Departments of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Canada.
Department of Anatomic Pathology, Sunnybrook Health Sciences Center, Toronto, Canada.
Histopathology. 2019 Feb;74(3):474-482. doi: 10.1111/his.13747. Epub 2018 Nov 4.
Intraductal and cribriform carcinoma of the prostate are increasingly recognised as independent prognosticators of poor outcome, both in prostate biopsies and surgical specimens. We studied the concordance of biopsy and prostatectomy diagnosis for these two subpathologies in relationship with pathological stage.
Mandatory synoptic reporting of intraductal and cribriform carcinoma in prostate biopsies and prostatectomy specimens was adopted by two academic institutions in November 2015. Synoptic reports of 245 biopsy and corresponding prostatectomy specimens were interrogated to determine the prevalence of intraductal and cribriform carcinoma. Sensitivity and specificity were determined, with prostatectomy diagnosis as the gold standard. Associations with pathological stage as primary outcome parameter were determined using univariable and multivariable logistic regression analysis. Prevalence of the combination of intraductal and cribriform carcinoma was 26.9% in biopsies and 51.8% in prostatectomy specimens. Sensitivity and specificity at biopsy were 47.2% and 94.9%, respectively. Intraductal and cribriform carcinoma at biopsy were associated with advanced pathological stage independent of grade (P = 0.013). Among patients with grade group 2 prostate cancer at biopsy, the more advanced pathological stage distribution was similar for those with a false negative and a true positive biopsy diagnosis of intraductal and cribriform carcinoma (P = 0.29).
In spite of low sensitivity, intraductal and cribriform carcinoma at biopsy was associated strongly with advanced stage at radical prostatectomy. As a false negative biopsy diagnosis was equally associated with advanced pathological stage, efforts should be undertaken to improve the sensitivity of biopsy diagnosis for intraductal and cribriform carcinoma.
前列腺导管内和筛状癌越来越被认为是前列腺活检和手术标本中预后不良的独立预测因子。我们研究了这两种亚病理学在与病理分期的关系中在活检和前列腺切除术诊断上的一致性。
2015 年 11 月，两个学术机构开始强制报告前列腺活检和前列腺切除术标本中的导管内和筛状癌。通过询问 245 份活检和相应的前列腺切除术标本的摘要报告，确定了导管内和筛状癌的患病率。以前列腺切除术诊断为金标准，确定了敏感性和特异性。使用单变量和多变量逻辑回归分析，将病理分期作为主要结果参数的关联。在活检中，导管内和筛状癌的组合患病率为 26.9%，在前列腺切除术标本中为 51.8%。在活检中的敏感性和特异性分别为 47.2%和 94.9%。在独立于分级的情况下，活检中的导管内和筛状癌与较晚的病理分期相关（P=0.013）。在活检中为 2 级前列腺癌的患者中，导管内和筛状癌假阴性和真阳性活检诊断的患者之间，更晚期的病理分期分布相似（P=0.29）。
尽管敏感性低，但活检中的导管内和筛状癌与根治性前列腺切除术中的晚期阶段密切相关。由于假阴性活检诊断同样与晚期病理分期相关，因此应努力提高活检诊断导管内和筛状癌的敏感性。
