前列腺活检中“恶性可疑”诊断对癌症的预测价值
Diagnosis of "suspicious for malignancy" in prostate biopsies: predictive value for cancer.
作者信息
Iczkowski K A, Bassler T J, Schwob V S, Bassler I C, Kunnel B S, Orozco R E, Bostwick D G
机构信息
Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
Urology. 1998 May;51(5):749-57; discussion 757-8. doi: 10.1016/s0090-4295(98)00109-5.
OBJECTIVES
Prostate needle biopsies occasionally contain an atypical small acinar proliferation (ASAP) that is suspicious for but not diagnostic of malignancy. The predictive value of ASAP for cancer has not been studied in a large series.
METHODS
To determine the reproducibility and clinical significance of ASAP in a large urologic reference laboratory, we retrospectively studied 295 patients with ASAP diagnosed from 1991 to 1995. Each patient had at least one follow-up biopsy. Mean patient age was 68.0 years (range 40 to 89). Numerous clinical and histologic features were assessed to determine their predictive value for malignancy on subsequent biopsy.
RESULTS
Adenocarcinoma was identified on follow-up biopsy in 125 patients (42%), with a median follow-up of 5.7 months (range 0.1 to 43). Gleason score varied from 4 to 9 (mean 6.2). Cumulative detection of 125 cancers was 90% after second biopsy and 99% after third biopsy. Serum prostate-specific antigen, digital rectal examination result, and patient age were not predictive of cancer on follow-up biopsy. Likewise, the number of biopsy cores and histologic findings including number of acini per focus of ASAP, number of foci of ASAP, degree of nuclear and nucleolar enlargement, and presence of luminal pink granular secretions, mucin, or crystalloids were not predictive of cancer. Stratifying our level of suspicion into three categories (favor benign, uncertain, and favor carcinoma) did not differentially predict subsequent cancer (44%, 44%, and 41% of patients, respectively; P = 0.86) nor the percentage of tissue involved by cancer. No clinical or pathologic feature affected the likelihood of subsequent cancer. In 39% of patients, cancer was only contralateral to or in a different sextant site from the initial ASAP site.
CONCLUSIONS
The high predictive value of ASAP for subsequent adenocarcinoma warrants repeat biopsy. Sampling should include multiple sites in the prostate.
目的
前列腺穿刺活检偶尔会发现非典型小腺泡增生（ASAP），其可疑为恶性但不能确诊。尚未在大量病例中研究ASAP对癌症的预测价值。
方法
为了确定ASAP在大型泌尿外科参考实验室中的可重复性和临床意义，我们回顾性研究了1991年至1995年诊断为ASAP的295例患者。每位患者至少进行了一次随访活检。患者平均年龄为68.0岁（范围40至89岁）。评估了众多临床和组织学特征，以确定它们对后续活检中恶性肿瘤的预测价值。
结果
125例患者（42%）在随访活检中确诊为腺癌，中位随访时间为5.7个月（范围0.1至43个月）。Gleason评分从4到9不等（平均6.2）。第二次活检后125例癌症的累计检出率为90%，第三次活检后为99%。血清前列腺特异性抗原、直肠指检结果和患者年龄不能预测随访活检中的癌症。同样，活检芯数量和组织学结果，包括每个ASAP病灶的腺泡数量、ASAP病灶数量、核及核仁增大程度以及腔内粉红色颗粒分泌物、黏液或晶体的存在，也不能预测癌症。将我们的怀疑程度分为三类（倾向良性、不确定和倾向癌）并不能差异预测后续癌症（分别为44%、44%和4l%的患者；P = 0.86），也不能预测癌症累及的组织百分比。没有临床或病理特征影响后续癌症的可能性。在39%的患者中，癌症仅与初始ASAP部位对侧或位于不同的象限部位。
结论
ASAP对后续腺癌的高预测价值值得重复活检。取样应包括前列腺的多个部位。
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