Emre ALTINTAŞ, Mehmet KAYNAR, Özcan KILIÇ, Ali Furkan BATUR, Murat GÜL, Halil ÖZER, Murat CELİK, Serdar GÖKTAŞ

Füzyon Biyopsi Sonrası Prostat Kanseri Saptanan Hastalarda Biyopsi Sonrası Patoloji ile Radikal Prostatektomi Sonrası Patolojinin Karşılaştırılması

Amaç:Füzyon biyopsisi sonrası prostat kanseri (PCa) saptanan hastaların radikal prostatektomi (RP) sonrası final patolojileri ile biyopsi sonrası patolojilerini Uluslararası Ürolojik Patoloji Derneği (ISUP) derecelendirme sistemine göre karşılaştırmak. Gereç ve Yöntem: Bu retrospektif çalışmada Ocak 2020-Ağustos 2022 yılları arasında füzyon biyopsi ve beraberinde sistematik biyopsi yapılan 182 hastanın verileri tarandı. Bu hastaların tümü multiparametrik MRG (mp-MRG) görüntülemesi yapılan PIRADS-3 lezyonu olan ve biyopsi naiv hastalardı. Biyopsi sonucunda PCa saptanan 89 hasta çalışmaya dahil edildi. Hastaların yaş, PSA, PSA dansitesi, PI-RADS'a göre lezyon dereceleri incelendi. Bu hastalardan RP yapılan 60 hastanın biyopsi sonrası (füzyon ve sistematik biyopsi) patoloji sonuçlarıyla RP sonrası final patoloji sonuçları karşılaştırıldı. Bulgular: Füzyon biyopsisi ve RP sonrası patolojik sonuçlar karşılaştırıldı. Her bir ISUP derecesi için RP ve füzyon biyopsisi arasındaki bireysel uyum orta ila neredeyse mükemmeldi (0,558 ila 0,848). RP ve füzyon biyopsisi arasındaki genel uyum değerlendirildiğinde, ağırlıklı kappa 0,721 (%95 CI: 0,577 ila 0,865) olarak hesaplandı ve bu uyum önemli uyum olarak belirlendi. Diğer yandan, RP sonrası sistematik biyopsi ve patoloji sonuçları arasındaki genel uyum ağırlıklı kappa 0,544 (%95 GA: 0,405 ila 0,683) olarak hesaplanmış ve bu uyum orta düzeyde uyum olarak belirlenmiştir. Sonuç: Çalışmamızda füzyon biyopsi sonrası patoloji sonucuyla RP sonrası final patoloji arasındaki uyumun standart TRUS prostat biyopsisine göre daha yüksek oranda olduğunu gösterdik. Bu uyumun hastaların tedavisinin düzenlenmesinde ve takibinde önemli olduğunu düşünüyoruz.

Anahtar Kelimeler:

Prostat kanseri, mp-MRG, mp-MRG, mp-MRG, mp-MRG, füzyon biyopsi, ISUP derecesi

Comparison of Post Biopsy Pathology and Post Radical Prostatectomy Pathology in Patients with Prostate Cancer Detected After Fusion Biopsy

Aims: To compare the post-radical prostatectomy (RP) final pathologies and post-biopsy pathologies of the patients diagnosed with prostate cancer (PCa) after fusion biopsy according to the International Society of Urological Pathology (ISUP) grading system. Material and Methods: In this retrospective study, data of 182 patients who underwent fusion biopsy and concomitant systematic biopsy between January 2020 and August 2022 was reviewed. All these patients were biopsy naive with PIRADS-3 lesions according to the multiparametric MRI (mp-MRI) imaging. A total of 89 patients with PCa detected by biopsy were included in the study. Age, PSA, PSA density, and lesion grades according to PI-RADS were analysed. The post-biopsy (fusion and systematic biopsy) pathology results of 60 patients who underwent RP were compared with the final pathology results after RP. Results: Pathological results after fusion biopsy and RP were compared. The individual agreement between RP and fusion biopsy for each ISUP grade was moderate to almost excellent (0.558 to 0.848). When the overall agreement between RP and fusion biopsy was evaluated, the weighted kappa was calculated as 0.721 (95% CI: 0.577 to 0.865), which was determined as substantial significant agreement. On the other hand, the overall agreement between systematic biopsy and pathology results after RP was calculated as weighted kappa 0.544 (95% CI: 0.405 to 0.683) and this agreement was determined as moderate agreement. Conclusion: Our study showed that the concordance between the pathology result after fusion biopsy and the final pathology after RP was higher than the standard TRUS prostate biopsy. We think this compliance is crucial in the regulation and follow-up of the treatment of the patients.

