Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - Postępy Nauk Medycznych 11/2016, s. 812-818 | DOI: 10.5604/08606196.1222882
*Łukasz Nyk1, Michał A. Skrzypczyk2, Stanisław Szempliński2, Mieszko Kozikowski1, Wojciech Michalak1, Sebastian Piotrowicz1, Szymon Kawecki1, Tomasz Dzik3, Maciej Wysocki4, Andrzej Borówka1, Jakub Dobruch1, 2
Comparison of prostate cancer grades after biopsy and radical prostatectomy
Porównanie złośliwości raka stercza ocenione na podstawie biopsji i badania preparatów operacyjnych
11st Unit of Didactics, Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock
Head of Department: Jakub Dobruch, MD, PhD
22nd Unit of Didactics, Department of Urology, Centre of Postgraduate Medical Education, Professor W. Orłowski Independent Public Teaching Hospital, Warsaw
Head of Department: Jakub Dobruch, MD, PhD
3Pathomorphology Division, Międzylesie Specialist Hospital, Warsaw
Head of Division: Tomasz Dzik, MD, PhD
4Pathomorphology Division, Bielany Hospital, Warsaw
Head of Division: Jan Faryna, MD, PhD
Streszczenie
Wstęp. Raka stercza rozpoznaje się na podstawie biopsji mającej z reguły charakter wielomiejscowej biopsji rdzeniowej, wykonanej igłą tru-cut pod kontrolą ultrasonografii przezodbytniczej (TRUScoreBx). Ważnym elementem oceny PCa jest określenie stopnia jego złośliwości, którą definiuje się na podstawie skali Gleasona. Istniej odmienność ocen złośliwości raka określonej na podstawie badania rdzeni tkankowych oraz na podstawie badania materiału operacyjnego.
Cel pracy. Prównanie złośliwości raka stercza ocenione na podstawie biopsji i badania preparatów operacyjnych.
Materiał i metody. Materiał badawczy stanowiły gromadzone prospektywnie dane medyczne dotyczące kolejnych 212 chorych poddanych prostatektomii radykalnej (PR), u których raka stercza (ang. prostate cancer – PCa) rozpoznano na podstawie wielomiejscowej biopsji rdzeniowej stercza wykonanej pod kontrolą ultrasonografii przezodbytniczej (TRUScoreBx).
Wyniki. Złośliwością najczęściej rozpoznawaną na podstawie badania rdzeni tkankowych pochodzących z TRUScoreBx była złośliwość 4 i 5 w skali Gleasona (46,3%). Złośliwość określoną jako Gl.s. > 7 stwierdzono u 32 (15,2%) chorych. Z kolei na podstawie badania specymenów operacyjnych najczęściej rozpoznano pierwotnie złośliwość Gl.s. 7 (34,8%) i Gl.s. 5 (23,3%). Różnice między ocenami złośliwości określonej na podstawie badania rdzeni tkankowych (Gl.s.Bx) i ocenami złośliwości określonej na podstawie badania specymenów operacyjnych (Gl.s.PR) są statystycznie znamienne. Zgodność dotyczyła 34,3% ocen, zaś brak zgodności 65,7% ocen.
Wnioski. Nasze badanie udowadnia, że występują różnice między globalną złośliwością raka stercza (Gl.s.) określoną na podstawie oceny histopatologicznej rdzeni tkankowych pochodzących z biopsji stercza, a określoną na podstawie badania preparatów po operacji.
Summary
Introduction. Prostate cancer is diagnosed on the basis of transrectal ultrasound-guided multiple-core biopsy (TRUScoreBx) done with a tru-cut needle. One of the most important issues in prostate cancer diagnosis is estimation of its malignancy. It is defined according to Gleason score system which grades malignancy according to 5 Gleason patterns, with 1 being the least, and 5 being the most malignant. There are discrepancies between prostate cancer grading in prostate biopsy and after radical prostatectomy.
Aim. To compare prostate cancer grade after biopsy and radical prostatectomy.
Material and methods. Research material consisted of prospectively collected medical data for 212 consecutive patients who underwent radical prostatectomy (RP) at the Urology Department of the CPME, and were diagnosed with PCa based on transrectal ultrasound-guided multiple-core biopsy (TRUScoreBx).
Results. The most frequent Gleason score in TRUScoreBx was 4 and 5 (46.3%), while Gleason score > 7 was found in 32 (15.2%) patients. The most frequent Gleason score in post prostatectomy material was 7 (34.8%) and 5 (23.3%). The differences between Gleason score in TRUScoreBx and post prostatectomy material were statistically significant. Concordance was found in 34.3% whereas a lack of it in 65.7%.
Conclusions. Our study demonstrates that there are differences between the global malignancy of prostate cancer (Gl.s.) determined on the basis of histopathological examination of tissue cores obtained in prostate biopsy and examination of surgery specimens.
