Egevad Lars, Delahunt Brett, Yaxley John, Samaratunga Hemamali
Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
Pathol Int. 2019 Feb;69(2):55-66. doi: 10.1111/pin.12761. Epub 2019 Jan 29.
Histological grading of prostate cancer is one of the most important tissue-based parameters for prediction of outcome and treatment response. Gleason grading remains the foundation of prostate cancer grading, but has undergone a series of changes in the past 30 years, often initiated by consensus conference decisions. This review summarizes the most important modifications that were introduced by the 2005 and 2014 International Society of Urological Pathology (ISUP) revisions of Gleason grading and discusses the impact that these have had on current grading practices. A considerable inflation in Gleason scores has been observed, especially following the ISUP 2005 revision, and the effects of this are discussed. ISUP 2014 grading recommendations are described, including the reporting of ISUP grades 1-5. Controversial issues include methods for reporting of grades on needle biopsies, reporting of percent Gleason grades 4/5 and grading of cribriform and intraductal carcinoma of the prostate. Educational programs developed recently to promote standardization of grading are described and their results assessed.
前列腺癌的组织学分级是预测预后和治疗反应的最重要的基于组织的参数之一。 Gleason分级仍然是前列腺癌分级的基础，但在过去30年中经历了一系列变化，这些变化通常由共识会议决定发起。 本综述总结了2005年和2014年国际泌尿病理学会（ISUP）对Gleason分级的修订所引入的最重要修改，并讨论了这些修改对当前分级实践的影响。 已经观察到Gleason评分有相当大的膨胀，特别是在ISUP 2005修订之后，并讨论了其影响。 描述了ISUP 2014分级建议，包括ISUP 1-5级的报告。 有争议的问题包括针吸活检分级的报告方法、Gleason 4/5级百分比的报告以及前列腺筛状癌和导管内癌的分级。 描述了最近为促进分级标准化而开展的教育项目，并评估了其结果。
