Transrektal iğne biyopsisinden elde edilen örneklerin ‘International Society of Urological Pathology Gleason-scores’ değerleri ile karar vermek ne kadar doğru?

Abstract

Giriş ve Amaç: Lokalize prostat kanserinin tedavisine ilişkin karar esas olarak transrektal iğne biyopsisinin histopatolojik sonuçlarına bağlıdır. Transrektal iğne biyopsileri ile radikal prostatektomi örneklerinin sonuçları arasındaki uyumun değişken olduğu bildirilmiştir. Bu çalışmada aynı kurumun homojen sonuçlarını incelemeyi amaçladık. Gereç ve Yöntemler: Radikal prostatektomi (RP) ve transrektal ultrason eşliğinde prostat biyopsisi (TRUS-Bx) işlemlerinin her ikisi de kurumumuzda yapılan 230 hasta çalışmaya dahil edildi. Demografik özellikler, TRUS-Bx öncesi PSA seviyeleri (ng/ml), TRUS-Bx ve RP'den elde edilen örneklerin ‘International Society of Urological Pathology (ISUP) Gleason grup dereceleri kaydedildi ve uyum açısından değerlendirildi. Bulgular: 250 hastanın 137'sinde RP örneklerinin ISUP Gleason dereceleri, TRUS-Bx patoloji sonuçları ile uyumluydu (%59,6). İlk biyopside ISUP Gleason derece 2 veya 3 veya 4 veya 5 olduğu bildirilen 125 hastanın 20'sinde (%16) derece düşüşü ve ISUP Gleason derece 1 olduğu bildirilen 147 hastanın 42’sinde (%29) derece yükselişi final patolojilerde izlendi. Sonuç: RP örneklerinin ISUP Gleason derecelerini öngörmede TRUS-Bx sonuçlarının yetersiz kalabileceği kanısındayız.

Keywords

• prostat kanseri
• prostatektomi
• biyopsi

Decision-making based on International Society of Urological Pathology Gleason-scores obtained from transrectal needle biopsy of the Prostate: How Accurate Could We Be ?

Abstract

Objective: The decision about the treatment of localized prostate cancer (PC) depends mainly on the histopathological results of transrectal needle biopsy. The agreement between the results of transrectal needle biopsies and radical prostatectomy specimens were reported to be varying. In this study, we aimed to investigate one institution’s homogenous repertory. A fair agreement could be revealed, and probable strategies to improve the rate of agreement are discussed. Materials and Methods: 230 eligible patients who underwent radical prostatectomy (RP) and transrectal ultrasound guided prostate biopsy (TRUS-Bx) in our instutition were included in the study. Demographic characteristics, PSA levels (ng/ml) prior to TRUS-Bx, International Society of Urological Pathology (ISUP) Gleason group grades obtained from TRUS-Bx and RP were recorded and evaluated for concordance. Results:137 of 250 patients RP pathology ISUP Gleason grades were compatible with TRUS-Bx pathology results (%59,6). 20 of 125 (%16) patients who reported to be ISUP Gleason grade 2 or 3 or 4 or 5 in initial biopsy found to be downgraded and 42 of 147 patients (29%), reported to have ISUP Gleason grade 1 upgraded in the final pathology. Conclusion: In the diagnosis of PC, TRUS-Bx is an insufficient method to show the correct ISUP Gleason grade in radical prostatectomy specimen pathology.

Keywords

• prostate cancer
• prostatectomy
• biopsy

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