Contemporary Gleason Grading of Prostatic Carcinoma An Update With Discussion on Practical Issues to Implement the 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma
Contemporary Gleason Grading of Prostatic Carcinoma An Update With Discussion on Practical Issues to Implement the 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma
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DOI：
10.1097/pas.0000000000000820
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发表时间：
2017-04-01
影响因子：
5.6
通讯作者：
Humphrey, Peter A.
中科院分区：
文献类型：
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作者：
Epstein, Jonathan I.;Amin, Mahul B.;Humphrey, Peter A.
2014年国际泌尿病理学会分级会议主要会议论文集于2015年及时出版，内容涉及：（1）普通腺泡癌各种分级模式的定义，（2）导管内癌的分级； (3) 支持之前提议的新级别组。当前的手稿除了强调实施 2014 年建议的实际问题外，还根据 2014 年会议后发表的大量研究提供了最新的观点。 2014 年共识会议提出的一项重要新建议是报告针刺活检和根治性前列腺切除术 (RP) 标本中格里森评分为 7 的百分比模式 4。本手稿提供了如何记录百分比模式 4 以及在哪些情况下可能不需要记录此信息的选项。 2014年会议的另一个共识是用小高级模式取代“三级模式”。次要高级表明术语“第三级”不应该仅仅是第三个最常见的模式，而且它应该是次要的或范围有限的。尽管 2014 年共识会议并未对 5% 的具体界限进行投票，但与结果相关的基于证据的数据文献中使用的对次要高级模式的唯一量化是 5% 的界限。在 2014 年共识会议上，一致同意遵循 2005 年共识会议中提出的关于针刺活检的分级规则，不使用三级，并且将最常见和最高的分级模式汇总在一起作为格里森评分。因此，术语“三级”或“次要高等级模式”仅适用于存在 3 个等级模式的 RP 样本，例如 3 + 4 = 7 或 4 + 3 = 7 且格里森模式 5 < 5%。 2014 年会议建议，在可预见的将来，新的等级组将与格里森系统一起报告。次要高等级模式不会改变年级组，例如，在当前实践中，人们会报告格里森分数 3 + 4 = 7（年级组 2）和次要（高等教育）模式 5。在 2014 年共识会议上讨论了如果年级组 1 至 5 最终取代格里森分数 2 至 10，将如何处理次要高年级模式。在上面的示例中，可以将其报告为年级组 2具有较小的高等级模式，或者可能可以缩写为 2+ 等级组。 2014 年会议的建议与 2005 年对不同等级的单独核心进行分级的共识相同：只要核心在单独的容器中提交或核心在同一容器中但由泌尿科医师指定其位置（即通过不同颜色的墨水），则将单独的格里森分数分配给单独的核心。本手稿的大多数作者的做法是，如果核心以更具体的解剖方式提交，而不仅仅是左与右（即每个六分仪部位、MRI 目标等），那么来自该特定部位的同一个罐子中的多个核心的等级将被平均在一起，因为它们来自前列腺内的同一位置。如果一个罐子中有多个碎片核心，则一致同意为该罐子提供全局格里森评分。 2014 年会议的建议与 2005 年关于对 RP 标本中的单独癌症结节进行分级的共识相同：应为每个主要结节分配单独的格里森评分。在不寻常出现较高阶段的非主要结节（即较小结节）的情况下，还应为该结节分配一个等级。如果较小结节之一是前列腺内最高级别的病灶，则还应记录该较小结节的级别。研究和会议后发表的研究中出现的一个新问题是，与形状不良或融合的腺体相比，筛状形态与较差的预后相关，并且在未来可能会被具体纳入分级实践中。我们相信，2014 年共识会议的结果和本文提供的更新对于我们的专业促进前列腺癌分级报告和当代前列腺癌治疗的统一性至关重要。
The primary proceedings of the 2014 International Society of Urological Pathology Grading Conference were published promptly in 2015 and dealt with: (1) definition of various grading patterns of usual acinar carcinoma, (2) grading of intraductal carcinoma; and (3) support for the previously proposed new Grade Groups. The current manuscript in addition to highlighting practical issues to implement the 2014 recommendations, provides an updated perspective based on numerous studies published after the 2014 meeting. A major new recommendation that came from the 2014 Consensus Conference was to report percent pattern 4 with Gleason score 7 in both needle biopsies and radical prostatectomy (RP) specimens. This manuscript gives the options how to record percentage pattern 4 and under which situations recording this information may not be necessary. Another consensus from the 2014 meeting was to replace the term tertiary-grade pattern with minor high-grade pattern. Minor high-grade indicates that the term tertiary should not merely be just the third most common pattern but that it should be minor or limited in extent. Although a specific cutoff of 5% was not voted on in the 2014 Consensus meeting, the only quantification of minor high-grade pattern that has been used in the literature with evidence-based data correlating with outcome has been the 5% cutoff. At the 2014 Consensus Conference, there was agreement that the grading rule proposed in the 2005 Consensus Conference on needle biopsies be followed, that tertiary be not used, and that the most common and highest grade patterns be summed together as the Gleason score. Therefore, the term tertiary or minor high-grade pattern should only be used in RP specimens when there are 3 grade patterns, such as with 3 + 4 = 7 or 4 + 3 = 7 with < 5% Gleason pattern 5. It was recommended at the 2014 Conference that for the foreseeable future, the new Grade Groups would be reported along with the Gleason system. The minor high-grade patterns do not change the Grade Groups, such that in current practice one would, for example, report Gleason score 3 + 4 = 7 (Grade Group 2) with minor (tertiary) pattern 5. It was discussed at the 2014 Consensus Conference how minor high-grade patterns would be handled if Grade Groups 1 to 5 eventually were to replace Gleason scores 2 to 10. In the above example, it could be reported as Grade Group 2 with minor high-grade pattern or potentially this could be abbreviated to Grade Group 2+. The recommendation from the 2014 meeting was the same as in the 2005 consensus for grading separate cores with different grades: assign individual Gleason scores to separate cores as long as the cores were submitted in separate containers or the cores were in the same container yet specified by the urologist as to their location (ie, by different color inks). It is the practice of the majority of the authors of this manuscript that if the cores are submitted in a more specific anatomic manner than just left versus right (ie, per sextant site, MRI targets, etc.), that the grade of multiple cores in the same jar from that specific site are averaged together, given they are from the same location within the prostate. In cases with multiple fragmented cores in a jar, there was agreement to give a global Gleason score for that jar. The recommendation from the 2014 meeting was the same as in the 2005 consensus for grading separate nodules of cancer in RP specimens: one should assign a separate Gleason score to each dominant nodule(s).In the unusual occurrence of a nondominant nodule (ie, smaller nodule) that is of higher stage, one should also assign a grade to that nodule. If one of the smaller nodules is the highest grade focus within the prostate, the grade of this smaller nodule should also be recorded. An emerging issue in the studies and those published subsequent to the meeting was that cribriform morphology is associated with a worse prognosis than poorly formed or fused glands and in the future may be specifically incorporated into grading practice. We believe that the results from the 2014 Consensus Conference and the updates provided in this paper are vitally important to our specialty to promote uniformity in reporting of prostate cancer grade and in the contemporary management of prostate cancer.