Correlação entre a graduação histológica de biópsias e do espécimen cirúrgico em câncer da prostata

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Abstract

Foram estudados, retrospectivamente, os prontuários de 120 pacientes com câncer localizado da próstata nos estádios clínicos T1, T2 e T3a e que foram submetidos a 1infadenectomia ilíaca e a cirurgia radical da próstata. Todos haviam sido graduados pela escala de Gleason através de biópsias da próstata guiadas pela ultra-sonografia transretal. Correlacionamos a graduação histo1ógica destas biópsias da próstata com a graduação final obtida no exame da peça cirúrgica correspondente e obtivemos exata concordância em 39 pacientes (32,50%). Ao considerarmos a concordância de ± 1unidade, observamos concordância de resultado em 81 pacientes (67,50%). A subgraduação histológica das biópsias prostáticas foi encontrada em 75 pacientes (62,50%) dos casos.

Translated abstract

The treatment of patients with adenocarcinoma of the prostate is based on the tumor stage and grade. For this reason the interpretation of the biopsy especimen is crucial and demands a great expertize from its examiner. ln order to define the accuracy of biopsy interpretation we settled the present study, trying to correlate the relationship between the histological grade of the biopsy especimens and the definitive pathological report read by the same pathologist. One hundred and twenty patients with localized prostate cancer stages TI - T3a submitted to radical prostatectomy were evaluated. The histological grade of the tumor was defined using the Gleason score sistem and a correlation was made between the score of biopsy and the surgical especimens. Complete agreement of the Gleason score was seen in 39 patients (32,5%) and if 1 digit discordance (± 1 Gleason score) was not considered, agreement was seen in 81 patients (67,5%). Seventy five tumors (62,5%) were undergraded and the rate of discordance was more common in patients with grade 2 to 4 tumors. According to our date, we conclude that the histological evaluation of the biopsy especimen in prostate cancer tends to underevaluate the true Gleason score of the tumor.

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Most cited references 39

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Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications.

M S Cookson, N Fleshner, S M Soloway … (1997)

Despite the reliability of Gleason grading with respect to the same specimen, the correlation between the biopsy and prostatectomy specimen is less well defined. We compared the accuracy of Gleason grading of biopsies in predicting histological grading of radical retropublic prostatectomy specimens. Gleason scores of 18 gauge needle biopsies were compared to those of radical retropublic prostatectomy specimens in 226 consecutive patients. In addition to comparing numeric discrepancies, differences between biopsy and specimen Gleason scores of 2 or more and a change in group from Gleason scores 2 to 4, 5 to 7 or 8 to 10 were evaluated by kappa testing, as well as any change in group from Gleason scores 2 to 4, 5 and 6, 7 and 8 to 10. The biopsy score was identical to the specimen score in 31% of cases, while 26% were discrepant by 2 or more Gleason scores. Overall, 54% of biopsies were under graded, while 15% were over graded. If only cases in which discrepancies of 2 or more Gleason scores and a change in group were considered, there was good overall agreement (kappa 0.468, accuracy 80%). Among the cases with any change in group, the accuracy was only 46% with poor agreement (kappa 0.153). Overall, the reliability of Gleason grading of needle biopsies in predicting final pathology was good. However, the limitations of Gleason grading based on biopsy should be considered when discussing treatment options and comparing results based on biopsy data.

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Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectomies.

D Bostwick (1994)

The automated spring-loaded 18-gauge gun recently introduced for prostatic needle biopsy provides less than half the tissue of the traditional 14-gauge biopsy, possibly influencing the accuracy and predictive ability of biopsy tumor grade. In order to determine the value of tumor grade in contemporary needle biopsy specimens, we compared grade in 316 biopsies with matched whole-mounted radical retropubic prostatectomy specimens according to Gleason primary pattern, Gleason secondary pattern, Gleason score, percent of Gleason patterns 4 and 5, and nuclear grade. Biopsy grading accuracy was correlated with rates of capsular perforation, seminal vesicle invasion, pelvic lymph node metastasis, serum prostate specific antigen level, prostatic volume, prostatic weight, cancer volume, perineural invasion, DNA ploidy, and pathologic stage. The greatest grading error was encountered with low-grade tumors; there was no correlation of grading error with clinical staging error or other pathologic factors. Significant differences were noted between biopsy and prostatectomy for Gleason primary pattern, secondary pattern, and score. The percent of poorly differentiated carcinoma (Gleason patterns 4 and 5) in biopsies and prostatectomies showed a moderate positive correlation. The results indicate that the accuracy of 18-gauge needle biopsy in predicting tumor grade in the prostatectomy is similar to that reported with 14-gauge biopsies. Based on these findings, we recommend that the Gleason score (sum of primary and secondary patterns) be employed in all needle biopsies, recognizing that the accuracy of grade is decreased in cases with low-grade cancer and small amounts of cancer.