Nishikimi Toshinori, Tsuzuki Toyonori, Oohashi Tomoyoshi, Yamauchi Yushi, Ishida Ryo, Yamada Hiroshi, Yokoi Keisuke, Kobayashi Hiroaki
Department of Urology, Nagoya Daini Red Cross Hospital.
Department of Pathology, Nagoya Daini Red Cross Hospital.
Nihon Hinyokika Gakkai Zasshi. 2016;107(2):87-92. doi: 10.5980/jpnjurol.107.87.
(Objective) The Clinical Practice Guidelines for Prostate Cancer (2012 Edition) recommend a 10- to 12-core biopsy comprising six standard cores from the apex, midgland, and base as well as cores from six peripheral zones (PZ) outside these sites. In this study, we compared localization results (mapping) based on 12-core prostate biopsy specimens from the six standard sites and six PZ outside these sites with results based on radical prostatectomy specimens. (Subjects and methods) Of the 208 patients with prostate cancer who underwent radical prostatectomy at our hospital between January 2011 and July 2014, the 139 who had a 12-core biopsy before surgery were included in this study. Prostate needle biopsies were performed transrectally and the same pathologist evaluated preoperative biopsy specimens and resected pathology specimens. Patient age ranged from 52 to 77 years (median: 68 years). Prostate-specific antigen levels at the time of biopsy ranged from 3.1 to 84.7 ng/ml (median: 7.3 ng/ml) and the weight of excised tissue ranged from 17 to 90 g (median: 37 g). The surgical method was laparotomy in 63 cases, laparoscopy in 12 cases, and robot-assisted in 64 cases. The preoperative T classification was cT1c in 84 cases, cT2a in 29 cases, cT2b in 15 cases, and cT2c in 11 cases. The preoperative Gleason score was 3+3=6 in 36 cases, 3+4=7 in 48 cases, 4+3=7 in 33 cases, 4+4=8 in 9 cases, 4+5=9 in 11 cases, and 5+4=9 in 2 cases. The postoperative T classification was pT2a in 38 cases, pT2b in 12 cases, pT2c in 17 cases, pT2+in 20 cases, pT3a in 47 cases, and pT3b in 5 cases. The postoperative Gleason score was 3+3=6 in 19 cases, 3+4=7 in 60 cases, 4+3=7 in 39 cases, 4+4=8 in 1 case, 4+5=9 in 14 cases, 5+4=9 in 5 cases, and 5+5=10 in 1 case. (Results) The concordance rate for detection of cancer (localization) in the 12 sites of the preoperative biopsy and the same sites of resected specimens was 59.2% (median: 7.11/12). Furthermore, the Gleason score of the resected specimen was higher than the preoperative score for 79 patients (56.8%) and 63 of the 88 patients (71.6%) whose cancer was classified as unilateral on the basis of the preoperative biopsy were found to have cancer on the other side as well when the resected specimen was examined. (Conclusion) The results suggest that localization is not always consistent between positive biopsy sites and sites in resected specimens. This indicates that when attempting to localize prostate cancer preoperatively, it is necessary to use other tests such as MRI as well.
（目的）《前列腺癌临床实践指南（2012年版）》推荐进行10至12针活检，包括来自前列腺尖部、中部和基部的6针标准活检组织以及这些部位以外6个外周带（PZ）的活检组织。在本研究中，我们将基于来自六个标准部位及这些部位以外六个外周带的12针前列腺活检标本的定位结果（图谱）与基于前列腺根治性切除术标本的结果进行了比较。（对象与方法）在2011年1月至2014年7月间于我院接受前列腺根治性切除术的208例前列腺癌患者中，本研究纳入了术前进行过12针活检的139例患者。经直肠进行前列腺穿刺活检，由同一位病理学家评估术前活检标本和切除的病理标本。患者年龄范围为52至77岁（中位数：68岁）。活检时前列腺特异性抗原水平范围为3.1至84.7 ng/ml（中位数：7.3 ng/ml），切除组织重量范围为17至90 g（中位数：37 g）。手术方式为剖腹手术63例，腹腔镜手术12例，机器人辅助手术64例。术前T分期为cT1c 84例，cT2a 29例，cT2b 15例，cT2c 11例。术前Gleason评分3 + 3 = 6为36例，3 + 4 = 7为48例，4 + 3 = 7为33例，4 + 4 = 8为9例，4 + 5 = 9为11例，5 + 4 = 9为2例。术后T分期为pT2a 38例，pT2b 12例，pT2c 17例，pT2 + 20例，pT3a 47例，pT3b 5例。术后Gleason评分3 + 3 = 6为19例，3 + 4 = 7为60例，4 + 3 = 7为39例，4 + 4 = 8为1例，4 + 5 = 9为14例，5 + 4 = 9为5例，5 + 5 = 10为1例。（结果）术前活检12个部位与切除标本相同部位的癌症检测（定位）符合率为59.2%（中位数：7.11/12）。此外，79例患者（56.8%）切除标本的Gleason评分高于术前评分，并且在术前活检基础上被分类为单侧癌的88例患者中，63例（71.6%）在检查切除标本时发现另一侧也有癌。（结论）结果表明，活检阳性部位与切除标本中的部位之间的定位并不总是一致的。这表明在术前试图定位前列腺癌时，还需要使用其他检查，如MRI。
