Acessibilidade / Reportar erro
Artigos Originais • Rev. Col. Bras. Cir. 26 (1) • Fev 1999 • https://doi.org/10.1590/S0100-69911999000100006   copiar

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

Correlation between histologic biopsy grading and radical prostatectomy specimen in prostate cancer

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumos

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.

Câncer da próstata; Biópsia da próstata; Escore de Gleason

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.

Prostate cancer; Prostate biopsy; Gleason score

ARTIGOS ORIGINAIS

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

Correlation between histologic biopsy grading and radical prostatectomy specimen in prostate cancer

José Cury, TCBC-SPI; Miguel Srougi, TCBC-SPII; Kátia Ramos Moreira LeiteIII; Luiz Heraldo Camara LopesIII; Paulo Campos CarneiroIV

IProfessor Doutor e Chefe do Setor de Doenças da Próstata, Disciplina de Urologia da UNIFESP-EPM

IIProfessor Titular, Disciplina de Urologia da UNIFESP-EPM

IIIMédico Patologista do Hospital Sírio Libanês - SP

IVDoutor do Departamento de Patologia da FMUSP

Endereço para correspondência Endereço para correspondência: Dr. José Cury Rua Leandro Dupret, 204 - cj.44 04025-010 - São Paulo - SP

RESUMO

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.

Unitermos: Câncer da próstata; Biópsia da próstata; Escore de Gleason.

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.

Key words: Prostate cancer; Prostate biopsy; Gleason score.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERÊNCIAS

1. Kastendieck H - Morphologic des prospatacarcinoms in stanz biopsien und totalem prostatektomien. Untersuchungen zur frage der relevanz bioptischer befundaussagen. Pathologe 2:31, 1980. In Catalona WJ, Stein AJ, Fair WR: J UroI1982;127:919-922.

2. Catalona WJ, Stein AJ, Fair WR - Grading errors in prostatic needle biopsies: relation to the accuracy of tumor grade in predicting pelvic linph node metástases. J Urol 1982;127:919-922.

3. Lange PH, Narayan P - Understaging and undergrading of prostate cancer. Urology 1983;21:113-118.

4. Garnett JE, Oyasu R, Grayhack JT - The accuracy of diagnostic biopsy specimens in predcting tumor grades by Gleasons classification of radical prostatectomy specimens. J Urol 1984;131:690-693.

5. Bostwick OG - Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectomies. J Surg Patho[1994;18:796-803.

6. Humphrey PA, Baty J, Keetch O - Relatioship between serun prostate specific antigen, needle biopsy findings, and histopathologic features of prostatic carcinoma in radical prostatectomy tissues. Cancer 1995; 75:1842-1849.

7. Peller PA, Young OC, Marmaduke OP, et al - Sextant prostate biopsies. A histopathologic correlation with radical prostatectomy specimens. Cancer 1995;75:530-538.

8. Kojima M, Troncoso P, Babaian RJ - Use of prostate specific antigen and tumor volume in predcting needle biopsy grading error. Urology 1995;45:807-812.

9. Ravery V, Boccon-Gibod LA, Dauge-Geffroy MC, et al - Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistant/recurrent detectable PSA after radical prostatectomy. Urology 1994;44:371-376.

10. Epstein JI - The diagnosis and reporting of adenocarcinoma of the prostate in core needle biopsy specimens. Cancer 1996;78: 350-356.

11. Gleason DF - Histologic grading in clinical staging of prostatic carcinoma. In Tannenbaum, M (eds). Urologic Pathology - The prostate. Philadelphia, Lea Febiger, 1977,pp.171-197.

12. Srougi M - "Câncer da Próstata". In Srougi M, Simon SD (eds): Câncer Urológico. 2a.ed. São Paulo: Ed. Platina, 1996, pp.281-359.

13. Stamey TA, McNeal JE- "Adenocarcinoma of the prostate". In Walsh PC, Retik AB, Stamey TA, et al (eds): Campbells Urology. 6ª edição. Philadelphia: W B Saunders, 1992, pp.1159-1221.

