Yüksek dereceli intraepitelyal neoplazi ve atipik küçük asiner proliferasyonun prostat biyopsisinde öneminin değerlendirilmesi

Year 2014, Volume: 9 Issue: 2, 48 - 53, 01.05.2014

Abdulmuttalip Şimşek Faruk Özgör Onur Küçüktopçu Mehmet Fatih Akbulut Murat Şahan Ali Sezer Ömer Sarılar Zafer Gökhan Gürbüz

Abstract

Amaç: Transrektal ultrason eşliğinde prostat biyopsisi yapılan hastalarda biyopsi sonuçlarımızı açıklamak ve patolojisi atipik küçük asiner proliferasyon ASAP veya yüksek dereceli intraepitelyal neoplazi HGPIN gelen hastalarda tekrar biyopsinin önemini vurgulamakGereç ve Yöntemler: Kliniğimizde Ekim 2007 ile Nisan 2013 tarihleri arasında 1763 hastaya yaptığımız transrektal ultrason eşliğinde prostat biyopsisi TRUS-Bx işleminin verileri geriye dönük olarak değerlendirildi. Değerlendirilen 1763 TRUS-Bx işleminin, 73’inin ikinci kez tekrarlayan biyopsi, 6’sının ise üçüncü kez tekrarlayan biyopsi olduğu görüldü. Biyopsi raporuna ulaşılamayan ve/veya PSA değeri saptanamayan 338 hasta çalışma dışı tutuldu. Çalışmaya dahil edilen tüm biyopsi işlemlerinin toplam 1337 hastaya uygulandığı görüldü. Hastalar ilk patoloji sonuçlarına göre 6 gruba ayrıldı.Bulgular: İlk biyopside hastaların %25,4’ ünün adenokanser tanısı aldığı görüldü. Hastaların %0,5’ inde birden çok odakta HGPIN ; %7,1’ inde ASAP saptandı ve %0,2’sinde ASAP ile beraber HGPIN görüldü. Bu üç gruptaki hastaların tekrar biyopsilerinde adenokanser saptanma oranları sırasıyla %40, %31 ve %50 olarak bulundu. Sonuç: Patolojilerinde HGPIN ve/veya ASAP bulguları olan hastalar yakın takibe alınmalı, bu patolojik bulguların önemi hakkında hastalar bilgilendirilip, takibe devam etmeleri ve uygun görülen zamanlarda tekrar biyopsilerinin yapılması konusunda ikna edilmelidir

Keywords

ASAP , HGPIN , prostat biyopsi

Assessing the significance of high grade prostatic intraepithelial neopasia and atypical small acinar proli- feration in prostate biopsy

Abstract

Objective: To evaluate pathological results of patients who underwent transrectal ultrasonography guided prostate biopsy and rebiopsy of patients with atypical small acinar proliferation ASAP and high grade intraepithelial neoplasia HGPIN .Material and Methods: We evaluated 1763 pathology results of transrectal ultrasonography guided prostate biopsy between October 2007 and April 2013. Of these 1763 pathology results, 73 of patients were underwent re biopy and 6 of them were underwent third biopsy. Total of 338 patients without a proper pathology result and results with no PSA value were ruled out from study. Pathology results included into the study were performed on 1337 patients. Patients were grouped in to 6 groups according to their first pathology results.Results: According to the first pathology result 25.4% of patients were enrolled into adenocancer group. High grade intraepithelial neoplasia more than one focus, ASAP and ASAP+HGPIN were seen 0.5%, 7.1% and 0.2% of patients, respectively. Re biopsy of these 3 groups detected adenocancer 40%,31% and 50% in orderly.Conclusion: Patients with pathology results of HGPIN and/or ASAP should be followed up carefuly and patients should be informed about the importance of rebiopsy

Keywords

ASAP , HGPIN , prostate biopsy

References

• Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96.
• Stamey TA, Yang N, Hay AR, et al. Prostate-specific anti- gen as a serum marker for adenocarcinoma of the prosta- te. N Engl J Med 1987;317:909-16.
• Moore CK, Karikehalli S, Nazeer T et al. Prognostic sig- nificance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contempo- rary era. J Urol 2005;173:70–2.
• Heidenreich A, Bastian PJ, Bellmunt J. et al. EAU 2013 Gu- idelines on Prostate Cancer
• Koca O, Çalışkan S, Öztürk Mİ, Güneş M, Karaman MI. Significance of Atypical Small Acinar Proliferation and High-Grade Prostatic Intraepithelial Neoplasia in Prostate Biopsy Korean J Urol 2011; 52:736–40.
• Schoenfield L, Jones JS, Zippe CD, et al. The incidence of high-grade prostatic intraepithelial neoplasia and atypical glands suspicious for carcinoma on first-time saturation needle biopsy, and the subsequent risk of cancer. BJU Int 2007;99:770-4.
• Amin MM, Jeyaganth S, Fahmy N, et al. Subsequent pros- tate cancer detection in patients with prostatic intraepithe- lial neoplasia or atypical small acinar roliferation Can Urol Assoc J 2007; 1: 245–9.
• Alsikafi NF, Brendler CB, Gerber GS, Yang XJ. High-grade prostatic intraepithelial neoplasia with adjacent atypia is associated with a higher incidence of cancer on subsequ- ent needle biopsy than high-grade prostatic intraepithelial neoplasia alone. Urology 2001;57:296-300.
• López JI. Prostate adenocarcinoma detected after high- grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. BJU Int 2007 ;100:1272-6.
• Park SJ, Miyake H, Hara I, Eto H. Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy. Int J Urol 2003;10:68–71.
• Bostwick DG, Srigley J, Grignon D, et al. Atypical adeno- matous hyperplasia of the prostate: morphologic criteria for its distinction from well-differentiated carcinoma.Hum Pathol 1993;24:819-32.
• Iczkowski KA, MacLennan GT, Bostwick DG. Atypical small acinar proliferation suspicious for malignancy in prostate needle biopsies: clinical significance in 33 cases. Am J Surg Pathol 1997;21:1489-95.
• Amin M, Boccon-Gibod L, Egevad L, et al. Prognostic and predictive factors and reporting of prostate carcinoma in prostate needle biopsy specimens. Scand J Urol Nephrol Suppl 2005;216:20-33.
• Bostwick DG, Brawer MK. Prostatic intra-epithelial neoplasia and early invasion in prostate cancer. Can- cer 1987;15:788-94.
• Ryu JH, Kim YB, Lee JK, Kim YJ, Jung TY. Predictive Fac- tors of Prostate Cancer at Repeat Biopsy in Patients with an Initial Diagnosis of Atypical Small Acinar Proliferation of the Prostate Korean J Urol 2010; 51: 752–6.