The Value of Mandatory Second Opinion Pathology Review of Prostate Needle Biopsy Interpretation Before Radical Prostatectomy
The Value of Mandatory Second Opinion Pathology Review of Prostate Needle Biopsy Interpretation Before Radical Prostatectomy
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DOI：
10.1016/j.juro.2010.03.021
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发表时间：
2010-07-01
影响因子：
6.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
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作者：
Brimo, Fadi;Schultz, Luciana;Epstein, Jonathan I.
目的：我们确定在根治性前列腺切除术前进行强制性第二意见病理检查以解释前列腺穿刺活检的价值。材料和方法：我们比较了所有1年内来我院行根治性前列腺切除术的病例的病理参数，包括良性、非典型或恶性诊断、最终Gleason评分、核心阳性数、核心最高癌率、神经周围浸润或前列腺外延伸。一个主要的Gleason评分差异被定义为改变到不同的风险类别（6,7和8-10）。我们将核心癌症最高百分比的显著差异定义为30%或更高。结果：855例原诊断为前列腺腺癌的病例中，有844例（98.8%）经穿刺活检和前列腺切除术证实为前列腺癌，其中9例（1%）为非典型，2例（0.2%）为良性。Gleason评分差异较大124例（14.7%），其中升级57例（46.0%），降级67例（54%）。在最终Gleason评分为6的病例中，有8.4%的患者最初诊断为7分（7.8%）或8-10分（0.6%），最终评分为7分的患者中有21%的患者最初诊断为6分（13.2%）或8-10分（7.8%），61例8-10分患者中有21例（34%）最初诊断为7分或7分以下。6 ~ 7分不一致的有80例（64.5%）。在各报告核心数阳性的777例中，有71例（9.1%）存在差异。经复查，阳性核心数增高45例（63.4%），降低26例（36.6%）。我们注意到，在844例可评估病例中，有76例（9%）癌症最初被低估，其中核心的最高癌症百分比有显著差异。复查时，76例中有60例（78.9%）癌症间断累及核心。回顾发现，844例病例中有138例（16.3%）发生了神经周围侵犯，138例中有37例（26.8%）未被报道。其中4例穿刺活检显示前列腺外展。结论：与10多年前在本机构进行的一项小型研究相比，未确诊癌症的发生率相同（1.2%）。据我们所知，这是第一个通过审查阳性岩心数量和岩心中最大阳性百分比（每个差异9%）来分析一致性的研究。在少数情况下，强制性的前列腺穿刺活检第二意见导致显著差异，可能影响治疗。
Purpose: We determined the value of mandatory second opinion pathology review to interpret prostate needle biopsy before radical prostatectomy.Materials and Methods: In all cases referred to our institution for radical prostatectomy in 1 year we compared pathological parameters in original and reviewed pathology reports, including benign, atypical or malignant diagnosis, final Gleason score, positive core number, core highest cancer percent and perineural invasion or extraprostatic extension. A major Gleason score discrepancy was defined as a change to a different risk category (6, 7 and 8-10). We defined a significant difference in the highest percent of cancer in a core as 30% or greater.Results: Of the 855 cases originally diagnosed as prostatic adenocarcinoma cancer was confirmed in 844 (98.8%) by needle biopsy and prostatectomy, of which 9 (1%) were atypical and 2 (0.2%) were benign upon review. A major discrepancy in Gleason score was present in 124 cases (14.7%), of which 57 (46.0%) were upgraded and 67 (54%) were downgraded. Of cases with a final Gleason score of 6, 8.4% were originally diagnosed as 7 (7.8%) or 8-10 (0.6%), 21% with a final score of 7 had an original score of 6 (13.2%) or 8-10 (7.8%) and 21 of 61 (34%) with a score of 8-10 were originally diagnosed as 7 or less. There were 80 cases (64.5%) of disagreement between scores 6 and 7. Of the 777 cases with the positive core number in each report 71 (9.1%) had discrepancies. After review the positive core number was higher in 45 cases (63.4%) and lower in 26 (36.6%). We noted a significant difference in the highest cancer percent in a core in 76 of 844 evaluable cases (9%) in which cancer was originally underestimated. In 60 of 76 cases (78.9%) cancer discontinuously involved the core on review. Review revealed perineural invasion in 138 of 844 cases (16.3%) that was not originally reported in 37 of 138 (26.8%). In 4 cases review showed extraprostatic extension on needle biopsy.Conclusions: Compared to a smaller study more than 10 years ago at our institution the rate of unconfirmed cancer was identical (1.2%). To our knowledge this is the first study to analyze concordance upon review of the number of positive cores and maximum percent positive in a core (each discrepancy 9%). In a few cases mandatory second opinion on prostate needle biopsy results in significant differences that may affect therapy.