Ano de Publicação: 2011
AUTORIA
Luciana Schultz, MD,* Carlos E. Maluf, MD,w Roge´rio C. da Silva, MD,w
Rodrigo de H. Falashi, MD,w Matheus V. da Costa, MD,*
and Maria Ines O. Schultz, MD*
RESUMO
In addition to clinical data, prostatic biopsy (Bx) reports
orient urologists in outlining the patient’s treatment options.
Discontinuous involvement of a core by multiple foci of
cancer is not infrequent; however, there is currently no consensus
as to which method of quantification should be the
standard. We applied 2 distinct approaches to quantify the
length of cancer foci in the Bx and compared the results to
prostatectomy (RP) parameters. All patients with matched Bx
and RP treated by the same medical team between 2006 and
2010 were consecutively included in the study. Tumor extent in
the Bx was estimated by multiple approaches, and the length
was measured in millimeters. The subset of cases with discontinuous
foci of cancer in a single core was initially reported
by adding each foci and ignoring the benign intervening prostatic
tissue, which was designated as additive quantification
(AQ). Upon slide review, these foci were reassessed as a single
focus and measured by linear quantification (LQ). RPs were
partially embedded according to the International Society of
Urological Pathology recommendations, and the percentage of
tumor was evaluated with graphic precision. Mean percentage of
the tumor in RP (%RP) and in the Bx were arbitrarily classified
as limited (<6%) and nonlimited (Z6%). Bx parameters were
then correlated with %RP and margin status. All methods of
quantification of the tumor in the Bx obtained excellent correlation
with %RP. LQ and AQ diverged in 14/38 patients, with a
mean total length of cancer of 5.8mm more than the length
obtained by LQ in the same population, accurately upgrading
6/14 cases to nonlimited. This subset (LQ>AQ) was more often
seen in Bx with significantly more positive cores (P=0.003) of
predominantly Gleason score 7 and associated with positive
surgical margins in RP (P=0.034) independent of %RP (21%