Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/201759
Type: Artigo de periódico
Title: Intraductal Carcinoma Of The Prostate: Interobserver Reproducibility Survey Of 39 Urologic Pathologists.
Author: Iczkowski, Kenneth A
Egevad, Lars
Ma, Jun
Harding-Jackson, Nicholas
Algaba, Ferran
Billis, Athanase
Camparo, Philippe
Cheng, Liang
Clouston, David
Comperat, Eva M
Datta, Milton W
Evans, Andrew G
Griffiths, David F
Guo, Charles C
Hailemariam, Seife
Huang, Wei
Humphrey, Peter A
Jiang, Zhong
Kahane, Hillel
Kristiansen, Glen
La Rosa, Francisco G
Lopez-Beltran, Antonio
MacLennan, Gregory T
Magi-Galluzzi, Cristina
Merrimen, Jennifer
Montironi, Rodolfo
Osunkoya, Adeboye O
Picken, Maria M
Rao, Nagarjun
Shah, Rajal B
Shanks, Jonathan H
Shen, Steven S
Tawfik, Ossama W
True, Lawrence D
Van der Kwast, Theodorus
Varma, Murali
Wheeler, Thomas M
Zynger, Debra L
Sahr, Natasha
Bostwick, David G
Abstract: The diagnosis of intraductal carcinoma (IDC) of the prostate remains subjective because 3 sets of diagnostic criteria are in use. An internet survey was compiled from 38 photomicrographs showing duct proliferations: 14 signed out as high-grade prostatic intraepithelial neoplasia (HGPIN), 17 IDC, and 7 invasive cribriform/ductal carcinoma. Each image was assessed for the presence of 9 histologic criteria ascribed to IDC. Thirty-nine respondents were asked to rate images as (1) benign/reactive, (2) HGPIN, (3) borderline between HGPIN and IDC, (4) IDC, or (5) invasive cribriform/ductal carcinoma. Intraclass correlation coefficient was 0.68. There was 70% overall agreement with HGPIN, 43% with IDC, and 73% with invasive carcinoma (P < .001, χ(2)). Respondents considered 19 (50%) of 38 cases as IDC candidates, of which 5 (26%) had a two-thirds consensus for IDC; two-thirds consensus for either borderline or IDC was reached in 9 (47%). Two-thirds consensus other than IDC was reached in the remaining 19 of 38 cases, with 15 supporting HGPIN and 4 supporting invasive carcinoma. Findings that differed across diagnostic categories were lumen-spanning neoplastic cells (P < .001), 2× benign duct diameters (P < .001), duct space contours (round, irregular, and branched) (P < .001), papillary growth (P = .048), dense cribriform or solid growth (both P = .023), and comedonecrosis (P = .015). When the 19 of 38 images that attained consensus for HGPIN or invasive carcinoma were removed from consideration, lack of IDC consensus was most often attributable to only loose cribriform growth (5/19), central nuclear maturation (5/19), or comedonecrosis (3/19). Of the 9 histologic criteria, only 1 retained significant correlation with a consensus diagnosis of IDC: the presence of solid areas (P = .038). One case that attained IDC consensus had less than 2× duct enlargement yet still had severe nuclear atypia and nucleomegaly. Six fold nuclear enlargement was not significant (P = .083), although no image had both 6× nuclei and papillary or loose cribriform growth: a combination postulated as sufficient criteria for IDC. Finally, 20.5% of respondents agreed that an isolated diagnosis of IDC on needle biopsy warrants definitive therapy, 20.5% disagreed, and 59.0% considered the decision to depend upon clinicopathologic variables. Although IDC diagnosis remains challenging, we propose these criteria: a lumen-spanning proliferation of neoplastic cells in preexisting ducts with a dense cribriform or partial solid growth pattern. Solid growth, in any part of the duct space, emerges as the most reproducible finding to rule in a diagnosis of IDC. Comedonecrosis is a rarer finding, but in most cases, it should rule in IDC. Duct space enlargement to greater than 2× the diameter of the largest, adjacent benign spaces is usually present in IDC, although there may be rare exceptions.
Subject: Cribriform
High-grade Prostatic Intraepithelial Neoplasia
Interobserver Variability
Intraductal Carcinoma
Prostate
Solid
Survey
Rights: fechado
Identifier DOI: 10.1016/j.anndiagpath.2014.08.010
Address: http://www.ncbi.nlm.nih.gov/pubmed/25263387
Date Issue: 2014
Appears in Collections:Artigos e Materiais de Revistas Científicas - Unicamp

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