Uropathologists Dotaz Zobrazit nápovědu
Úvod: Při rozhodování o způsobu a časování léčby karcinomu prostaty se opíráme mimo jiné o následující informace: klinické stádium onemocnění, Gleasonovo skóre a preference pacienta. Cílem naší práce bylo vyhodnotit důsledky úprav gradingu karcinomu prostaty s ohledem na závěry z konference uropatologů konané v r. 2005 v USA. Klinický soubor a metody: na souboru 159 pacientů po radikální prostatektomii z období let 2003 - 2006 jsme provedli srovnání gradingu podle konvenčního a modifikovaného hodnocení a vyhodnotili možnost indikace aktivní surveillance. Výsledky: zatímco byla shoda Gleasonova skóre v biopsiích a po radikálních prostatektomiích konvenčním hodnocením v 34,6 %, k podhodnocení došlo u 62,2 %. Naopak modifikovaným hodnocením jsme dosáhli shody v 59,7 % a podhodnoceno bylo jen 28,3 % preparátů. V tomto ohledu by splňovalo indikaci aktivního monitoringu dle konvenčního hodnocení 22,6 % a dle modifikovaného hodnocení 18,8 % pacientů. Závěr: prokázali jsme zpřesnění výpovědní hodnoty Gleasonova skóre modifikovaným způsobem s ohledem na grading v pooperační histologii.
Objective: When deciding about form and timing of prostate cancer treatment we rely on following information: clinical staging of disease, Gleason score and patient's preferences. The aim of our study was to evaluate impact of prostate cancer grading modification regarding to conclusions from conference of uropathologists which took place in 2005 in the USA. Clinical material and methods: We performed reevaluation of biopic and operative specimens in group of 159 patients after radical prostatectomy from years 2003 - 2006 according to conventional and modified Gleason grading. Results: While agreement between pre- and postoperative specimens according to conventional evaluation was 34.6 %, underrating in 62.2 % occurred. On the other hand the modified evaluation showed agreement in 59.7 % and underrating occurred only in 28.3 % of specimens. In a view of this finding, active surveillance could be a choice for 22.6 % and 18.8 % patients according to conventional and modified evaluation, respectively. Conclusion: More accurate Gleason grading according to modified evaluation regarding score in postoperative histology was confirmed.
OBJECTIVE: To compare the accuracy in detecting variant histologies (VH) at transurethral resection of bladder (TURB) and radical cystectomy (RC) specimen among tertiary referral centres, in order to investigate potential reasons of discrepancies from the pathological point of view. PATIENTS AND METHODS: Clinical and histopathological data of TURB specimen and subsequent cystectomy specimen of 3,445 RC candidate patients have been retrospectively collected from 24 tertiary referral centres between 1980 and 2021. VH considered in the analysis were pure squamous cell carcinoma, urothelial carcinoma with squamous differentiation, pure adenocarcinoma, urothelial carcinoma with glandular differentiation, micropapillary bladder cancer (BCa), neuroendocrine BCa, and other variants. The degree of agreement between TURB and RC concerning the identification of VH was expressed as concordance, classified according to Cohen's kappa coefficient. RESULTS: A VH was reported in 17% of TURB specimens, 45% of which were not confirmed in RC. The lowest concordance rate was reported for micropapillary BCa with 11 out of 18 (61%) centres reporting no agreement, whereas neuroendocrine BCa achieved the highest concordance rate with only 3 centres (17%) reporting no agreement. Our results shows that even among centres with the advantage of a referent uropathologist the micropapillary variant is characterized by scarce accuracy between TURB and RC. Differences in TURB specimen acquisition by the urologist and in sampling methods among different centres are the main limitations of the study. CONCLUSIONS: Accuracy of TURB in detecting VH is poor for certain VH, in particular for micropapillary BCa, with evident variation among centres. Novel diagnostic tools are required to better identify these VH and drive patients toward a personalized treatment.
- MeSH
- cystektomie metody MeSH
- karcinom z přechodných buněk * patologie MeSH
- lidé MeSH
- močový měchýř patologie MeSH
- nádory močového měchýře * diagnóza farmakoterapie chirurgie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Papillary urothelial neoplasm of low malignant potential (PUN-LMP) was introduced as a noninvasive, noncancerous lesion and a separate grade category in 1998. Subsequently, PUN-LMP was reconfirmed by World Health Organization (WHO) 2004 and WHO 2016 classifications for urothelial bladder tumors. OBJECTIVES: To analyze the proportion of PUN-LMP diagnosis over time and to determine its prognostic value compared to Ta-LG (low-grade) and Ta-HG (high-grade) carcinomas. To assess the intraobserver variability of an experienced uropathologist assigning (WHO) 2004/2016 grades at 2 time points. MATERIALS AND METHODS: Individual patient data of 3,311 primary Ta bladder tumors from 17 hospitals in Europe and Canada were available. Transurethral resection of the tumor was performed between 1990 and 2018. Time to recurrence and progression were analyzed with cumulative incidence functions, log-rank tests and multivariable Cox-regression stratified by institution. Intraobserver variability was assessed by examining the same 314 transurethral resection of the tumorslides twice, in 2004 and again in 2018. RESULTS: PUN-LMP represented 3.8% (127/3,311) of Ta tumors. The same pathologist found 71/314 (22.6%) PUN-LMPs in 2004 and only 20/314 (6.4%) in 2018. Overall, the proportion of PUN-LMP diagnosis substantially decreased over time from 31.3% (1990-2000) to 3.2% (2000-2010) and to 1.1% (2010-2018). We found no difference in time to recurrence between the three WHO 2004/2016 Ta-grade categories (log-rank, P = 0.381), nor for LG vs. PUN-LMP (log-rank, P = 0.238). Time to progression was different for all grade categories (log-rank, P < 0.001), but not between LG and PUN-LMP (log-rank, P = 0.096). Multivariable analyses on recurrence and progression showed similar results for all 3 grade categories and for LG vs. PUN-LMP. CONCLUSIONS: The proportion of PUN-LMP has decreased to very low levels in the last decade. Contrary to its reconfirmation in the WHO 2016 classification, our results do not support the continued use of PUN-LMP as a separate grade category in Ta tumors because of the similar prognosis for PUN-LMP and Ta-LG carcinomas.
- MeSH
- invazivní růst nádoru MeSH
- karcinom z přechodných buněk patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru epidemiologie MeSH
- nádory močového měchýře patologie MeSH
- odchylka pozorovatele MeSH
- papilární karcinom patologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stupeň nádoru MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- Kanada MeSH
