Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
J Urol. 2020 Feb;203(2):311-319. doi: 10.1097/JU.0000000000000526. Epub 2019 Sep 4.
Prostatic adenocarcinoma with cribriform morphology and/or intraductal carcinoma has higher recurrence and mortality rates after radiation and surgery. While the prognostic impact of these features is well studied, concordance with cribriform morphology and/or intraductal carcinoma on biopsy and prostatectomy has only recently gained attention. Our primary objective was to evaluate the diagnostic performance of biopsy to detect cribriform morphology and/or intraductal carcinoma in paired biopsy and prostatectomy specimens in a large contemporary cohort.
Patients who underwent prostate biopsy or had biopsies reviewed prior to prostatectomy at a tertiary hospital between November 2017 and November 2018 were included in study. Sensitivity and specificity were calculated to assess concordance with cribriform morphology and/or intraductal carcinoma on biopsy and prostatectomy. The association of biopsy diagnosed with cribriform morphology and/or intraductal carcinoma with adverse pathology was assessed by multivariable regression.
Of the 455 men who underwent prostatectomy 216 (47.5%) had biopsy identified with cribriform morphology and/or intraductal carcinoma. For cribriform morphology and/or intraductal carcinoma the sensitivity and specificity of biopsy was 56.5% and 87.2%, respectively. In men eligible for active surveillance sensitivity was 34.1% and specificity was 88.1%. Magnetic resonance imaging targeted biopsies did not improve sensitivity (53.5%). Cribriform morphology and/or intraductal carcinoma identified on prostatectomy correlated with adverse pathological findings. However, compared to cribriform morphology and/or intraductal carcinoma negative biopsies, biopsies identified with cribriform morphology and/or intraductal carcinoma were not independently associated with adverse pathology. This was likely due to biopsy low sensitivity.
In this cohort biopsy was not sensitive for detecting cribriform morphology and/or intraductal carcinoma and this was not improved by magnetic resonance imaging fusion. However, specificity was high, suggesting that when present on biopsy, cribriform morphology and/or intraductal carcinoma may be considered in treatment planning algorithms.
具有筛状形态和/或管内癌的前列腺腺癌在接受放疗和手术治疗后复发和死亡率较高。虽然这些特征的预后影响已得到充分研究，但在活检和前列腺切除术上与筛状形态和/或管内癌的一致性最近才受到关注。我们的主要目的是评估在大型当代队列中，活检检测活检和前列腺切除标本中筛状形态和/或管内癌的诊断性能。
本研究纳入了 2017 年 11 月至 2018 年 11 月期间在一家三级医院接受前列腺活检或前列腺切除术前接受活检的患者。计算敏感性和特异性以评估活检和前列腺切除术上的筛状形态和/或管内癌的一致性。通过多变量回归评估活检诊断的筛状形态和/或管内癌与不良病理之间的关联。
在接受前列腺切除术的 455 名男性中，有 216 名（47.5%）的活检标本中发现有筛状形态和/或管内癌。对于筛状形态和/或管内癌，活检的敏感性和特异性分别为 56.5%和 87.2%。在适合主动监测的男性中，敏感性为 34.1%，特异性为 88.1%。磁共振成像靶向活检并未提高敏感性（53.5%）。前列腺切除标本中发现的筛状形态和/或管内癌与不良病理发现相关。然而，与筛状形态和/或管内癌阴性的活检相比，活检中发现的筛状形态和/或管内癌与不良病理之间没有独立相关性。这可能是由于活检的敏感性较低。
在本队列中，活检对检测筛状形态和/或管内癌不敏感，而磁共振成像融合并不能提高其敏感性。然而，特异性很高，这表明当活检中存在筛状形态和/或管内癌时，可以考虑将其纳入治疗计划算法。
