Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Pathology Service, Champalimaud Clinical Center, Lisbon, Portugal.
Virchows Arch. 2019 Dec;475(6):735-744. doi: 10.1007/s00428-019-02666-x. Epub 2019 Oct 7.
Focal or non-focal/extensive extraprostatic extension of prostate carcinoma is an important pathologic prognostic parameter to be reported after radical prostatectomy. Currently, there is no agreement on how to measure and what are the best cutoff points to be used in practice. We hypothesized that digital microscopy would potentially provide more objective measurements of extraprostatic extension, thus better defining its clinical significance. To further our knowledge on digital prostate pathology, we evaluated the status of extraprostatic extension in 107 consecutive laparoscopic radical prostatectomy samples, using digital and conventional light microscopy. Mean linear and radial measurements of extraprostatic extension by digital microscopy significantly correlated to pT status (p = 0.022 and p = 0.050, respectively) but only radial measurements correlated to biochemical recurrence (p = 0.042) and grade groups (p = 0.022). None of the measurements, whether conventional or digital, were associated with lymph node status. Receiving operating characteristic analysis showed a potential cutoff point to assess linear measurements by conventional (< vs. > 24.21 mm) or digital microscopy (< vs. > 15 mm) or by radial measurement (< vs. > 1.6 mm). Finally, we observed an association between the number of paraffin blocks bearing EPE with pT (p = 0.041) status (digital microscopy), and linear measurements by conventional (p = 0.044) or digital microscopy (p = 0.045) with lymph node status. Reporting EPE measurements by digital microscopy, both linear and radial, and the number of paraffin blocks with EPE, might provide additional prognostic features after radical prostatectomy.
前列腺癌的局灶性或非局灶性/广泛的前列腺外扩展是根治性前列腺切除术后需要报告的重要病理预后参数。目前，对于如何测量以及在实践中使用哪些最佳截断值尚无共识。我们假设，数字显微镜可能会提供前列腺外扩展的更客观测量，从而更好地定义其临床意义。为了进一步了解数字前列腺病理学，我们使用数字和常规显微镜评估了 107 例连续腹腔镜根治性前列腺切除术样本中的前列腺外扩展情况。数字显微镜下前列腺外扩展的平均线性和径向测量值与 pT 状态显著相关（p=0.022 和 p=0.050），但只有径向测量值与生化复发（p=0.042）和分级组相关（p=0.022）。无论是常规还是数字测量，均与淋巴结状态无关。接收者操作特征分析显示，评估常规（< vs. >24.21mm）或数字显微镜（< vs. >15mm）线性测量值或通过径向测量值（< vs. >1.6mm）评估的潜在截断点。最后，我们观察到石蜡块上带有 EPE 的数量与 pT（p=0.041）状态（数字显微镜）之间存在关联，以及常规（p=0.044）或数字显微镜（p=0.045）线性测量值与淋巴结状态之间存在关联。通过数字显微镜报告 EPE 测量值，无论是线性还是径向，以及带有 EPE 的石蜡块数量，可能会在根治性前列腺切除术后提供额外的预后特征。
