Lillaz J, Delorme G, Guichard G, Bernardini S, Chabannes E, Bittard H, Kleinclauss F
Service d'urologie et transplantation rénale, centre hospitalier universitaire de Besançon, 2, place Saint-Jacques, 25030 Besançon, France.
Prog Urol. 2012 Jun;22(7):408-14. doi: 10.1016/j.purol.2012.03.002. Epub 2012 Apr 17.
The therapeutic approach of prostate cancer depends mainly on pathological criteria obtained through prostate biopsy. The low accuracy of prostate biopsy for Gleason grade determination is well known but its accuracy for bilateral or multifocal tumor has not been evaluated. The goal of this study was to assess the concordance between prostate biopsy and whole prostate specimen obtained after radical prostatectomy especially for bilateral and/or multifocal tumor.
We retrospectively compared the pathological results of prostate biopsy cores to the prostate specimen in patients who underwent radical prostatectomy in our department between the 01/01/1999 and the 31/12/2008. The criteria analyzed were the Gleason score, tumor bilaterality or multifocality. The impact of the number of prostate biopsy cores was also analyzed.
Two hundred and five complete histological records were studied. Regarding the Gleason score overall concordance was 55%. In 38%, prostate biopsies downgraded the Gleason score. This concordance decreased with tumor differentiation (90.6% for Gleason 6 vs. 31% for Gleason greater than 7). For the tumor bilaterality, 78% of cancers affected both lobes at the definitive specimen analysis while only 49% were bilateral at prostate biopsies, achieving a concordance of 61%. Multifocal disease was observed in 36% at definitive pathology analysis with low concordance with prostate biopsies (36%). The number of biopsies increased the concordance for the Gleason score (60 to 81% for Gleason 7 and from 28 to 50% for Gleason greater than 7) and tumor location (44 to 70%).
Pathological criteria and tumor mapping obtained from prostate biopsies were not very reliable especially when the tumor was poorly differentiated. An increased number of prostate biopsy core improved the sensitivity and specificity for the Gleason score diagnostic and of the tumor mapping.
前列腺癌的治疗方法主要取决于通过前列腺活检获得的病理标准。前列腺活检在确定 Gleason 分级方面的低准确性是众所周知的，但其对双侧或多灶性肿瘤的准确性尚未得到评估。本研究的目的是评估前列腺活检与根治性前列腺切除术后获得的整个前列腺标本之间的一致性，特别是对于双侧和/或多灶性肿瘤。
我们回顾性比较了 1999 年 1 月 1 日至 2008 年 12 月 31 日期间在我们科室接受根治性前列腺切除术的患者前列腺活检组织芯与前列腺标本的病理结果。分析的标准包括 Gleason 评分、肿瘤双侧性或多灶性。还分析了前列腺活检组织芯数量的影响。
研究了 205 份完整的组织学记录。关于 Gleason 评分，总体一致性为 55%。在 38%的病例中，前列腺活检降低了 Gleason 评分。这种一致性随着肿瘤分化程度降低（Gleason 6 为 90.6%，而 Gleason 大于 7 为 31%）。对于肿瘤双侧性，在最终标本分析中 78%的癌症累及双侧叶，而在前列腺活检时只有 49%为双侧，一致性为 61%。在最终病理分析中，36%观察到多灶性疾病，与前列腺活检的一致性较低（36%）。活检数量增加提高了 Gleason 评分（Gleason 7 从 60%提高到 81%，Gleason 大于 7 从 28%提高到 50%）和肿瘤定位（从 44%提高到 70%）的一致性。
从前列腺活检获得的病理标准和肿瘤定位不是非常可靠，尤其是当肿瘤分化较差时。增加前列腺活检组织芯数量可提高 Gleason 评分诊断和肿瘤定位的敏感性和特异性。
