Concordance of biopsy and prostatectomy diagnosis of intraductal and cribriform carcinoma in a prospectively collected data set

Masoomian, Mehdi; Downes, Michelle; Sweet, Joan; Cheung, Carol C.; Evans, Andrew; Fleshner, Neil; Maganti, Manjula; Kwast, Theodorus H. van der

doi:10.1111/his.13747

Cited by 51 publications

(45 citation statements)

References 25 publications

(65 reference statements)

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“…There were no G1 cases in the cohort and 90% of the assessable G were ≥G3. Ninety‐seven per cent of the cohort was ≥pT3a and two‐thirds of the cases had positive surgical margins, supporting the idea of IDC and CC pathology being predominantly identified in advanced disease . Overall, only seven patients (one no ISUP‐G and six G5) with nodal metastatic disease lacked IDC/CC.…”

Section: Discussionmentioning

confidence: 73%

“…Ninety-seven per cent of the cohort was ≥pT3a and two-thirds of the cases had positive surgical margins, supporting the idea of IDC and CC pathology being predominantly identified in advanced disease. 22 Overall, only seven patients (one no ISUP-G and six G5) with nodal metastatic disease lacked IDC/CC. This highlights the power of either IDC or CC for predicting concomitant nodal metastases in G2-4 prostatic adenocarcinomas.…”

Section: Discussionmentioning

confidence: 89%

“…The following prostatectomy pathological parameters were recorded: contemporary ISUP‐G, stage, margin status, pattern 5 subtypes (solid, necrosis, single cells), presence/absence of IDC and CC. IDC and CC were diagnosed in accordance with previously reported definitions . The corresponding lymph nodes were reviewed and the number of retrieved nodes, number of positive nodes, size of metastases (measured microscopically) and the presence/absence of ENE (defined as extension of metastatic deposit beyond the capsule of the node) were documented.…”

Section: Methodsmentioning

confidence: 99%

“…IDC and CC were diagnosed in accordance with previously reported definitions. 18,22 The corresponding lymph nodes were reviewed and the number of retrieved nodes, number of positive nodes, size of metastases (measured microscopically) and the presence/absence of ENE (defined as extension of metastatic deposit beyond the capsule of the node) were documented. The largest positive lymph node was then further assessed for the percentage of morphological patterns present with an ISUP grade assigned based on the composite Gleason score of the most frequent and the highest Gleason pattern present (as per reporting of radical prostatectomy Gleason score).…”

Section: A S E S E L E C T I O N a N D R E V I E Wmentioning

confidence: 99%

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Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Downes

Kwast

2019

Histopathology

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Aims Lymph node metastases at the time of prostatectomy are an infrequent finding. The correlation of the pattern of nodal metastases with patient outcome has yet to be explored. Methods and results Lymph node‐positive prostatectomies were retrospectively reviewed. The presence of cribriform carcinoma (CC), intraductal carcinoma (IDC) and ISUP grade (G) were documented. The largest nodal metastasis was assessed for the morphological patterns present. G was assigned to the metastasis based on percentage morphological patterns present. Statistical analysis used spss to assess disease‐specific survival (DSS), disease‐free survival (DFS) and distant metastasis‐free survival (DMFS). One hundred and ten cases were identified: G5 (n = 52), G4 (n = 8), G3 (n = 34), G2 (n = 10) and no G (n = 6; treatment effect). IDC or CC was present in 103 (94%) specimens. More than one positive node correlated with worse DFS [P = 0.012, hazard ratio (HR) = 1.951, 95% confidence interval (CI) = 1.142–3.331] and DMFS (P = 0.009, HR = 2.647, 95% CI = 1.239–5.651). G in the prostate and nodal metastasis were poorly correlated (kappa = 0.073, P = 0.195). The presence of pattern 5 was seen in 33 nodes (30%) and correlated with DFS (P = 0.020, HR = 1.903, 95% CI = 1.091–3.320), DSS (P = 0.021, HR = 5.937, 95% CI = 1.084–32.533) and DMFS (P = 0.007, HR = 2.695, 95% CI = 1.269–5.726). Nodal cribriform pattern showed no prognostic correlation and pattern 3 metastasis showed a significant trend towards better outcome (DMFS P = 0.033, HR = 0.431, 95% CI = 0.194–0.958). Conclusions IDC or CC is identified in 94% of node‐positive prostate cancers. Although G in the largest nodal metastasis has prognostic significance, its G does not reflect that of the primary prostatic adenocarcinoma.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: A S E S E L E C T I O N a N D R E V I E Wmentioning

confidence: 99%

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Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Downes

