Lesions missed on prostate biopsies in cases sent in for consultation
Lesions missed on prostate biopsies in cases sent in for consultation
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DOI：
10.1002/pros.10182
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发表时间：
2003-03-01
期刊：
影响因子：
2.8
通讯作者：
Epstein, JI
中科院分区：
文献类型：
--
作者：
Kronz, JD;Milord, R;Epstein, JI
背景资料。目前还没有关于前列腺针活检遗漏病变的频率的报告。方法：研究方法。在10个月的时间里，8/99到5/00，3,251例前列腺活检病例在会诊中被看到。结果：我们发现87例(2.7%)患者遗漏了病变(n=9家学术医院，n=44家社区医院，n=34家商业实验室)。总体而言，87名患者中有119个病灶被遗漏。漏诊的病变有：疑似癌症的小非典型腺体(35例41个病变)、前列腺癌(32例39个病变)、高级别前列腺上皮内瘤变(HGPIN)(30例34个病变)、HGPIN伴邻小非典型腺体(5例5个病变)--一些男性有不止一种类型的漏诊病变。对遗漏的病变的检测将导致：3251名患者中的15名(0.5%)的护理发生明确变化，或17名(0.5%)患者的护理可能发生变化(双侧癌症与单侧癌症；HGPIN与非典型癌症)。在21例(24%)的病例中，在我们医院会诊之前，至少有两位病理学家看到了切片。结论：尽管在以会诊为基础的前列腺活检人群中，遗漏病变的前列腺活检的数量相对较高(2.7%)，但遗漏病变的检测只会影响0.5%的所有患者的治疗方式的确定改变或另外0.5%的患者可能的治疗方式的改变。我们的数据低估了遗漏的病变，因为在41%的病例中，整个标本没有提交审查。虽然我们遗漏病变的发生率在一定程度上说明了问题的严重性，但不能将其等同于未选定病例中遗漏病变的风险。前列腺54：310-314,2003。(C)2003年Wiley-Liss，Inc.
BACKGROUND. There are no reports on how often lesions are missed on prostate needle biopsies. METHODS. Over a 10-month period, 8/99 to 5/00,3,251 prostate biopsy cases were seen in consultation.RESULTS. We identified 87 (2.7%) patients with missed lesions (n = 9 academic hospitals; n = 44 community hospitals; n = 34 commercial labs). Overall, 119 lesions were missed in 87 patients. Missed lesions were as follows: small atypical glands suspicious for cancer (41 lesions in 35 patients), prostatic adenocarcinoma (39 cancers in 32 patients), high grade prostatic intraepithelial neoplasia (HGPIN) (34 lesions in 30 patients), and HGPIN with adjacent small atypical glands (five lesions in five patients)-some men with more than one type of missed lesion. Detection of the missed lesions would have resulted in either: a definite change in care in 15 of 3,251 (0.5%) patients or a possible change in care (bilateral cancer vs. unilateral cancer; HGPIN vs. atypical) in 17 (0.5%) patients. In 21 (24%) of the cases, the slides were seen by at least two pathologists prior to consultation at our hospital.CONCLUSIONS. Although the number of prostate biopsies with missed lesions in a consult-based population of prostate biopsies appears relatively high (2.7%), the detection of the missed lesions would have only effected a definite change in care in 0.5% of all patients or a possible change in care in another 0.5% of patients. Our data underestimates missed lesions, as the entire specimen was not submitted for review in 41% of cases. Although our incidence of missed lesions gives some indication as to the magnitude of the problem, it cannot be equated with the risk of missing lesions in unselected cases. Prostate 54: 310-314, 2003. (C) 2003 Wiley-Liss, Inc.