| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- 20100727- 前列腺穿刺够癌吗？
| 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
-
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.
-
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
| 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。 |
| 以下是引用doudou20080626在2010-8-23 17:30:00的发言： 学习了，前段时间遇到一例，本人考虑为高分化癌，科主任直接给我否定了。其实它的PSA也是25，P63部分腺体不表达。迷惑的是我们的P504S阴性。 |
P504S这个抗体做出来有时是会使人困惑，这其中有技术方面的原因，也有抗体供应方面的问题。
技术上的问题主要可能有固定是否及时的因素，因为P504s是一种参与脂肪酸支链及其之间产物代谢的酶，如果固定不及时或固定不良，容易导致该酶降解。技术上的因素还有抗原修复的步骤没掌握好火候，这个平常要拿阳性对照片去试，看什么样的修复温度和修复时间比较合适。还有一些IHC操作细节问题。
抗体供应上的问题主要是这个抗体使用的相对较少，所以在购买前供应商那里可能储藏的时间较长，其效价降低，特别是即用型抗体，买来后很少用而久存，也会降低效价。这时，解决的办法就是在即用型抗体中，加几滴未稀释的原始一抗，以提供有效抗体效价，说不定使用起来效果会好些。
仅供参考。
- 王军臣
