Fragmentation Of Prostatic Needle Biopsy Cores Containing Adenocarcinoma: The Role Of Specimen Submission

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 10 Sep 2009 - 6:00 PDT

email to a friend   printer friendly   opinions  

UroToday.com - Fragmentation of a prostate biopsy core can potentially impact the pathologic interpretation. A report in online version of the British Journal of Urology International by Dr. Jonathan Epstein's group at Johns Hopkins University assesses this variable.

A retrospective review was performed from 2007 to 2008 for prostate biopsy cases that contained prostate cancer (CaP) in fragmented cores. A total of 463 cases were identified. A control set of 200 cases with CaP but no fragmented cores served as the control group. The comparison included the number of parts per case, the number of cores per specimen part, and number of parts containing cancer. The highest overall Gleason score in the cases with unfragmented cores was compared with the highest Gleason score within fragmented cores. They found the mean number of parts per case in the fragmented group was 7.5 with no significant difference in the number of parts per case in the fragmented and unfragmented groups.

The mean number of cores per specimen was higher in the fragmented group (2.6) compared to the unfragmented group (2.1). Analysis confirmed an association between fragmentation and the number of cores per part. There were a greater number of parts with CaP in the fragmented group (2.8) compared to the unfragmented group (1.6). Fragmentation was associated with the number of parts containing cancer. Fragmented cores also were associated with a higher Gleason score mean (6.6) compared to 6.2 in the unfragmented group.

The differences cited in this analysis may impact models that assess patient risk and outcomes. For example, the percentage or number of cores involved with cancer is used to estimate outcomes or determine if a patient is a candidate for active surveillance. The accurate percentage of a core involved with CaP cannot be determined when cores are fragmented. The investigators point out that a fragmented core involved with 50% CaP might actually only be involved with 10% of the entire core prior to fragmentation. Similarly, the Gleason score can be affected if cancer is contained in two fragments and the most predominant pattern may be altered by the fragmentation. They felt that Gleason grade 4 tissue is more likely to fragment as it contains less stroma to hold it together.

Fajardo DA, Epstein JI
BJU Int. 2009 Jul 6. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.08737.x

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2009 - UroToday

• Additional
• References
• Citations