Gleason Misclassification Rate Is Independent of Number of Biopsy Cores in Systematic Biopsy
| Autor: | Liza, Quintana, Ashley, Ward, Sean J, Gerrin, Elizabeth M, Genega, Seymour, Rosen, Martin G, Sanda, Andrew A, Wagner, Peter, Chang, William C, DeWolf, Huihui, Ye |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Biopsy Urology Concordance medicine.medical_treatment 030232 urology & nephrology urologic and male genital diseases Article 03 medical and health sciences 0302 clinical medicine medicine Humans Diagnostic Errors Grading (tumors) Aged Retrospective Studies Prostatectomy medicine.diagnostic_test business.industry Prostate Prostatic Neoplasms Retrospective cohort study Magnetic resonance imaging Middle Aged Surgery Neck of urinary bladder 030220 oncology & carcinogenesis T-stage Biopsy Large-Core Needle Radiology Neoplasm Grading business |
| Zdroj: | Urology. 91:143-149 |
| ISSN: | 0090-4295 |
| Popis: | Objective To compare the utility of saturation core biopsy and 12-core biopsy in detecting true Gleason grades, using final pathology in prostatectomy specimens as outcome measures, with a particular interest in Gleason upgrading. Patients and Methods We compared the concordance rates of Gleason grades diagnosed on biopsies and prostatectomy specimens in 375 consecutive patients, including 106 saturation biopsies (18-33 cores, median = 20 cores) and 269 12-core biopsies. Grading bias was addressed by a central rereview of all cases that had discordance in reporting high Gleason grades (Gleason grade ≥ 4) on biopsies and prostatectomy specimens. Results For patients with high Gleason grades on final pathology, saturation and 12-core biopsy schemes had a comparable sensitivity, specificity, negative and positive predictive values (72.5% vs 69.5%, 91.9% vs 97.6%, 64.2% vs 58.4%, and 94.3% vs 98.5%, respectively) in detecting high Gleason grades. On multivariate analysis, prebiopsy serum prostate-specific antigen and clinical T stage independently predicted Gleason upgrading; saturation biopsy was not a significant predictor. Approximately one-third of cases where high Gleason grade was not present in the biopsy were attributed to the confinement of high-grade tumors to unusual anatomic locations such as anterior lobes, apex, bladder neck, and parasagittal zones. Conclusion Our study showed that Gleason misclassification rate is independent of the number of biopsy cores in systematic biopsy. One of the reasons for missing high Gleason grade tumors on systematic biopsy was unusual tumor location outside of the biopsy grid, supporting the need for improved detection technique such as magnetic resonance imaging-guided targeted biopsies. |
| Databáze: | OpenAIRE |
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