14. Oesterling JE, Suman VJ, Zincke H, et al - PSA-detected (clinical stage Tlc or BO) prostate cancer. Urol Clin North Am 1993; 20:687-693.

15. Bostwick DG - Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectornies. J Surg Pathol 1994a; 18:796-803.

16. Bigg SW, Kavoussi LR, Catalona WJ - Role of nerve-sparing radical prostatectomy for clinical stage B2 prostate cancer. J Urol 1990; 144:1.420-1.423.

17. Kileen KP, Libertino JÁ, Sughayer MA, et al - Pathologic review of consecutive radical prostatectomy specimens. Nerve sparing versus nonnerve sparing. Urology 1991;38:212-215.

18. Ravery V, Szabo J, Toublanc M, et al - A single positive prostate biopsy in six does not predict a 10w-volume prostate tumour. Br J Urol 1996;77:724-728.

19. Thickman D, Speers WC, Philpott PJ, et al - Effect of the number of core biopses of the prostate on predicting Gleason score of prostate cancer. J Urol 1996;156:110-113.

20. Spires SE, Cibull ML, Wood DP Jr, et al - Gleason histologic grading in prostatic carcinoma correlation of 18 gauge core biopsy with prostatectomy. Arch Pathol Lab Med 1994;118: 705-708.

21. Paulson DF - Assessment of anatomic extent and biologic hazard of prostatic adenocarcinoma. Urology 1980;15:537-541.

22. Kramer AS, Spahr 1, Brendler CB, et al- Experience with Gleason's histopathologic grading in prostate cancer. J Urol 1980;124: 223-225.

23. Cookson MS, Fleshner NE, Soloway SM, et al - Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol 1997; 157:559-562.

24. Tannenbaum M, Tannenbaum S, De Sanctis PN, et al - Prognostic significance of nucleolar surface area in prostate cancer. Urology 1982;19:546-551.

25. Epstein 11, Wa1sh PC, Carmichael M, et al - Pathological and clinical findings to predict tumor extent of non-palpable (stage Tlc) prostate cancer. JAMA 1994a; 271 :368-374.

Recebido em 8/7/98

Aceito para publicação em 9/11/98

Trabalho da Disciplina de Urologia, Universidade Federal de São Paulo - Escola Paulista de Medicina - São Paulo.

