*Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI †Facultad de Medicina (School of Medicine), Universidad Peruana Cayetano Heredia, Lima, Peru.
Am J Surg Pathol. 2015 Feb;39(2):281-6. doi: 10.1097/PAS.0000000000000344.
When prostate needle biopsies are involved discontinuously by tumor, no consensus remains on the optimal method of tumor quantification. We investigated whether discontinuous biopsy involvement usually results from a large tumor focus or multiple small foci. Prostate needle biopsies with discontinuous tumor and corresponding whole-mounted radical prostatectomies from 2008 to 2013 were analyzed. Linear length and percentage of biopsy involvement were measured both including and subtracting the benign intervening tissue. The corresponding region of the prostatectomy specimen was evaluated for tumor size and multifocality. From over 800 biopsy sets and 400 prostatectomies performed annually, 40 patients met inclusion criteria. Excluding benign tissue, length and percentage of biopsy involvement ranged from 1 to 7 mm and 5% to 66% (median 2.5 mm, 20%), whereas including intervening tissue yielded 4 to 15.5 mm and 25% to 100%, (median 7 mm, 70%), respectively. Benign intervening tissue measured from 2 to 10.5 mm (median 3.5 mm). In 31 patients (78%), a single tumor focus was present in the corresponding region of the prostate (the dominant tumor in 25/31). In 9 patients, multiple small foci were present. Eleven patients could have been excluded from active surveillance eligibility by measuring tumor from end to end (>50% involvement), of whom only 1 met criteria for clinically insignificant cancer at prostatectomy. Discontinuous tumor in a prostate biopsy often results from a single tumor focus in the corresponding region of the prostate (78%). Therefore, we recommend that an end-to-end measurement be provided, with accompanying diagnostic comment that this often correlates with the size of a single tumor focus.
当前列腺针吸活检出现肿瘤不连续累及时，肿瘤定量的最佳方法仍存在争议。我们研究了不连续活检累及是否通常是由大的肿瘤焦点还是多个小焦点引起的。分析了 2008 年至 2013 年间具有不连续肿瘤的前列腺针吸活检和相应的全前列腺切除术标本。测量了包括和不包括良性间隔组织的活检累及的线性长度和百分比。评估了前列腺切除术标本中肿瘤大小和多灶性。在每年进行的 800 多个活检组和 400 例前列腺切除术中，有 40 名患者符合纳入标准。不包括良性组织时，活检累及的长度和百分比范围为 1 至 7 毫米和 5%至 66%（中位数 2.5 毫米，20%），而包括间隔组织时，长度和百分比分别为 4 至 15.5 毫米和 25%至 100%（中位数 7 毫米，70%）。良性间隔组织的长度为 2 至 10.5 毫米（中位数 3.5 毫米）。在 31 名患者（78%）中，在相应的前列腺区域存在单个肿瘤焦点（25/31 例为主要肿瘤）。在 9 名患者中，存在多个小焦点。通过从头到尾测量肿瘤（>50%累及），11 名患者可以被排除在主动监测的资格之外，但只有 1 名患者在前列腺切除术后符合临床意义不大的癌症标准。前列腺活检中的不连续肿瘤通常是由相应前列腺区域的单个肿瘤焦点引起的（78%）。因此，我们建议提供从头到尾的测量，并附有诊断性评论，指出这通常与单个肿瘤焦点的大小相关。
