Pathology

Abstract

): abst #633, 138ABackground: Although there is a sizable body of literature relating to PIN and atypical glands suspicious for cancer, many areas remain unresolved and practice patterns are varied.Design: A questionnaire was sent to 93 GU pathologists in countries around the world with the purpose to survey current practices of diagnosing and reporting prostate needle biopsies with PIN and atypia.Results: The response rate was 69%. The term PIN was universally acknowledged for preneoplastic lesions. However, if cytological or architectural atypia were pronounced, 44% would use intraductal carcinoma.PIN was graded by 83%, usually as low/high grade PIN (LGPIN/HGPIN) or, more commonly, as HGPIN only. Lesions that may qualify for LGPIN were never mentioned (58%) or only rarely mentioned in the descriptive part of the report (25%). Architectural patterns of PIN were usually not specified (81%) and those who specified never commented on their significance. The majority (75%) did not comment that HGPIN is premalignant and 63% would not recommend a repeat biopsy. With invasive cancer also present, 69% would still mention HGPIN. Basal cell stains were used in <5% of HGPIN cases (67%). HGPIN would be diagnosed by 56% in the absence of prominent nucleoli, most commonly based on prominent pleomorphism (53%), marked hyperchromasia (47%) or mitotic figures (28%). Among diagnostic criteria for HGPIN were different degrees of nucleolar prominence (52%), or nucleoli seen in at least 10% of cells (33%). Number of cores involved with HGPIN was specified by half of the respondents.Lesions suspicious for but not diagnostic of carcinoma were reported as ASAP (47%) or atypia/atypical glands/suspicious (48%). Degree of suspicion of cancer in atypical acinar lesions was defined by 41%. Only 34% always recommended repeat biopsy, while 30% would do it depending on referring doctor and 13% depending on patient age.Conclusions: For controversial areas relating to PIN and atypical glands, our survey provides information to general pathologists about how GU pathologists deal with these issues.