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- 20100727- 前列腺穿刺够癌吗？
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echohanxiao 离线
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| 以下是引用shandongzhang在2010-8-25 13:58:00的发言：
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感谢金主任精辟的评析！
感谢张主任对以上引用文摘的精准摘译！
- 王军臣
| 以下是引用xljin8在2010-8-25 12:42:00的发言：
前列腺活检组织中单个不典型病灶（上述文献定义为直径小于1mm) 与癌的鉴别是病理诊断的难题。张主任提供的文献已很好的证明此点。即使是训练有素、有丰富经验的专家，对这种病例的诊断一致性不到50%、而普通病理医生诊断的一致性仅30%。 这种情况在教科书中称为不典型小腺泡增生（Atypical small acinar proliferation, ASAP), 与癌的鉴别诊断并不能根据一项指标， 而要综合分析结构（Pattern）、细胞学、生长方式、和IHC标记。可疑腺泡的数量越少、结构与邻近正常腺泡越接近，诊断就越困难。在前列腺活检中ASAP的发生率约为3%，其中45%经泌尿病理专家会诊可明确诊断。如果患者年龄小于75岁，可建议再次活检，大于75岁，可由临床医生和患者讨论是否再活检。 |
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本帖最后由 于 2010-08-25 12:44:00 编辑
前列腺活检组织中单个不典型病灶（上述文献定义为直径小于1mm) 与癌的鉴别是病理诊断的难题。张主任提供的文献已很好的证明此点。即使是训练有素、有丰富经验的专家，对这种病例的诊断一致性不到50%、而普通病理医生诊断的一致性仅30%。
这种情况在教科书中称为不典型小腺泡增生（Atypical small acinar proliferation, ASAP), 与癌的鉴别诊断并不能根据一项指标， 而要综合分析结构（Pattern）、细胞学、生长方式、和IHC标记。可疑腺泡的数量越少、结构与邻近正常腺泡越接近，诊断就越困难。在前列腺活检中ASAP的发生率约为3%，其中45%经泌尿病理专家会诊可明确诊断。如果患者年龄小于75岁，可建议再次活检，大于75岁，可由临床医生和患者讨论是否再活检。
- xljin8
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Adenocarcinoma with Microvacuolated Cytoplasm (Xanthomatoid Carcinoma; “Foamy Gland” Carcinoma)
Adenocarcinoma with microvacuolated cytoplasm is characterized by cells with abundant microvacuoles in the cytoplasm that displace the nuclei basally Diagnostic difficulty is encountered when this pattern predominates, owing to the small size and hyperchromasia of the nuclei that may be interpreted as benign. This tumor is not a distinct clinicopathologic entity.
| 以下是引用海上明月在2010-8-24 12:50:00的发言： 请楼主张主任发表贵单位意见。谢谢！ |
谢谢王主任的关注，在回答问题之前让我们共同学习一下有关内容：
Variability in Diagnostic Opinion Among Pathologists
for Single Small Atypical Foci in Prostate Biopsies
(Am J Surg Pathol 2010;00:000–000)
Abstract: Pathologists are increasingly exposed to prostate
biopsies with small atypical foci, requiring differentiation
between adenocarcinoma, atypical small acinar proliferation
suspicious for malignancy, and a benign diagnosis. We studied
the level of agreement for such atypical foci among experts in
urologic pathology and all-round reference pathologists of the
European Randomized Screening study of Prostate Cancer
(ERSPC). For this purpose, we retrieved 20 prostate biopsies
with small (most <1 mm) atypical foci. Hematoxylin and eosinstained
slides, including 10 immunostained slides were digitalized
for virtual microscopy. The lesional area was not marked.
Five experts and 7 ERSPC pathologists examined the cases.
Multirater k statistics was applied to determine agreement and
significant differences between experts and ERSPC pathologists.
The k value of experts (0.39; confidence interval, 0.29-0.49) was
significantly higher than that of ERSPC pathologists (0.21;
confidence interval, 0.14-0.27). Full (100%) agreement was
reached by the 5 experts for 7 of 20 biopsies. Experts and
ERSPC pathologists rendered diagnoses ranging from benign
to adenocarcinoma on the same biopsy in 5 and 9 biopsies,
respectively. Most of these lesions comprised between 2 and 5
atypical glands. The experts diagnosed adenocarcinoma (49%)
more often than the ERSPC pathologists (32%) (P<0.001). As
agreement was particularly poor for foci comprising <6 glands,
we would encourage pathologists to obtain intercollegial consultation
of a specialized pathologist for these lesions before a
carcinoma diagnosis, whereas clinicians may consider to perform
staging biopsies before engaging on deferred or definite therapy.
Key Words: prostate cancer, prostate biopsy, pathology,
diagnostics, interobserver variation, virtual microscopy
