Combined histoarchitectural and cytological biopsy grading improves grading accuracy in low‐grade prostate cancer

Abstract

Abbreviations & AcronymsObjectives: Accurate tumor grading on prostate biopsy represents the mainstay for therapy planning. Biopsy undergrading is a persistent diagnostic dilemma with therapeutic relevance. We questioned whether Gleason grading combined with an established alternative grading system incorporating cytological parameters improves grading accuracy. Methods: Needle biopsies of 968 patients and the corresponding radical prostatectomy specimens were graded according to the Gleason grading system. In addition, all biopsies were graded according to the histo-and cytological grading system of Helpap. Biopsy Gleason grade, as well as the combined Gleason/Helpap grade, was compared with the final Gleason score and the pathological tumor-stage of the corresponding radical prostatectomy. Results: In biopsy Gleason score 6 cancers, an upgrading was seen in 76.0% of the patients (98/129), and 30.2% of them (39/129) showed non-organ confined disease. In combined biopsy Gleason 6/Helpap 2a patients, a final Gleason score of 6 was found in 22 out of 24 patients (91.7%, P < 0.0001), and all 24 patients showed organ-confined disease (pT2a). In biopsy Gleason 6/Helpap 2b cancers, a final Gleason score of 6 was found in just 9 out of 105 patients (8.6%), and the rate of organ-confined disease decreased to 62.8% (66/105, P = 0.0001). In higher Gleason grades, combined biopsy grading failed to show a diagnostic benefit over sole Gleason grading. Conclusion: Combined biopsy Gleason/Helpap grading improves the identification of low-grade/low-stage cancers and might contribute to more precise therapy planning in prostate cancer management.

Significance of Gleason Grading of Low-Grade Carcinoma of the Prostate with Therapeutic Option of Active Surveillance

“…In addition to the histological and architectural pattern of Gleason, the WHO-Mostofi and Helpap grading systems classify cytomorphological pattern like the nucleolar pattern. In usual reports of prostate cancer besides the histological pattern, in every case number location and size or prominence of nucleoli besides degrees of anaplasia of the nuclei are described [19]. We have only classified the nucleolar pattern in groups of: (1) only few small nucleoli in central location within the nucleus; (2) moderate, centrally located nucleoli; (3) marked or prominent eccentrically located nucleoli.…”

“…The specialities of architecture and histology of the well-known Gleason grading with the loss of glandular differentiation, glandular fusions and those of the combined histological and cytological grading have been described [5,17,18,19,20,21,22,23,24,25,26,27]. …”

“…314 (71.5%) of these had GS 6 and 7 (pattern 3 + 4) and were classified as low and intermediate grade. The basic results of the cell kinetic analysis of all 960 cases of low- and high-grade (risk) carcinomas by the Gleason and combined histological and cytological grading for a higher grade of grading accuracy in general were recently published [19,20]. Furthermore, for glandular fusion studies and the correlations of Gleason grading, tumor extension and PSA values, 2,500 biopsy specimens with prostate cancer were analyzed by Gleason grading.…”

“…Summary [19,26]: Score 0–1 = Helpap grade Ia, b (low grade) (incidental carcinoma); score 2 = Helpap grade IIa (low to intermediate grade); score 3 = Helpap grade IIb (intermediate to high grade); score 4–5 = Helpap grade IIIa, b (high grade).…”

“…This grading combination is based upon the normal diagnostic findings of the prostate cancer and it is not a new grading system [19]. …”