Section of Pathology, Department of Molecular and Translational Medicine, University of Brescia, Brescia 25121, Italy.
Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona 37126, Italy.
Asian J Androl. 2024 Nov 1;26(6):575-581. doi: 10.4103/aja202440. Epub 2024 Sep 10.
A crucial aspect of prostate cancer grading, especially in low- and intermediate-risk cancer, is the accurate identification of Gleason pattern 4 glands, which includes ill-formed or fused glands. However, there is notable inconsistency among pathologists in recognizing these glands, especially when mixed with pattern 3 glands. This inconsistency has significant implications for patient management and treatment decisions. Conversely, the recognition of glomeruloid and cribriform architecture has shown higher reproducibility. Cribriform architecture, in particular, has been linked to the worst prognosis among pattern 4 subtypes. Intraductal carcinoma of the prostate (IDC-P) is also associated with high-grade cancer and poor prognosis. Accurate identification, classification, and tumor size evaluation by pathologists are vital for determining patient treatment. This review emphasizes the importance of prostate cancer grading, highlighting challenges like distinguishing between pattern 3 and pattern 4 and the prognostic implications of cribriform architecture and intraductal proliferations. It also addresses the inherent grading limitations due to interobserver variability and explores the potential of computational pathology to enhance pathologist accuracy and consistency.
前列腺癌分级的一个关键方面，特别是在低危和中危癌症中，是准确识别格里森 4 型腺体，其中包括形态不规则或融合的腺体。然而，病理学家在识别这些腺体方面存在显著的不一致性，尤其是当它们与 3 型腺体混合时。这种不一致性对患者的管理和治疗决策有重大影响。相反，肾小球样和筛状结构的识别显示出更高的可重复性。特别是，筛状结构与 4 型亚型中最差的预后相关。前列腺导管内癌 (IDC-P) 也与高级别癌症和预后不良相关。病理学家的准确识别、分类和肿瘤大小评估对于确定患者的治疗至关重要。本综述强调了前列腺癌分级的重要性，突出了区分 3 型和 4 型、筛状结构和管内增生的预后意义等挑战。它还探讨了由于观察者间变异性导致的内在分级限制，并研究了计算病理学提高病理学家准确性和一致性的潜力。
