Lane R B, Lane C G, Mangold K A, Johnson M H, Allsbrook W C
Department of Pathology, Medical College of Georgia, Augusta 30912-3605, USA.
Arch Pathol Lab Med. 1998 Sep;122(9):833-5.
The automated biopsy gun and increased screening for adenocarcinoma of the prostate have led to increased numbers of biopsies with only tiny foci of prostatic carcinoma. Consequently, the risk of failing to sample a small focus of carcinoma histologically has increased as well. Most pathologists routinely sample prostatic needle biopsies at more than 1 level. An expert panel has recently suggested that prostatic needle biopsies be sampled at at least 2 levels. However, there have been no studies measuring the amount of additional tissue sampled by multiple levels versus 1 level.
Forty-two prostatic needle biopsies were serially sectioned at 4-microm levels. Hematoxylin-eosin-stained slides were prepared from every fifth section. The total length of each biopsy was compared with the length sampled by 1 level (50% through the block) and 3 levels (25%, 50%, and 75% through the block).
Sampling the tissue at 1 level missed an average of 23.4% of the total biopsy length. Sampling the tissue at 3 levels significantly improved this average to 7% (P = .0001).
This study shows that a single histologic section of a prostatic needle biopsy often fails to sample a significant portion of available tissue. This could occasionally result in failure to sample a small focus of prostatic carcinoma. The authors recommend that prostatic needle biopsies be routinely sampled at 3 levels (approximately 25%, 50%, and 75% through the block).
自动活检枪的应用以及前列腺腺癌筛查的增加，导致仅发现微小前列腺癌灶的活检数量增多。因此，在组织学上未能取到小癌灶样本的风险也相应增加。大多数病理学家常规对前列腺穿刺活检在一个以上层面取材。一个专家小组最近建议前列腺穿刺活检至少在两个层面取材。然而，尚无研究测量多层面取材与单层面取材相比所增加的组织量。
42例前列腺穿刺活检标本连续切成4微米厚的切片。每隔5张切片制备苏木精-伊红染色玻片。将每个活检标本的总长度与单层面（通过组织块的50%）和三层面（通过组织块的25%、50%和75%）取材的长度进行比较。
单层面取材平均遗漏活检标本总长度的23.4%。三层面取材可将这一平均值显著改善至7%（P = 0.0001）。
本研究表明，前列腺穿刺活检的单张组织学切片常常无法取到相当一部分可用组织。这偶尔可能导致未能取到小的前列腺癌灶样本。作者建议前列腺穿刺活检常规在三个层面取材（通过组织块约25%、50%和75%处）。
