Garnett J E, Oyasu R, Grayhack J T
J Urol. 1984 Apr;131(4):690-3. doi: 10.1016/s0022-5347(17)50583-2.
We reviewed the tissue histology of 115 patients with clinically localized carcinoma to determine the correlation between tumor grades in the biopsy and the prostatectomy specimen. Gleason's primary and secondary pattern score systems were used, and each specimen was graded on a scale of 2 to 10 by a referee pathologist in a blind fashion. If the difference in the summed primary and secondary grades in the 2 specimens was no more than 1 grade, the discrepancy was regarded as insignificant. In all but 32 cases initial diagnostic biopsy specimens predicted accurately the final prostatectomy specimen score. The discrepancy was 3 grades in 7 cases and 2 grades in 25 cases. As a result, the lesions in 19 cases were changed from a well differentiated (2 to 4), a moderately differentiated (5 to 7) or a poorly differentiated (8 to 10) lesion to another of these categories. The lesions were upgraded from a well differentiated to a moderately differentiated category in 9 cases and from a moderately to a poorly differentiated category in 4 cases. The lesions were downgraded from a moderately differentiated to a well differentiated category in 6 cases. In 13 other cases the discrepancy was 2 but the lesion remained within the moderately differentiated group. Although in 19 cases the cancerous tissue occupied less than 10 per cent of the biopsy specimen, accurate prediction could be made in 16. The results indicate that diagnostic biopsy specimens will predict the grade of the primary tumor in a majority (72 per cent) but not all of the cases.
我们回顾了115例临床局限性癌患者的组织组织学，以确定活检和前列腺切除标本中肿瘤分级之间的相关性。采用Gleason的主要和次要模式评分系统，由一名裁判病理学家以盲法对每个标本进行2至10分的分级。如果两个标本的主要和次要分级总和差异不超过1级，则认为差异不显著。除32例病例外，初始诊断活检标本准确预测了最终前列腺切除标本的评分。7例差异为3级，25例差异为2级。结果，19例病变从高分化（2至4级）、中分化（5至7级）或低分化（8至10级）病变转变为另一类病变。9例病变从高分化升级为中分化，4例从中分化升级为低分化。6例病变从中分化降级为高分化。在其他13例病例中，差异为2级，但病变仍处于中分化组。尽管在19例病例中癌组织占活检标本的比例不到10%，但其中16例仍可做出准确预测。结果表明，诊断活检标本能在大多数（72%）但并非所有病例中预测原发肿瘤的分级。
