From the Departments of Pathology (Dr Fine, Ms Meisels, Drs Al-Ahmadie, Chen, Gopalan, Sirintrapun, Tickoo, and Reuter) and Epidemiology and Biostatistics (Dr Vickers), Memorial Sloan Kettering Cancer Center, New York, New York.
Arch Pathol Lab Med. 2020 Mar;144(3):356-360. doi: 10.5858/arpa.2019-0224-OA. Epub 2019 Oct 4.
CONTEXT.—: In prostate cancer, "tertiary" higher-grade patterns (TPs) have been associated with biochemical recurrence after radical prostatectomy.
OBJECTIVE.—: To determine variation regarding definition and application of TPs.
DESIGN.—: Online survey regarding TPs in a range of grading scenarios circulated to 105 experienced urologic pathologists.
RESULTS.—: Among 95 respondents, 40 of 95 (42%) defined TPs as "third most common pattern" and 55 (58%) as "minor pattern/less than 5% of tumor." In a tumor with pattern 3 and less than 5% pattern 4, of the 95 respondents, 35 (37%) assigned 3 + 3 = 6 with TP4, while 56 (59%) assigned 3 + 4 = 7. In a tumor with pattern 4 and less than 5% pattern 5, of the 95 respondents, 51 (54%) assigned 4 + 4 = 8 with TP5, while 43 (45%) assigned 4 + 5 = 9. Six scenarios were presented in which the order of most common patterns was 3, 4, and 5 (Group 1) or 4, 3, and 5 (Group 2) with varying percentages. In both groups, when pattern 5 was less than 5%, we found that 98% and 93% of respondents would assign 3 + 4 = 7 or 4 + 3 = 7 with TP5. In scenarios with 15% or 25% pattern 5, most respondents (70% and 80%, respectively) would include pattern 5 as the secondary grade, that is, 3 + 5 = 8 (Group 1) or 4 + 5 = 9 (Group 2). For 85 of 95 (89%), a TP would not impact Grade Group assignment.
CONCLUSIONS.—: This survey highlights substantial variation in practice patterns regarding definition and application of "tertiary" grading in radical prostatectomy specimens. High consistency was observed in 3 + 4 = 7/4 + 3 = 7 scenarios with truly minor pattern 5. These findings should inform future studies assessing the standardization and predictive value of "tertiary" patterns.
在前列腺癌中，“三级”高级别模式（TPs）与根治性前列腺切除术后的生化复发有关。
确定在一系列分级情况下，TPs 的定义和应用存在差异。
向 105 名经验丰富的泌尿科病理学家发送了关于各种分级情况下 TPs 的在线调查。
在 95 名回复者中，40 名（42%）将 TPs 定义为“第三常见模式”，55 名（58%）定义为“次要模式/小于肿瘤的 5%”。在具有模式 3 且小于 5%模式 4 的肿瘤中，95 名回复者中有 35 名（37%）将 3 + 3 = 6 分配给 TP4，而 56 名（59%）将 3 + 4 = 7 分配给 TP4。在具有模式 4 且小于 5%模式 5 的肿瘤中，95 名回复者中有 51 名（54%）将 4 + 4 = 8 分配给 TP5，而 43 名（45%）将 4 + 5 = 9 分配给 TP5。呈现了六个场景，其中最常见模式的顺序为 3、4 和 5（第 1 组）或 4、3 和 5（第 2 组），并且百分比不同。在两组中，当模式 5 小于 5%时，我们发现 98%和 93%的回复者将用 3 + 4 = 7 或 4 + 3 = 7 分配给 TP5。在具有 15%或 25%模式 5 的场景中，大多数回复者（分别为 70%和 80%）将模式 5 作为次要分级，即 3 + 5 = 8（第 1 组）或 4 + 5 = 9（第 2 组）。对于 95 名中的 89%（85 名），TP 不会影响等级组的分配。
本调查突出了在根治性前列腺切除术后标本中，TP 的定义和应用方面存在着大量的实践模式差异。在真正较小的模式 5 情况下，3 + 4 = 7/4 + 3 = 7 场景中观察到了高度的一致性。这些发现应该为评估“三级”模式的标准化和预测价值的未来研究提供信息。
