Bostwick D G, Qian J, Frankel K
Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 1995 Nov;154(5):1791-4.
High grade prostatic intraepithelial neoplasia is the most likely precursor of invasive prostate cancer. The identification of prostatic intraepithelial neoplasia in needle biopsy specimens warrants repeat biopsy because of its high predictive value for cancer. The incidence of prostatic intraepithelial neoplasia in contemporary needle biopsies is unknown.
To determine the incidence of patients requiring repeat needle biopsy because of abnormal findings in needle aspirations (high grade prostatic intraepithelial neoplasia and microscopic foci suspicious for but not diagnostic of malignancy), we compared the pathological findings in 400 prostatic needle biopsies, including 200 consecutive cases from an academic medical center (Mayo Clinic) and an equal number from a private practice laboratory (Glendale Memorial Hospital and Health Center).
The biopsies revealed similar findings from the 2 medical centers: benign prostatic tissue in 41.5 to 50% of the cases, prostatic intraepithelial neoplasia in 16.5 to 9.5%, foci suspicious for but not diagnostic of malignancy in 1.5 to 2.5% and cancer in 40.5 to 38% (Mayo Clinic versus Glendale Memorial, respectively). Clinical information was available from the 200 Mayo Clinic patients who underwent biopsy, and there was no difference in the distribution of findings by digital rectal examination or transrectal ultrasound, although the median serum prostate specific antigen concentration was higher in patients with prostatic intraepithelial neoplasia and cancer than in those with benign biopsies.
High grade prostatic intraepithelial neoplasia is a frequent finding in needle biopsies and is present in up to 16.5% of the cases. There was no apparent difference in the incidence of prostatic intraepithelial neoplasia and cancer between 2 geographically diverse medical centers. Up to 18% of patients are candidates for another biopsy based on needle biopsy findings of prostatic intraepithelial neoplasia or foci suspicious for but not diagnostic of malignancy.
高级别前列腺上皮内瘤变是浸润性前列腺癌最可能的前驱病变。由于其对癌症具有较高的预测价值，在针吸活检标本中识别出前列腺上皮内瘤变需要重复活检。当代针吸活检中前列腺上皮内瘤变的发生率尚不清楚。
为了确定因针吸异常结果（高级别前列腺上皮内瘤变和可疑但不能诊断为恶性肿瘤的微小病灶）而需要重复针吸活检的患者发生率，我们比较了400例前列腺针吸活检的病理结果，其中包括来自一家学术医疗中心（梅奥诊所）的200例连续病例以及来自一家私人执业实验室（格伦代尔纪念医院和健康中心）的同等数量病例。
两个医疗中心的活检显示出相似的结果：41.5%至50%的病例为良性前列腺组织，16.5%至9.5%为前列腺上皮内瘤变，1.5%至2.5%为可疑但不能诊断为恶性肿瘤的病灶，40.5%至38%为癌症（分别为梅奥诊所和格伦代尔纪念医院）。可获取接受活检的200例梅奥诊所患者的临床信息，尽管前列腺上皮内瘤变和癌症患者的血清前列腺特异性抗原浓度中位数高于活检为良性的患者，但通过直肠指检或经直肠超声检查，结果分布并无差异。
高级别前列腺上皮内瘤变在针吸活检中是常见发现，高达16.5%的病例存在该病变。两个地理位置不同的医疗中心之间，前列腺上皮内瘤变和癌症的发生率没有明显差异。基于前列腺上皮内瘤变或可疑但不能诊断为恶性肿瘤的针吸活检结果，高达18%的患者需要再次活检。