Kwast

2019

Histopathology

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“…Therefore, it has been proposed that patients without cribriform architecture might be eligible for active surveillance 15–20 . However, prostate biopsies are subject to significant sampling errors with tumour undergrading in up to 40%, and there is low sensitivity for detection of cribriform architecture 21–23 . Moreover, in contrast to radical prostatectomy specimens, minor high‐grade patterns are always taken into account when prostate cancer biopsies are graded.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy

et al. 2020

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Aims: Invasive cribriform and intraductal carcinoma are associated with aggressive disease in Grade Group 2 (GG2) prostate cancer patients. However, the characteristics and clinical outcome of patients with GG2 prostate cancer without cribriform architecture (GG2À) as compared with those with Grade Group 1 (GG1) prostate cancer are unknown. The aim of this study was to investigate the clinical and pathological characteristics of GG1 and GG2À prostate cancer in radical prostatectomy specimens. Methods and results: We reviewed 835 radical prostatectomy specimens for Grade Group, pT stage, surgical margin status, and the presence of cribriform architecture. Biochemical recurrence-free survival and metastasis were used as clinical outcomes. GG1 prostate cancer was seen in 207 patients, and GG2 prostate cancer was seen in 420 patients, of whom 228 (54%) showed cribriform architecture (GG2+) and 192 (46%) did not. GG2À patients had higher prostate-specific antigen levels (9.4 ng/ml versus 7.0 ng/ml; P < 0.001), more often had extraprostatic extension (36% versus 11%; P < 0.001) and had more positive surgical margins (27% versus 17%; P = 0.01) than GG1 patients. GG2À patients had shorter biochemical recurrence-free survival (hazard ratio 2.7, 95% confidence interval 1.4-4.9; P = 0.002) than GG1 patients. Lymph node and distant metastasis were observed neither in GG2À nor in GG1 patients, but occurred in 22 of 228 (10%) GG2+ patients. Conclusion: In conclusion, patients with GG2À prostate cancer at radical prostatectomy have more advanced disease and shorter biochemical recurrencefree survival than those with GG1 prostate cancer, but both groups have a very low risk of developing metastasis.

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Prevalence of adverse pathology features in grade group 2 prostatectomy specimens with syn‐ or metachronous metastatic disease

Downes

Jain

et al. 2021

The Prostate

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Background: To validate the importance of recently established adverse histopathology features (cribriform pattern and intraductal carcinoma) as contraindication for deferred treatment of Gleason score 7 (3 + 4) (grade group [GG] 2) prostate cancer, we investigated their frequency in GG2 radical prostatectomies with syn-or metachronous metastatic disease.Methods: GG2 prostatectomy specimens of patients with concomitant lymph node metastasis or distant metastasis at follow-up were identified in a clinical database of a tertiary care center and their pathology was reviewed for pathological stage, lymphovascular invasion, Gleason grade 4 subpatterns, presence of tertiary grade 5, and ductal adenocarcinoma histology. A control group of 99 GG2 prostatectomy specimens who had no metastatic disease (controls) was reviewed for the same adverse pathological features.Results: Of 1860 GG2 prostatectomy specimens (operated between 2002 and 2020), 45 (2.4%) had concurrent regional lymph node metastases or distant metastases at follow-up. Pathological stage distribution of cases and controls was 24% and 79% pT2, 42% and 15% pT3a, 33% and 6.1% pT3b -T4, respectively (p < 0.001).Eleven of 45 cases (24%) had ≤10% Gleason grade 4 component. Cribriform pattern or intraductal carcinoma was present in 84% of cases versus 34% of controls (p < 0.001), tertiary grade 5 in 16% of cases versus 5% controls (p = 0.05) and ductal adenocarcinoma in 16% of cases versus 2% of controls (p = 0.004). Among the seven cases without cribriform or intraductal carcinoma, two displayed ductal adenocarcinoma features.Conclusions: Well-established unfavorable histopathologic features (intraductal and cribriform pattern carcinoma, ductal adenocarcinoma) are represented in about 90% of GG2 prostate cancers with local or distant metastatic disease and are much less common (38%) in those without metastatic disease. Strikingly, about 25% of GG2 prostatectomy cases with metastatic disease had an organ-confined disease and/or a small percentage of Gleason grade 4 pattern. This further emphasizes the relative

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Concordance of biopsy and prostatectomy diagnosis of intraductal and cribriform carcinoma in a prospectively collected data set

Cited by 51 publications

References 25 publications

Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Clinical outcome comparison of Grade Group 1 and Grade Group 2 prostate cancer with and without cribriform architecture at the time of radical prostatectomy

Prevalence of adverse pathology features in grade group 2 prostatectomy specimens with syn‐ or metachronous metastatic disease

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