined Gleason/Helpap grade, was compared with the final Gleason score and the pathological tumor-stage of the corresponding radical prostatectomy.
In biopsy Gleason score 6 cancers, an upgrading was seen in 76.0% of the patients (98/129), and 30.2% of them (39/129) showed non-organ confined disease. In combined biopsy Gleason 6/Helpap 2a patients, a final Gleason score of 6 was found in 22 out of 24 patients (91.7%, P<0.0001), and all 24 patients showed organ-confined disease (pT2a). In biopsy Gleason 6/Helpap 2b cancers, a final Gleason score of 6 was found in just 9 out of 105 patients (8.6%), and the rate of organ-confined disease decreased to 62.8% (66/105, P=0.0001). In higher Gleason grades, combined biopsy grading failed to show a diagnostic benefit over sole Gleason grading.
Combined biopsy Gleason/Helpap grading improves the identification of low-grade/low-stage cancers and might contribute to more precise therapy planning in prostate cancer management.
在前列腺活检中准确进行肿瘤分级是制定治疗计划的基础。活检分级不足是一个持续存在的诊断难题，具有治疗相关性。我们质疑是否将格里森分级与包含细胞学参数的既定替代分级系统相结合可以提高分级准确性。
根据格里森分级系统对 968 例患者的针吸活检标本和相应的根治性前列腺切除术标本进行分级。此外，所有活检标本均根据 Helpap 的组织学和细胞学分级系统进行分级。比较活检格里森分级以及联合格里森/Helpap 分级与相应根治性前列腺切除术的最终格里森评分和病理肿瘤分期。
在活检格里森评分 6 级的癌症中，76.0%（98/129）的患者出现升级，其中 30.2%（39/129）的患者出现非器官受限疾病。在联合活检格里森 6/Helpap 2a 患者中，24 例患者中有 22 例（91.7%，P<0.0001）最终格里森评分为 6，所有 24 例患者均表现为器官受限疾病（pT2a）。在活检格里森 6/Helpap 2b 癌症中，105 例患者中仅有 9 例（8.6%）最终格里森评分 6，而器官受限疾病的发生率下降至 62.8%（66/105，P=0.0001）。在较高的格里森分级中，联合活检分级未能显示出优于单独格里森分级的诊断益处。
联合活检格里森/Helpap 分级提高了低分级/低分期癌症的识别能力，并可能有助于更精确的前列腺癌管理治疗计划。
