Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists

Abstract

The criteria for diagnosing prostatic intraepithelial neoplasia (PIN) and lesions suspicious for cancer are described in the literature. However, it is unknown how these are applied in practice by experts in genitourinary (GU) pathology. A questionnaire was sent to 93 GU pathologists in countries around the world with the purpose of surveying current practices. The response rate was 69% including 40 North American pathologists and 24 from other continents. For preneoplastic lesions, the term PIN was universally endorsed by the respondents. PIN was graded by 83%, usually as low/high-grade PIN (LGPIN/HGPIN) or as HGPIN only. Most respondents would usually not report lesions that may qualify for LGPIN. A majority (81%) did not specify architectural patterns of PIN. With both HGPIN and invasive cancer present, 69% would still mention HGPIN. Among the diagnostic criteria for HGPIN were any nucleoli visible (52%), or nucleoli seen in at least 10% of cells (33%). However, 56% would diagnose HGPIN in the absence of prominent nucleoli, most commonly based on prominent pleomorphism, marked hyperchromasia or mitotic figures. The number of cores involved with HGPIN was specified by 50%. Lesions suspicious for but not diagnostic of carcinoma were reported by 45% as atypia, atypical glands or suspicious for cancer and by 42% as atypical small acinar proliferation. The degree of suspicion was further defined by 41%. Our survey data may serve as a guideline to general pathologists on how to diagnose and report atypia and PIN in prostate biopsies. Keywords: prostatic neoplasms; prostatic intraepithelial neoplasia; pathology; male; human We have recently surveyed current practices of Gleason grading of prostate cancer among experts in genitourinary (GU) pathology. 1 On some issues, there was a high level of consensus among respondents, while on others, there was a significant disagreement, calling for standardization. There are reasons to believe that diagnosis and reporting of prostatic intraepithelial neoplasia (PIN) and lesions suspicious for cancer may also suffer from lack of uniformity. Over the last decades there has been a shift in nomenclature for these diagnoses. Lesions that used to be diagnosed as atypical hyperplasia or dysplasia are now known as PIN. 2 For lesions suspicious of cancer, the term atypical small acinar proliferation (ASAP) has been suggested. 3,4 It is unclear to what extent new terminology has been adopted worldwide. Criteria for diagnosing PIN have also evolved in recent years, and definitions have focused on nucleolar prominence. 5 Grading of preneoplastic lesions has moved from a three-tier system (PIN 1-3) to a two-tier system (LGPIN and HGPIN). 5 The purpose of this study was to survey current practice among GU pathologists of diagnosing and reporting PIN and lesions suspicious of but not diagnostic for prostatic carcinoma.

Complex patterns of ETS gene alteration arise during cancer development in the human prostate

“…In contrast, no clinical relevance has been associated with the presence of lower grade lesions, such as LG-PIN (Brawer et al, 1991;Epstein et al, 1995;Egevad et al, 2006). This is largely due to problems in the consistent diagnosis of low grade lesions (Epstein et al, 1995;Srigley et al, 2000;Egevad et al, 2006) leading to the diagnostic reporting of these appearances as an entity becoming largely obsolete. The presence of an ERG rearrangement means that this subgroup of LG-PIN, which would not currently be highlighted as a worrying sign of pre-neoplasia, can now be defined.…”

MYC Overexpression Induces Prostatic Intraepithelial Neoplasia and Loss of Nkx3.1 in Mouse Luminal Epithelial Cells

“…The key morphological features that are diagnostic of PIN and invasive carcinoma cells are changes in nuclear morphology such as enlargement of the nucleus, changes in chromatin structure, and marked nucleolar enlargement [6], [7], [8], [9]. A critical issue remaining in cancer biology, including in prostate cancer, is determining the phenotype and niche of the progenitor cell that becomes transformed.…”

Predicting prostate biopsy outcome: artificial neural networks and polychotomous regression are equivalent models

“…Limitations of placing HGPIN and ASAP together for analysis are obvious, but this was undertaken as they represent realistically the only other category of biopsy result that may be associated with malignancy and that are currently reported by pathologists [31]. ASAP denotes a higher risk of PC at repeat biopsy [32], and although HGPIN at biopsy has in the past few years been downgraded in importance, Epstein has reignited the issue by declaring that the amount of HGPIN may predict cancer [33].…”