Volavšek Metka, Blanca Ana, Montironi Rodolfo, Cheng Liang, Raspollini Maria R, Vau Nuno, Fonseca Jorge, Pierconti Francesco, Lopez-Beltran Antonio
Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Maimonides Biomedical Research Institute of Cordoba, Spain, Cordoba, Spain.
Virchows Arch. 2018 Mar;472(3):451-460. doi: 10.1007/s00428-018-2296-2. Epub 2018 Feb 16.
Positive surgical margin (PSM) extension reported as focal or non-focal/extensive is an important pathologic prognostic parameter after radical prostatectomy. Likewise, there is limited or no agreement on how to measure and what the best cut-off points to be used in practice are. We hypothesized that digital microscopy (DM) would potentially provide a more objective way to measure PSM and better define its clinical significance. To further our knowledge, we have evaluated PSM status in 107 laparoscopic radical prostatectomies using digital and conventional light microscopy (LM). DM evaluation detected three additional PSM cases, but no differences were seen (LM vs DM; p = 0.220). Mean linear measurement correlated to biochemical recurrence (BR) (LM, p = 0.002; DM, p = 0.001). ROC analysis identified a cut-off point to assess linear measurement by LM (3.5 mm) or DM (3.2 mm), but only digital measurement was significant for BR-free survival. Our study also evaluated a cut-off ≤ 3 mm that was associated to BR using LM (p = 0.023) or DM (p = 0.001). Finally, the number of paraffin blocks bearing PSM correlated with BR (p < 0.001) status with either LM or DM. In conclusion, DM produces similar data than LM but shows more accurate measurements. Reporting of PSM with score of ≤ 3 vs. > 3 mm linear extent using LM (3.2 mm if digital microscopy is applied) might represent an important prognostic feature after radical prostatectomy. Alternatively, reporting the number of blocks with PSM 1 vs. 2 or more might also provide important prognostic data in practice.
根治性前列腺切除术后，病理报告中切缘阳性（PSM）表现为局灶性或非局灶性/广泛性是一项重要的病理预后参数。同样，对于如何测量以及在实际应用中最佳的截断点是多少，目前存在的共识有限或几乎没有。我们推测数字显微镜（DM）可能会提供一种更客观的方法来测量PSM，并更好地定义其临床意义。为了进一步了解，我们使用数字显微镜和传统光学显微镜（LM）评估了107例腹腔镜根治性前列腺切除术中的PSM状态。数字显微镜评估检测到另外3例PSM病例，但未发现差异（LM与DM比较；p = 0.220）。平均线性测量与生化复发（BR）相关（LM，p = 0.002；DM，p = 0.001）。ROC分析确定了通过LM（3.5毫米）或DM（3.2毫米）评估线性测量的截断点，但只有数字测量对无BR生存具有显著意义。我们的研究还评估了≤3毫米的截断点，使用LM（p = 0.023）或DM（p = 0.001）时其与BR相关。最后，带有PSM的石蜡块数量与BR状态相关（p < 0.001），无论是使用LM还是DM。总之，DM产生的数据与LM相似，但显示出更准确的测量结果。使用LM报告PSM时，线性范围评分≤3毫米与>3毫米（如果应用数字显微镜则为3.2毫米）可能是根治性前列腺切除术后的一个重要预后特征。或者，报告有1个PSM块与2个或更多PSM块的情况在实际应用中也可能提供重要的预后数据。
