A contemporary study correlating prostate needle biopsy and radical prostatectomy gleason score
A contemporary study correlating prostate needle biopsy and radical prostatectomy gleason score
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DOI：
10.1016/j.juro.2007.11.057
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发表时间：
2008-04-01
影响因子：
6.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
--
作者：
Fine, Samson W.;Epstein, Jonathan I.
目的：我们确定前列腺穿刺活检和根治性前列腺切除术的Gleason分级的当代实践模式是否已经发展。材料和方法：我们将穿刺活检（分配在约翰霍普金斯医院和其他机构）和根治性乳房切除术Gleason评分，对2002年至2003年在约翰霍普金斯医院接受根治性乳房切除术的1,455名男性进行了研究，结果：1994年，外部机构诊断Gleason评分2-4分的针吸活检占1.6%（1,455例中的23例），而1994年为22.3%（390例中的87例）。在Gleason评分为2-4的针吸活检中，30.4%显示根治性切除术Gleason评分为7-10。在2002年至2003年，没有约翰霍普金斯医院针吸活检被指定为格里森评分2-4。Gleason评分为6分或更低的针吸活检与根治性乳腺癌切除术Gleason评分相关的准确性为80.0%，而旧数据的准确性为63%。对于针吸活检Gleason评分≥ 7，35.5%（机构外）和24.8%（约翰霍普金斯医院）的根治性前列腺切除术显示Gleason评分<7。总体而言，外部和约翰霍普金斯医院穿刺活检诊断与根治性乳腺癌切除术Gleason评分的一致率分别为69.7%和75.9%。直接比较约翰霍普金斯医院和其他地方的针吸活检Gleason评分显示81.8%的一致性，其中Gleason评分5-6为87.1%，Gleason评分7为68.1%，Gleason评分8-10为35.1%。对于Gleason评分为8-10的外针活检，59.4%的约翰霍普金斯医院Gleason评分为7或更低。相反，对于Gleason评分为8-10的约翰霍普金斯医院针活检，64.9%的外针活检Gleason评分为7或更低。对于Gleason评分为5-6，7和8-10的针活检，非器官局限性疾病的发生率在约翰霍普金斯医院分别为17.7%、47.8%和50.0%，而在其他机构分别为18.2%、44.6%和37.5%。在过去的十年中，曾经普遍存在的针吸活检分级不足的情况几乎被消除。所有仍被指定为Gleason评分2-4的病例在根治性乳腺癌切除术时显示Gleason评分5或更高，近三分之一显示Gleason评分7-10，重申Gleason评分2-4是不应该进行的针吸活检诊断。如通过分级过高和分级过低的变量以及与病理分期的不良相关性所证明的，在针吸活检上分配Gleason模式4和总体Gleason评分8-10的困难仍然是一个重要问题。
Purpose: We determined whether contemporary practice patterns of Gleason grading for prostate needle biopsy and radical prostatectomy have evolved.Materials and Methods: We correlated needle biopsy (assigned at Johns Hopkins Hospital and other institutions) and radical prostatectomy Gleason score for 1,455 men who underwent radical prostatectomy at Johns Hopkins Hospital from 2002 to 2003, and compared the results with those of a 1994 study of similar design.Results: Outside institutions diagnosed Gleason score 2-4 in 1.6% (23 of 1,455) of needle biopsies vs 22.3% (87 of 390) in 1994. Of needle biopsies labeled Gleason score 2-4, 30.4% revealed radical prostatectomy Gleason score 7-10. In 2002 to 2003 no Johns Hopkins Hospital needle biopsy was assigned Gleason score 2-4. Needle biopsies designated Gleason score 6 or less had 80.0% accuracy with regard to radical prostatectomy Gleason score vs 63% accuracy in older data. For needle biopsy Gleason score 7 or greater, 35.5% (outside institution) and 24.8% (Johns Hopkins Hospital) of radical prostatectomies displayed Gleason score less than 7. Overall, outside and Johns Hopkins Hospital needle biopsy diagnoses showed 69.7% and 75.9% agreement with radical prostatectomy Gleason score, respectively. Direct comparison of Johns Hopkins Hospital and needle biopsy Gleason scores elsewhere revealed 81.8% agreement, with 87.1% for Gleason score 5-6, 68.1% for Gleason score 7 and 35.1% for Gleason score 8-10. For 59.4% of outside needle biopsies with Gleason score 8-10, Johns Hopkins Hospital Gleason score was 7 or less. Conversely, for 64.9% of Johns Hopkins Hospital needle biopsies with Gleason score 8-10, outside Gleason score was 7 or less. For needle biopsies with Gleason score 5-6, 7 and 8-10, the incidence of nonorgan confined disease at radical prostatectomy was 17.7%, 47.8% and 50.0%, respectively, for Johns Hopkins Hospital vs 18.2%, 44.6% and 37.5% for outside institutions.Conclusions: The last decade has seen the near elimination of once prevalent under grading of needle biopsy. All cases still assigned Gleason score 2-4 show Gleason score 5 or greater at radical prostatectomy and nearly a third reveal Gleason score 7-10, reaffirming that Gleason score 2-4 is a needle biopsy diagnosis that should not be made. As evidenced by variable over grading and under grading, as well as poor correlation with pathological stage, difficulties in the assignment of Gleason pattern 4 and overall Gleason score of 8-10 on needle biopsy remain an important issue.