Current Perspectives on the Gleason Grading of Prostate Cancer
Current Perspectives on the Gleason Grading of Prostate Cancer
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DOI：
10.1043/1543-2165-133.11.1810
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发表时间：
2009-11-01
影响因子：
4.6
通讯作者：
Shah, Rajal B.
中科院分区：
文献类型：
--
作者：
Shah, Rajal B.
上下文。自1966年由Donald Gleason提出以来，Gleason分级一直是前列腺癌诊断和治疗的基石。随着前列腺特异性抗原筛查的广泛应用，前列腺癌的诊断和治疗模式发生了巨大的变化。此外，更好地了解前列腺癌的形态谱及其随后的结果，促进了分级标准和报告实践的细化，适用于当代实践管理。-介绍前列腺癌Gleason分级的当代观点和方法。数据源。-个人实践经验，医学文献综述，摘自2005年国际泌尿外科病理学会关于前列腺癌Gleason分级的共识声明。-本综述论述了当代实践中分级转变的趋势，很少使用Gleason模式1和2，并讨论了Gleason模式3和4的组织学标准的改进；前列腺癌异常形态变异的Gleason分级方法高等第三系模式意义5；以及在根治性前列腺切除术中报告扩展多核活检和多灶性前列腺癌的实践建议。最后，讨论了共识建议在当前实践中的影响、局限性和缺陷。（Arch Pathol Lab Med. 2009; 133: 1810-1816）
Context.-Since its description in 1966 by Donald Gleason, the Gleason grading has remained a cornerstone in the diagnosis and management of prostate cancer. With widespread use of the prostate specific antigen screening, the diagnosis and management patterns of prostate cancers have dramatically changed. In addition, better understanding of the morphologic spectrum of prostate cancer and its subsequent outcome have prompted the refinement of the grading criteria and reporting practices applicable to contemporary practice management.Objective.-To present contemporary perspectives and approaches to the Gleason grading of prostate cancer.Data Sources.-Personal practice experience, review of medical literature, and excerpts from the 2005 International Society of Urological Pathology Consensus Statement on Gleason Grading of Prostate Cancer.Conclusions.-This review addresses the trend in contemporary practice toward a grading shift, with rare utilization of Gleason patterns 1 and 2, and discusses the refinement of histologic criteria for Gleason patterns 3 and 4; approaches to Gleason grading in the setting of unusual variant morphologies of prostate cancer; significance of higher tertiary pattern 5; and practice recommendations for reporting in the setting of extended multiple core biopsies and multifocal prostate cancers in radical prostatectomy. Finally, the impact of consensus recommendations in current practice, its limitations and pitfalls, are also addressed. (Arch Pathol Lab Med. 2009; 133: 1810-1816)