INTRODUCTION
9273 prostate cancer (PCa) diagnoses were registered in Poland in 2010. Analysis of epidemiological data indicates a gradual increase in PCa incidence and PCa-associated mortality in Poland over the last decades, with mortality climbing slower than incidence (fig. 1, 2). Prostate cancer is predominantly found in the peripheral zone (70%), particularly in the apex area. 10-15% of patients develop PCa in the transitional, and 15-20% in the central zone (fig. 3) (1-3). PCa is diagnosed based on the examination of biopsy specimens, typically transrectal ultrasound guided multiple-core biopsy performed with tru-cut needle (TRUScoreBx). Finger-guided multi-core biopsy (FGcoreBx) or fine-needle aspiration multicore biopsy (FNABx) that is also a finger-guided type of biopsy are justified only in patients with clinically evident PCa that requires solely histo- or cytopathological verification, without the need to accurately determine features assessable in TRUScoreBx (4-7). The key element of PCA evaluation is malignancy assessment, i.e. its grading. The malignancy is defined with Gleason score (Gl.s.) developed by Donald Gleason (1920-2008), in common use since 1978 (8, 9). According to this system, PCa is associated with 5 Gleason patterns ranging from the least (1) to most malignant (5), differing mostly by their architecture, and to a lesser degree by the features of the cancerous cells (fig. 4) (6). When grading a tumour, the dominant (primary) pattern within a given tumour is identified, along with the next-most frequent (secondary) one, and both are assigned numerical grades. The sum of these two numbers (referred to as Gleason numbers) reflects the cancer’s global malignancy, and is known as Gleason sum or Gleason score (Gl.s.), e.g. Gl.s. 7 (Gl.n. 4 + Gl.n. 3) means that 4 is the predominant malignancy pattern, with 3 being the next-most common one, with a reverse sequence of numbers (3 + 4) being prognostically more favourable. Discrepancies in the malignancy scores identified on the basis of tissue core samples and surgical specimens (removed prostate) have already been widely researched (10), with numerous urological studies worldwide devoted to the accuracy of grading. Both intraobserver and interobserver variability have been determined to be of substantial significance here (11-13). Polish urological literature, however, has so far not included publications on this subject, except for studies by the author of this paper (14-17).
Fig. 1. Incidence of prostate cancer and prostate cancer-related mortality in Poland between 2001-2010. Data according to www.onkologia.org.pl
Fig. 2. Prostate cancer incidence rate and mortality rate in Poland between 2001-2010. Data according to www.onkologia.org.pl
Fig. 3. McNeal’s zonal anatomy of the prostate: a – transverse section, b – longitudinal section
TZ – transition zone; PZ – peripheral zone; AFS – anterior fibromuscular stroma; CZ – central zone; U – urethra; ED – ejaculatory ducts (1)
Fig. 4. The 5 malignancy patterns in Gleason system of prostate cancer grading (6)
AIM
To compare prostate cancer grade after biopsy and radical prostatectomy.
MATERIAL AND METHODS
Research material consisted of prospectively collected medical data for 212 consecutive patients who underwent radical prostatectomy (RP) at the Urology Department of CPME, diagnosed with prostate cancer (PCa) based on transrectal ultrasound-guided multiple-core biopsy (TRUScoreBx). The tissue samples collected in prostate biopsy and the RP specimens were consecutively evaluated by the same experienced pathologist.
RESULTS
Comparison of prostate cancer grades based on histopathological examination of tissue cores from TRUScoreBx and of removed prostate and seminal vesicles specimens
The most common malignancy identified by the urologic pathologist in TRUScoreBx (UP-11) was Gleason score 4 and 5 (46.7%). Malignancy grade identified as Gl.s. > 7 was found in 32 patients (15.2%). The scores most frequently identified in radical prostatectomy specimens were Gleason scores 7 (34.8%) and 5 (23.3%).
Malignancy scores based on tissue core evaluation and examination of RP specimens (UP-11) are shown in table 1. The data were tested with Stuart-Maxwell test of marginal homogeneity, showing the discrepancies between malignancy scores based on examination of multiple core biopsy (Gl.s.Bx) samples and postoperative specimens (Gl.s.RP) to be statistically significant (p < 0.0001), thus evidencing a significant lack of concordance to exist between the scores. Similarly, kappa coefficient calculated for these scores (κ = 0.20) showed a considerable discrepancy between the scores (with κ = 1.0 there is full concordance = 100%, whereas κ = 0.20 means that statistically there is concordance in one in five cases). Hence, concordance was determined for 34.3% of the scores, and a lack thereof for 65.7% (tab. 2).
