Should pathologists continue to use the current pT2 substaging system for reporting of radical prostatectomy specimens?

Abstract

remaining 80 ml is injected. According the authors in patients with hematuria, split-bolus MDCT-urography and oral hydration provide complete opacification of the majority of upper urinary tract segments and are accurate for the diagnosis of upper tract urothelial tumors. Since the main objective of MDCT-urography is to detect all possible causes of hematuria, this study has some limitations. The authors did no include an analysis of the capability of split-bolus technique for the detection of urinary calculi, renal parenchymal tumor and bladder cancers. As we know small bladder cancer can be missed if only excretory phase of the full bladder is obtained.Another issue that could be addressed is how the renal parenchymal masses can be adequately characterized by the combined nephrographic /excretory phase obtained with split-bolus technique. Classically, renal masses are best characterized by the combination of findings obtained without intravenous contrast enhancement, scans obtained in nephrographic phase (70-90") and scans obtained in the excretory phase. In our opinion split bolus MDCT-urography may be useful for follow up patients with higher risk of develop upper tract urothelial cancer, particularly those already evaluated with cistoscopy. These patients should benefit with the use of this examination, which has high accuracy for the detection of urothelial cancer and uses low dose of radiation. Dr. Adilson PrandoHead, Department of Radiology and Diagnostic Imaging, Vera Cruz Hospital Campinas, São Paulo, Brazil E-mail: adilson.prando@gmail.com PATHOLOGY ___________________________________________________________________doi: 10.1590/S1677-553820100002000020Should pathologists continue to use the current pT2 substaging system for reporting of radical prostatectomy specimens? Background: During the International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens, 65.5% of the attendants answered that the current pT2 susbstaging system should not be used. Answering to another question, 63.4% favored to be reduced to two categories based on studies showing that pT2b does not exist. There was no consensus in regard to a minimum size for a second tumor to be considered for the whole case to be classified as pT2c as well as in regard to the definition of index tumor. We compared clinicopathologic findings and biochemical progression following surgery classifying pT2 patients into two categories. Design: The study was based on whole-mount consecutive surgical specimens from 142 patients with organ confined cancer. Using a semiquantitative method for evaluation of tumor extent, 10 positive points corresponds roughly to a 0.5ml tumor. We considered pT2a/pT2b substage (group 1) whenever a tumor presented > 10 positive points on only one side and pT2c whenever presented > 10 positive points on each of right and left side (group 2). The variables analyzed were: age, preoperative PSA, clinical stage, Gleason score on needle biopsy, and biochemica...

Is substaging necessary in patients with pathological stage T2 prostate cancer?

“…Diğer bir çalış-mada, klinik evre T2a ile T2b ve T2c evreler arasında biyokimyasal nüks açısından anlamlı fark olduğu tespit edilirken, patolojik evre T2a ile T2c hastalar arasında anlamlı farklılık bulunmamıştır. [14] Biz çalışmamızda klinik evrelerine göre hastalarımızın biyokimyasal nüks oranlarını araştırmayıp, patolojik alt evrelerin ameliyat öncesi verilerle öngörülüp öngörülemeyeceğine ve patolojik alt evrelemenin ek prognostik katkı sağlayıp sağlama-dığını araştırdık.…”

“…[19] 2002 TNM sınıflamasına göre pT2b tümörlerin saptanma oranı çalışmaların çoğunda çok düşüktür, [20][21][22] hatta bazı çalışmalarda hiç saptanmamıştır. [14] Farklı olarak bir çalışmada prostata sınırlı tümörlerin %61.1'inin pT2b olduğu bulunmuştur. [18] Ancak pT2b tümörlerin varlığı veya saptanmış olması ek bir prognostik katkı sağlamamıştır.…”