Joint Pathology Center, Silver Spring, MD, USA.
University of Maryland Medical Center, Baltimore, MD, USA.
Int J Surg Pathol. 2020 Aug;28(5):490-495. doi: 10.1177/1066896920907690. Epub 2020 Feb 19.
. The criteria for "active surveillance" depend in part on quantification of tumor extent and grade on prostate biopsies. It is known that false-negative biopsies may occur from incomplete sectioning of cores within the paraffin blocks. . We retrospectively analyzed a prostate biopsy series, which were subjected to a second round of sections, in order to determine the rate of missed cancers. . Of 1324 sets of prostate biopsies, 4.5% (60) showed additional involved cores or higher grade tumor on recut sections. In 27 patients (2.0%), the changed diagnosis resulted in a potential mild increase in National Comprehensive Cancer Network (NCCN) risk, from negative to very low (12), very low to low (12), and low to favorable intermediate (3). In 3 patients (0.2%), the changed diagnosis resulted in a significant increase in NCCN risk. Comparison of the initial sets of slides to the recuts demonstrated areas of absent tissue in many of the cases in which tumor segments were missed. In 2/3 cases with the significant grade increase, gaps were present in one that should have alerted the pathologist to incomplete sections, and the tumor was fragmented at the edge of the core appearing incompletely sampled. . A significant increase in risk was seen in this study in 0.2% of patients when blocks were recut for further sampling, with minor increases in 2%. While embedding issues only rarely resulted in clinically significant sampling error, the 3 significantly underdiagnosed cases underscore the need for pathologists to be alert to incomplete sections of prostate cores.
. “主动监测”的标准部分取决于前列腺活检中肿瘤程度和分级的量化。众所周知，由于石蜡块内的核心部分切割不完整，可能会出现假阴性活检。. 我们回顾性分析了一组前列腺活检，这些活检进行了第二轮切片，以确定遗漏癌症的比率。. 在 1324 组前列腺活检中，有 4.5%（60 例）在重新切割的切片上显示出更多受累的核心或更高分级的肿瘤。在 27 名患者（2.0%）中，改变的诊断导致国家综合癌症网络（NCCN）风险略有增加，从阴性变为极低（12 例）、极低变为低（12 例）和低变为有利的中等（3 例）。在 3 名患者（0.2%）中，改变的诊断导致 NCCN 风险显著增加。将初始切片与重切进行比较，在许多肿瘤段被遗漏的情况下，许多病例中都存在组织缺失区域。在 2/3 例分级显著增加的病例中，有一个病例存在间隙，这应该提醒病理学家存在不完整的切片，肿瘤在核心的边缘呈碎片状，似乎没有完全取样。. 在这项研究中，当重新切割样本以进一步取样时，有 0.2%的患者风险显著增加，有 2%的患者风险略有增加。虽然嵌入问题很少导致临床显著的取样误差，但 3 例明显漏诊的病例强调了病理学家需要警惕前列腺核心部分的不完整切片。