Tab. 1. Gleason scores assigned by the urologic pathologist (UP-11) based on multiple-core biopsy samples (Gl.s.Bx) and on radical prostatectomy specimens (Gl.s.RP)
 Gl.s.BxGl.s.RP
Gl.s.Number (N)Percentage (%)Number (N)Percentage (%)
231.4377.610049.99
373.3373.33
45325.24188.57
55727.144923.33
64320.483114.76
73215.2415.247334.7634.76
8125.717.14188.5715.24
920.95136.19
1010.4810.48
Total210100 210100 
Data for 210 patients, comprising 99% of the cohort
Tab. 2. Comparison of Gleason scores assigned by the urologic pathologist (UP-11) based on multiple-core biopsy samples (Gl.s.Bx) and on radical prostatectomy specimens (Gl.s.PR)
Gl.s.Number (N)Percentage (%) 
Gl.s.Bx = Gl.s.PR7234.2934.29Concordance
Gl.s.Bx > Gl.s.PR199.0565.71Lack of concordance
Gl.s.Bx < Gl.s.PR11956.67
Data for 210 patients, comprising 99% of the cohort
The comparison of PCa scores identified by the urologic pathologist (UP-11) based on multiple core biopsies (Gl.s.Bx) and on examination of RP specimens (Gl.s.RP) has been collectively presented in table 3.
Tab. 3. Concordance of Gleason scores assigned by the urologic pathologist (UP-11) based on multiple-core biopsy samples (Gl.s.Bx) and on radical prostatectomy specimens (Gl.s.PR): the number of concordant scores (Gl.s.Bx = Gl.s.RP) is shown in coloured fields, with the number of undergraded Gleason scores shown to the right (Gl.s.Bx < Gl.s.PR), and the number of overgraded Gleason scores (Gl.s.Bx > Gl.s.PR) shown to the left
Gl.s.BxGl.s.RPTotal
2345678910
20111000003
30203011007
401142071010053
500217132122057
60217101553043
7000102344032
801000254012
90000110002
100000000011
Total071849317318131210
Data for 210 patients, comprising 99% of the cohort
The data presented in tables 1-3 may be summarized to the following effect: comparison of PCa malignancy scores based on examination of multiple core biopsy samples and RP specimens demonstrates the global concordance to be 34.29%, however the rate of concordance for given scores varies considerably (tab. 4). Even though considering the small numbers of patients assigned some of the scores it is difficult to clearly determine the ranges of proportion of concordant and discordant scores, it is hardly surprising that among discrepancies (Gl.s.Bx ≠ Gl.s.RP) we primarily deal with undergraded PCa based on TRUScoreBx (Gl.s.Bx < Gl.s.RP). Moreover, table 4 demonstrates that the lower PCa malignancy determined in TRUScoreBx, the higher the risk of undergrading. The highest score concordance occurred in the case of Gl.s. 7 (nearly 70% Gl.s.Bx = Gl.s.RP). Malignancy was overgraded (Gl.s.Bx > Gl.s.RP) in all patients who were assigned Gl.s.Bx 9 prior to prostatectomy (even though they were few), and in nearly 25% of the patients assigned Gl.s.Bx 8 prior to prostatectomy. 55 patients were undergraded by 1 point (46.2% of undergraded scores), whereas even larger score discrepancy (undergrading) was found in as many as 64 patients (53.8% of undergraded scores).
Tab. 4. Percentage of Gleason scores assigned by the urologic pathologist (UP-11) based on multiple-core biopsy samples (Gl.s.Bx) and on radical prostatectomy specimens (Gl.s.RP): the percentage of concordant scores (Gl.s.Bx = Gl.s.RP) is shown in coloured fields, with the percentage of undergraded Gleason scores shown to the right (Gl.s.Bx < Gl.s.RP), and the percentage of overgraded Gleason scores (Gl.s.Bx > Gl.s.PR) shown to the left
Gl.s.BxGl.s.RPTotal
Gl.s.Bx < Gl.s.RP
2345678910
200.470.470.47000001.43
300.9501.4300.470.47003.33
400.476.669.523.334.760.470025.24
5000.958.096.1910.00.950.95027.14
600.950.473.334.767.142.381.43020.47
70000.47010.951.91.9015.24
800.470000.952.381.905.71
900000.470.470000.95
10000000000.470.47
Total Gl.s.Bx > Gl.s.RP000000000.47 
Data for 210 patients, comprising 99% of the cohort
Comparison of the first number comprising Gleason score based on TRUScoreBx and on examination of prostatectomy specimens

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otrzymano: 2016-10-12
zaakceptowano do druku: 2016-11-03

Adres do korespondencji:
*Łukasz Nyk
Klinika Urologii CMKP Centrum Zdrowia Otwock
ul. Borowa 14/18, 05-400 Otwock
ukinyk@poczta.fm

Postępy Nauk Medycznych 11/2016
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