Context.—Controversies and uncertainty persist in prostate cancer grading. Objective.—To update grading recommendations. Data Sources.—Critical review of the literature along with pathology and clinician surveys. Conclusions.—Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 þ 4 ¼ 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace ‘‘tertiary grade pattern’’ in radical prostatectomy (RP) with ‘‘minor tertiary pattern 5 (TP5),’’ and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 þ 5 ¼ 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (.50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) ‘‘atypical intraductal proliferation (AIP)’’ is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice.
The 2019 genitourinary pathology society (GUPS) white paper on contemporary grading of prostate cancer / Epstein, J. I.; Amin, M. B.; Fine, S. W.; Algaba, F.; Aron, M.; Baydar, D. E.; Beltran, A. L.; Brimo, F.; Cheville, J. C.; Colecchia, M.; Comperat, E.; da Cunha, I. W.; Delprado, W.; Demarzo, A. M.; Giannico, G. A.; Gordetsky, J. B.; Guo, C. C.; Hansel, D. E.; Hirsch, M. S.; Huang, J.; Humphrey, P. A.; Jimenez, R. E.; Khani, F.; Kong, Q.; Kryvenko, O. N.; Kunju, L. P.; Lal, P.; Latour, M.; Lotan, T.; Maclean, F.; Magi-Galluzzi, C.; Mehra, R.; Menon, S.; Miyamoto, H.; Montironi, R.; Netto, G. J.; Nguyen, J. K.; Osunkoya, A. O.; Parwani, A.; Robinson, B. D.; Rubin, M. A.; Shah, R. B.; So, J. S.; Takahashi, H.; Tavora, F.; Tretiakova, M. S.; True, L.; Wobker, S. E.; Yang, X. J.; Zhou, M.; Zynger, D. L.; Trpkov, K.. - In: ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE. - ISSN 0003-9985. - 145:4(2021), pp. 461-493. [10.5858/arpa.2020-0015-ra]
The 2019 genitourinary pathology society (GUPS) white paper on contemporary grading of prostate cancer
Colecchia M.;
2021-01-01
Abstract
Context.—Controversies and uncertainty persist in prostate cancer grading. Objective.—To update grading recommendations. Data Sources.—Critical review of the literature along with pathology and clinician surveys. Conclusions.—Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 þ 4 ¼ 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace ‘‘tertiary grade pattern’’ in radical prostatectomy (RP) with ‘‘minor tertiary pattern 5 (TP5),’’ and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 þ 5 ¼ 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (.50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) ‘‘atypical intraductal proliferation (AIP)’’ is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
