Diagnosis of "Poorly Formed Glands" Gleason Pattern 4 Prostatic Adenocarcinoma on Needle Biopsy An Interobserver Reproducibility Study Among Urologic Pathologists With Recommendations
Diagnosis of "Poorly Formed Glands" Gleason Pattern 4 Prostatic Adenocarcinoma on Needle Biopsy An Interobserver Reproducibility Study Among Urologic Pathologists With Recommendations
复制标题
DOI：
10.1097/pas.0000000000000457
复制
发表时间：
2015-10-01
影响因子：
5.6
通讯作者：
Shah, Rajal B.
中科院分区：
文献类型：
--
作者：
Zhou, Ming;Li, Jianbo;Shah, Rajal B.
前列腺癌（PCa）的Gleason模式（GP）4的准确识别对于患者的管理和诊断是至关重要的。形成不良的腺体是最常见的GP4亚型。我们研究了诊断的重复性和定量阈值的分级GP4不良形成的腺体和标准，以区分它们与切向切片GP3腺体。首先询问17位泌尿科病理学家，使用代表PCa腺体分化谱的病例来定义形成不良的腺体。一致认为没有或很少有管腔、细长压缩腺体和细长巢的癌腺体是形成不良的腺体。然后，参与者对第二组23例PCa病例进行评分，这些病例可能包含形成不良的腺体，观察者之间的一致性为0.34。共识诊断，定义为>70%的参与者的一致性，然后与每种情况下形成不良的腺体的定量（5，6至10，>10）和地形特征（群集，紧邻，并与其他形成良好的PCa腺体混合）相关。紧邻其他成形良好腺体的成形不良腺体（无论其数量如何）和5个成形不良腺体的小病灶（无论其位置如何）均未分级为GP 4。相反，大于10个不紧邻成形良好腺体的成形不良腺体的大病灶被分级为GP 4。分级不良形成的腺体是具有挑战性的。然而，一些形态学特征对于GP4诊断是可重复的。这项研究代表了一个重要的步骤，在标准化的基础上，定量和地形形态学特征的不良形成的腺体分级。
Accurate recognition of Gleason pattern (GP) 4 prostate carcinoma (PCa) on needle biopsy is critical for patient management and prognostication. Poorly formed glands are the most common GP4 subpattern. We studied the diagnostic reproducibility and the quantitative threshold of grading GP4 poorly formed glands and the criteria to distinguish them from tangentially sectioned GP3 glands. Seventeen urologic pathologists were first queried for the definition of poorly formed glands using cases representing a spectrum of PCa glandular differentiation. Cancer glands with no or rare lumens, elongated compressed glands, and elongated nests were considered poorly formed glands by consensus. Participants then graded a second set of 23 PCa cases that potentially contained poorly formed glands with a fair interobserver agreement (=0.34). The consensus diagnoses, defined as agreement by >70% participants, were then correlated with the quantitative (5, 6 to 10, >10) and topographic features of poorly formed glands (clustered, immediately adjacent to, and intermixed with other well-formed PCa glands) in each case. Poorly formed glands immediately adjacent to other well-formed glands regardless of their number and small foci of 5 poorly formed glands regardless of their location were not graded as GP4. In contrast, large foci of >10 poorly formed glands that were not immediately adjacent to well-formed glands were graded as GP4. Grading poorly formed glands is challenging. Some morphologic features are, however, reproducible for and against a GP4 diagnosis. This study represents an important step in standardization of grading of poorly formed glands based on quantitative and topographic morphologic features.