Bostwick D G
Department of Pathology, Mayo Clinic, Rochester, Minnesota 55905.
Am J Surg Pathol. 1994 Aug;18(8):796-803. doi: 10.1097/00000478-199408000-00006.
The automated spring-loaded 18-gauge gun recently introduced for prostatic needle biopsy provides less than half the tissue of the traditional 14-gauge biopsy, possibly influencing the accuracy and predictive ability of biopsy tumor grade. In order to determine the value of tumor grade in contemporary needle biopsy specimens, we compared grade in 316 biopsies with matched whole-mounted radical retropubic prostatectomy specimens according to Gleason primary pattern, Gleason secondary pattern, Gleason score, percent of Gleason patterns 4 and 5, and nuclear grade. Biopsy grading accuracy was correlated with rates of capsular perforation, seminal vesicle invasion, pelvic lymph node metastasis, serum prostate specific antigen level, prostatic volume, prostatic weight, cancer volume, perineural invasion, DNA ploidy, and pathologic stage. The greatest grading error was encountered with low-grade tumors; there was no correlation of grading error with clinical staging error or other pathologic factors. Significant differences were noted between biopsy and prostatectomy for Gleason primary pattern, secondary pattern, and score. The percent of poorly differentiated carcinoma (Gleason patterns 4 and 5) in biopsies and prostatectomies showed a moderate positive correlation. The results indicate that the accuracy of 18-gauge needle biopsy in predicting tumor grade in the prostatectomy is similar to that reported with 14-gauge biopsies. Based on these findings, we recommend that the Gleason score (sum of primary and secondary patterns) be employed in all needle biopsies, recognizing that the accuracy of grade is decreased in cases with low-grade cancer and small amounts of cancer.
最近推出的用于前列腺穿刺活检的自动弹簧加载18号活检枪所获取的组织量不到传统14号活检的一半，这可能会影响活检肿瘤分级的准确性和预测能力。为了确定当代穿刺活检标本中肿瘤分级的价值，我们根据Gleason主要模式、Gleason次要模式、Gleason评分、Gleason 4级和5级模式的百分比以及核分级，将316例活检标本的分级与配对的完整耻骨后根治性前列腺切除术标本进行了比较。活检分级准确性与包膜穿孔率、精囊侵犯、盆腔淋巴结转移、血清前列腺特异性抗原水平、前列腺体积、前列腺重量、癌体积、神经周围侵犯、DNA倍体和病理分期相关。低级别肿瘤的分级误差最大；分级误差与临床分期误差或其他病理因素无关。活检与前列腺切除术在Gleason主要模式、次要模式和评分方面存在显著差异。活检和前列腺切除术中低分化癌（Gleason 4级和5级模式）的百分比呈中度正相关。结果表明，18号穿刺活检在预测前列腺切除术中肿瘤分级的准确性与14号活检报告的准确性相似。基于这些发现，我们建议在所有穿刺活检中采用Gleason评分（主要和次要模式之和），同时认识到在低级别癌和少量癌的病例中分级准确性会降低。