  • 1. Kastendieck H - Morphologic des prospatacarcinoms in stanz biopsien und totalem prostatektomien. Untersuchungen zur frage der relevanz bioptischer befundaussagen. Pathologe 2:31, 1980. In Catalona WJ, Stein AJ, Fair WR: J UroI1982;127:919-922.
  • 2. Catalona WJ, Stein AJ, Fair WR - Grading errors in prostatic needle biopsies: relation to the accuracy of tumor grade in predicting pelvic linph node metástases. J Urol 1982;127:919-922.
  • 3. Lange PH, Narayan P - Understaging and undergrading of prostate cancer. Urology 1983;21:113-118.
  • 4. Garnett JE, Oyasu R, Grayhack JT - The accuracy of diagnostic biopsy specimens in predcting tumor grades by Gleasons classification of radical prostatectomy specimens. J Urol 1984;131:690-693.
  • 5. Bostwick OG - Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectomies. J Surg Patho[1994;18:796-803.
  • 6. Humphrey PA, Baty J, Keetch O - Relatioship between serun prostate specific antigen, needle biopsy findings, and histopathologic features of prostatic carcinoma in radical prostatectomy tissues. Cancer 1995; 75:1842-1849.
  • 7. Peller PA, Young OC, Marmaduke OP, et al - Sextant prostate biopsies. A histopathologic correlation with radical prostatectomy specimens. Cancer 1995;75:530-538.
  • 8. Kojima M, Troncoso P, Babaian RJ - Use of prostate specific antigen and tumor volume in predcting needle biopsy grading error. Urology 1995;45:807-812.
  • 9. Ravery V, Boccon-Gibod LA, Dauge-Geffroy MC, et al - Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistant/recurrent detectable PSA after radical prostatectomy. Urology 1994;44:371-376.
  • 10. Epstein JI - The diagnosis and reporting of adenocarcinoma of the prostate in core needle biopsy specimens. Cancer 1996;78: 350-356.
  • 11. Gleason DF - Histologic grading in clinical staging of prostatic carcinoma. In Tannenbaum, M (eds). Urologic Pathology - The prostate. Philadelphia, Lea Febiger, 1977,pp.171-197.
  • 12. Srougi M - "Câncer da Próstata". In Srougi M, Simon SD (eds): Câncer Urológico. 2a.ed. Săo Paulo: Ed. Platina, 1996, pp.281-359.
  • 13. Stamey TA, McNeal JE- "Adenocarcinoma of the prostate". In Walsh PC, Retik AB, Stamey TA, et al (eds): Campbells Urology. 6Ş ediçăo. Philadelphia: W B Saunders, 1992, pp.1159-1221.
  • 14. Oesterling JE, Suman VJ, Zincke H, et al - PSA-detected (clinical stage Tlc or BO) prostate cancer. Urol Clin North Am 1993; 20:687-693.
  • 15. Bostwick DG - Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectornies. J Surg Pathol 1994a; 18:796-803.
  • 16. Bigg SW, Kavoussi LR, Catalona WJ - Role of nerve-sparing radical prostatectomy for clinical stage B2 prostate cancer. J Urol 1990; 144:1.420-1.423.
  • 17. Kileen KP, Libertino JÁ, Sughayer MA, et al - Pathologic review of consecutive radical prostatectomy specimens. Nerve sparing versus nonnerve sparing. Urology 1991;38:212-215.
  • 18. Ravery V, Szabo J, Toublanc M, et al - A single positive prostate biopsy in six does not predict a 10w-volume prostate tumour. Br J Urol 1996;77:724-728.
  • 19. Thickman D, Speers WC, Philpott PJ, et al - Effect of the number of core biopses of the prostate on predicting Gleason score of prostate cancer. J Urol 1996;156:110-113.
  • 20. Spires SE, Cibull ML, Wood DP Jr, et al - Gleason histologic grading in prostatic carcinoma correlation of 18 gauge core biopsy with prostatectomy. Arch Pathol Lab Med 1994;118: 705-708.
  • 21. Paulson DF - Assessment of anatomic extent and biologic hazard of prostatic adenocarcinoma. Urology 1980;15:537-541.
  • 22. Kramer AS, Spahr 1, Brendler CB, et al- Experience with Gleason's histopathologic grading in prostate cancer. J Urol 1980;124: 223-225.
  • 23. Cookson MS, Fleshner NE, Soloway SM, et al - Correlation between Gleason score of needle biopsy and radical prostatectomy specimen: accuracy and clinical implications. J Urol 1997; 157:559-562.
  • 24. Tannenbaum M, Tannenbaum S, De Sanctis PN, et al - Prognostic significance of nucleolar surface area in prostate cancer. Urology 1982;19:546-551.
  • 25. Epstein 11, Wa1sh PC, Carmichael M, et al - Pathological and clinical findings to predict tumor extent of non-palpable (stage Tlc) prostate cancer. JAMA 1994a; 271 :368-374.

  • Endereço para correspondência:

    Dr. José Cury
    Rua Leandro Dupret, 204 - cj.44
    04025-010 - São Paulo - SP

    • Datas de Publicação

    • Publicação nesta coleção
      25 Fev 2010
    • Data do Fascículo
      Fev 1999

    Histórico

    • Aceito
      09 Nov 1998
    • Recebido
      08 Jul 1998
    Creative Common - by-nc 4.0
    This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
    Colégio Brasileiro de Cirurgiões Rua Visconde de Silva, 52 - 3º andar, 22271- 090 Rio de Janeiro - RJ, Tel.: +55 21 2138-0659, Fax: (55 21) 2286-2595 - Rio de Janeiro - RJ - Brazil
    E-mail: revista@cbc.org.br
    Acompanhe os números deste periódico no seu leitor de RSS