Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing.
Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing.
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DOI：
10.1016/j.juro.2013.02.072
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发表时间：
2013-06
影响因子：
6.6
通讯作者：
Taneja, Samir S.
中科院分区：
文献类型：
--
作者：
Bjurlin, Marc A.;Carter, H. Ballentine;Schellhammer, Paul;Cookson, Michael S.;Gomella, Leonard G.;Troyer, Dean;Wheeler, Thomas M.;Schlossberg, Steven;Penson, David F.;Taneja, Samir S.
临床实践中的最佳前列腺活检是基于充分检测具有临床意义的前列腺癌（灵敏度）、确保阴性采样的准确性（阴性预测值[NPV]）、有限检测临床不显著的癌症以及与全腺体手术病理学结果的良好一致性之间的平衡，以允许准确的风险分层和疾病定位用于治疗选择。在这种优化中固有的是用于病理评价的核心数量、位置、标记和处理的变化。迄今为止，在这方面没有达成共识。本次审查的目的有三个方面：1。明确疑似前列腺癌男性患者初次前列腺活检时活检针的最佳数量和位置，2。定义标记前列腺活检芯的最佳方法，用于病理处理，为所有潜在的临床场景提供相关和必要的临床信息，以及3。确定标本罐内允许的前列腺活检芯的最大数量，该数量不会妨碍组织的准确组织学评价。使用PubMed®进行了一项涵盖截至2012年7月的文献检索。此次搜索产生了大约550篇文章。根据本综述的三个目标中的哪一个对文章进行了审查和分类。提取、分析和总结数据。根据这篇文献综述和我们的临床经验提出了建议。与传统的六分仪采样方法相比，使用10-12芯扩展采样方案提高了癌症检出率（CDR），并通过增加NPV降低了患者需要重复活检的可能性，最终允许更准确的风险分层，而不会增加检测到不重要癌症的可能性。当芯的数量增加到12个芯以上时，诊断产量的增加变得微不足道。只有有限的证据支持使用超过12芯或饱和的初始活检方案。外周区的顶端和侧向取样增加了CDR，减少了重复活检的需要，并预测了椎间盘切除术的病理特征，而移行区活检则不能。几乎没有数据表明，知道单个阳性活检核心的确切部位可以提供有意义的临床信息。然而，通过活检确定肿瘤的偏侧性可能有助于预测囊外侵犯部位和制定治疗计划。在单个容器中放置多个活检芯（>2）似乎会损害病理学评价，这可能会降低CDR并增加不明确诊断的可能性。12芯系统活检将顶侧和远侧芯纳入模板分布中，可以最大限度地检测癌症，避免重复活检，并提供足够的信息来识别需要治疗的男性并规划该治疗，同时最大限度地减少对隐性、惰性前列腺癌的检测。该文献综述未提供令人信服的证据证明个体部位特异性核心标记有利于前列腺癌管理的临床决策。根据现有文献，我们建议每个广口瓶中包装不超过两个芯，以避免由于组织采样不足而导致CDR降低。
An optimal prostate biopsy in clinical practice is based on a balance between adequate detection of clinically significant prostate cancers (sensitivity), assuredness regarding the accuracy of negative sampling (negative predictive value [NPV]), limited detection of clinically insignificant cancers, and good concordance with whole-gland surgical pathology results to allow accurate risk stratification and disease localization for treatment selection. Inherent within this optimization is variation of the core number, location, labeling, and processing for pathologic evaluation. To date, there is no consensus in this regard. The purpose of this review is 3-fold: 1. To define the optimal number and location of biopsy cores during primary prostate biopsy among men with suspected prostate cancer, 2. To define the optimal method of labeling prostate biopsy cores for pathologic processing that will provide relevant and necessary clinical information for all potential clinical scenarios, and 3. To determine the maximal number of prostate biopsy cores allowable within a specimen jar that would not preclude accurate histologic evaluation of the tissue. A bibliographic search covering the period up to July, 2012 was conducted using PubMed®. This search yielded approximately 550 articles. Articles were reviewed and categorized based on which of the three objectives of this review was addressed. Data was extracted, analyzed, and summarized. Recommendations based on this literature review and our clinical experience is provided. The use of 10–12-core extended-sampling protocols increases cancer detection rates (CDRs) compared to traditional sextant sampling methods and reduces the likelihood that patients will require a repeat biopsy by increasing NPV, ultimately allowing more accurate risk stratification without increasing the likelihood of detecting insignificant cancers. As the number of cores increases above 12 cores, the increase in diagnostic yield becomes marginal. Only limited evidence supports the use of initial biopsy schemes involving more than 12 cores or saturation. Apical and laterally directed sampling of the peripheral zone increases CDR, reduces the need for repeat biopsies, and predicts pathological features on prostatectomy while transition-zone biopsies do not. There is little data to suggest that knowing the exact site of an individual positive biopsy core provides meaningful clinical information. However, determining laterality of cancer on biopsy may be helpful for both predicting sites of extracapsular extension and therapeutic planning. Placement of multiple biopsy cores in a single container (>2) appears to compromise pathologic evaluation, which can reduce CDR and increase the likelihood of equivocal diagnoses. A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoidance of a repeat biopsy, and adequate information for both identifying men who need therapy and planning that therapy while minimizing the detection of occult, indolent prostate cancers. This literature review does not provide compelling evidence that individual site-specific labeling of cores benefits clinical decision-making regarding the management of prostate cancer. Based upon the available literature, we recommend packaging no more than two cores in each jar to avoid reduction of CDR through inadequate tissue sampling.
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