Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Pathology and Lab Medicine, University of Calgary and Alberta Precision Labs, Calgary, AB, Canada.
Urol Oncol. 2021 May;39(5):295.e1-295.e8. doi: 10.1016/j.urolonc.2020.08.027. Epub 2020 Sep 15.
To survey urologic clinicians regarding interpretation of and practice patterns in relation to emerging aspects of prostate cancer grading, including quantification of high-grade disease, cribriform/intraductal carcinoma, and impact of magnetic resonance imaging-targeted needle biopsy.
The Genitourinary Pathology Society distributed a survey to urology and urologic oncology-focused societies and hospital departments. Eight hundred and thirty four responses were collected and analyzed using descriptive statistics.
Eighty percent of survey participants use quantity of Gleason pattern 4 on needle biopsy for clinical decisions, less frequently with higher Grade Groups. Fifty percent interpret "tertiary" grade as a minor/<5% component. Seventy percent of respondents would prefer per core grading as well as a global/overall score per set of biopsies, but 70% would consider highest Gleason score in any single core as the grade for management. Seventy five percent utilize Grade Group terminology in patient discussions. For 45%, cribriform pattern would affect management, while for 70% the presence of intraductal carcinoma would preclude active surveillance.
This survey of practice patterns in relationship to prostate cancer grading highlights similarities and differences between contemporary pathology reporting and its clinical application. As utilization of Gleason pattern 4 quantification, minor tertiary pattern, cribriform/intraductal carcinoma, and the incorporation of magnetic resonance imaging-based strategies evolve, these findings may serve as a basis for more nuanced communication and guide research efforts involving pathologists and clinicians.
调查泌尿科临床医生对前列腺癌分级中新兴方面的解读和实践模式，包括高级别疾病、筛状/管内癌的量化以及磁共振成像靶向活检的影响。
泌尿生殖病理学会向泌尿科和泌尿科肿瘤学专业的学会和医院科室分发了一份调查。共收集了 834 份回复，并使用描述性统计进行了分析。
80%的调查参与者根据活检中 Gleason 模式 4 的数量做出临床决策，而对于较高的分级组则较少使用。50%的人将“三级”解读为次要成分/<5%。70%的受访者希望对每根核心进行分级，并对每一组活检进行整体/总体评分，但 70%的人会将任何单个核心中最高的 Gleason 评分作为管理的等级。75%的人在患者讨论中使用分级组术语。对于 45%的人来说，筛状模式会影响管理，而对于 70%的人来说，管内癌的存在会排除主动监测。
这项关于前列腺癌分级实践模式的调查突出了当代病理报告与其临床应用之间的相似点和差异。随着对 Gleason 模式 4 量化、次要三级模式、筛状/管内癌的使用以及基于磁共振成像策略的整合的不断发展，这些发现可以为更细致的沟通提供依据，并指导涉及病理学家和临床医生的研究工作。
