Department of Pathology, Peking University Third Hospital, Peking University Health Science Center, Beijing, China.
Department of Urology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Virchows Arch. 2021 Mar;478(3):383-391. doi: 10.1007/s00428-020-03009-x. Epub 2021 Jan 6.
Discontinuous tumor involvement (DTI) is a not uncommon finding in the tumor in prostate needle core biopsies undertaken for diagnosis of prostate cancer (PCa). The objective of this review is to establish a clear definition of DTI in order to provide a standardized method of measurement which reliably reflects pathologic features and disease progression following radical prostatectomy (RP). A systematic literature search was performed using PubMed up to March 2020 to identify studies of PCa patients which included needle biopsies containing DTI and matched subsequent RP treatment with or without follow-up information. The methodology and quality of reporting of DTI are reviewed, compared, and summarized. DTI is a frequent finding in diagnostic biopsy for PCa (up to 30%). Six studies were compared by methods of measurement used for predicting pathologic features and outcomes which are observed in subsequent RP. In most cases with DTI (> 90%), intervening benign tissue in the tumor core was less than 5 mm. DTI found in the biopsy was likely to be associated with a single, irregular tumor nodule going in and out of the plane of the section, but DTI was not associated with multiple small foci of the tumor. Immunohistochemistry (IHC) also demonstrated that about 75% of cases of DTI shared an IHC profile which supports the concept that DTI most likely comes from a homogeneous tumor nodule. Furthermore, DTI was associated with positive surgical margin (PSM) and bilateral tumor in RP specimens. Compared to additive measurement (with the subtraction of intervening benign tissue), linear measurement (including intervening benign tissue) of DTI was more accurately predictive of aggressive disease in the RP including higher pT stage, PSM, and greater actual extent of the tumor. However, the advantage of linear measurement was lost in cases where there was an upgrade from the biopsy to the RP which may result from undersampling. For cases with either very small tumor foci or very extensive cancer volume, no difference was observed in these two methods of measurement. DTI in core biopsies may represent undersampling of a larger irregular nodule but likely does not result from multifocality and is similarly unlikely to represent multiclonality. Linear measurement of DTI was more accurately predictive of post-RP pathologic findings and oncologic prognosis. This method should be applied for patient selection for AS.
肿瘤内不连续累及（DTI）是在前列腺针芯活检中诊断前列腺癌（PCa）时常见的一种现象。本综述的目的是建立 DTI 的明确定义，以便提供一种标准化的测量方法，该方法能够可靠地反映前列腺根治性切除术（RP）后的病理特征和疾病进展。使用 PubMed 进行了系统的文献检索，截至 2020 年 3 月，以确定包含 DTI 的 PCa 患者的研究，并对包含 DTI 的针芯活检进行了匹配，随后对是否进行 RP 治疗以及是否有随访信息进行了匹配。本文回顾、比较和总结了 DTI 的方法学和报告质量。DTI 在诊断性前列腺活检中很常见（高达 30%）。通过比较用于预测后续 RP 中观察到的病理特征和结果的测量方法，对 6 项研究进行了比较。在大多数 DTI （> 90%）的情况下，肿瘤核心内的良性组织间隔小于 5mm。活检中发现的 DTI 可能与单个不规则肿瘤结节进出切片平面有关，但 DTI 与肿瘤的多个小结节无关。免疫组织化学（IHC）也表明，大约 75%的 DTI 病例具有支持 DTI 最有可能来自同质肿瘤结节的 IHC 特征。此外，DTI 与 RP 标本中的阳性手术切缘（PSM）和双侧肿瘤有关。与附加测量（减去良性组织间隔）相比，线性测量（包括良性组织间隔）的 DTI 更准确地预测 RP 中的侵袭性疾病，包括更高的 pT 分期、PSM 和更大的肿瘤实际范围。然而，在从活检到 RP 升级的情况下，线性测量的优势丧失，这可能是由于取样不足造成的。对于肿瘤灶非常小或癌体积非常大的病例，这两种测量方法没有差异。活检中的 DTI 可能代表较大不规则结节的取样不足，但不太可能是多灶性的，也不太可能代表多克隆性。DTI 的线性测量更准确地预测 RP 后的病理发现和肿瘤学预后。这种方法应该用于 AS 的患者选择。