Keywords:

prostate cancer, fusion biopsy, ISUP grade, mp-MRG, mp-MRG, mp-MRG, mp-MRG,

PDF

___

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
Bjurlin MA, Carter HB, Schellhammer P, Cookson MS, Gomella LG, Troyer D, et al. Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. The Journal of urology. 2013;189(6):2039-46.
Ng TK, Vasilareas D, Mitterdorfer AJ, Maher PO, Lalak A. Prostate cancer detection with digital rectal examination, prostate-specific antigen, transrectal ultrasonography and biopsy in clinical urological practice. BJU international. 2005;95(4):545-8.
Hoffman RM. Clinical practice. Screening for prostate cancer. The New England journal of medicine. 2011;365(21):2013-9.
Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. The Lancet. 2017;389(10071):815-22.
Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. 2018;378(19):1767-77.
Schoots IG, Padhani AR, Rouvière O, Barentsz JO, Richenberg J. Analysis of Magnetic Resonance Imaging–directed Biopsy Strategies for Changing the Paradigm of Prostate Cancer Diagnosis. European Urology Oncology. 2020;3(1):32-41.
Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, et al. ESUR prostate MR guidelines 2012. Eur Radiol. 2012;22(4):746-57.
Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging – Reporting and Data System: 2015, Version 2. European Urology. 2016;69(1):16-40.
N. Mottet (Chair) P. Cornford, R.C.N. van den Bergh, E. Briers, D.Eberli, G.De Meerleer et al. . EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidlines on Prostate Cancer,EAU.2023.
Moussa AS, Li J, Soriano M, Klein EA, Dong F, Jones JS. Prostate biopsy clinical and pathological variables that predict significant grading changes in patients with intermediate and high grade prostate cancer. BJU international. 2009;103(1):43-8.
Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Incidence and Predictive Factors Using the Modified Gleason Grading System and Factoring in Tertiary Grades. European Urology. 2012;61(5):1019-24.
Rajinikanth A, Manoharan M, Soloway CT, Civantos FJ, Soloway MS. Trends in Gleason score: concordance between biopsy and prostatectomy over 15 years. Urology. 2008;72(1):177-82.
Aykan S. TM, Şentürk A. B. , Temiz M. Z. , Semerciöz A. , Müslümanoğlu A. Y. Evaluation of the agrement between histopathology results of transrectal biopsy and radical prostatectomy specimens in patıent wıth radical prostatectomy. The New Journal of Urology. 2018;13:38-43.
Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, et al. MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis. N Engl J Med. 2020;382(10):917-28.
Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. The American journal of surgical pathology. 2016;40(2):244-52.
Joseph L. Fleiss BL, Myunghee Cho Paik. Statistical Methods for Rates and Proportions: John Wiley & Sons, Inc.; 5 September 2003.
Steinberg DM, Sauvageot J, Piantadosi S, Epstein JI. Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. The American journal of surgical pathology. 1997;21(5):566-76.
Goel S, Shoag JE, Gross MD, Al Hussein Al Awamlh B, Robinson B, Khani F, et al. Concordance Between Biopsy and Radical Prostatectomy Pathology in the Era of Targeted Biopsy: A Systematic Review and Meta-analysis. Eur Urol Oncol. 2020;3(1):10-20.
Carlson GD, Calvanese CB, Kahane H, Epstein JI. Accuracy of biopsy Gleason scores from a large uropathology laboratory: use of a diagnostic protocol to minimize observer variability. Urology. 1998;51(4):525-9.
Patel AR, Jones JS. Optimal biopsy strategies for the diagnosis and staging of prostate cancer. Current opinion in urology. 2009;19(3):232-7.
Dong F, Jones JS, Stephenson AJ, Magi-Galluzzi C, Reuther AM, Klein EA. Prostate cancer volume at biopsy predicts clinically significant upgrading. The Journal of urology. 2008;179(3):896-900; discussion
Öztürk S. A., Çifteci T, Özorak A. , Soyupek A. S. , Oksay T. , Ergün O. et al. Prostat Adenokarsinomlarında İğne Biyopsileri ile Radikal Prostatektomi Materyalleri Arasındaki Gleason Skor Uyumsuzluğu. SDÜ Tıp Fakültesi Dergisi. 2020;27:477-81.
Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C, et al. Multiparametric Magnetic Resonance Imaging (MRI) and MRI–Transrectal Ultrasound Fusion Biopsy for Index Tumor Detection: Correlation with Radical Prostatectomy Specimen. European Urology. 2016;70(5):846-53.
Tyson MD, Arora SS, Scarpato KR, Barocas D. Magnetic resonance-ultrasound fusion prostate biopsy in the diagnosis of prostate cancer. Urol Oncol. 2016;34(7):326-32.
Valerio M, Donaldson I, Emberton M, Ehdaie B, Hadaschik BA, Marks LS, et al. Detection of Clinically Significant Prostate Cancer Using Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsy: A Systematic Review. Eur Urol. 2015;68(1):8-19.
Coogan CL, Latchamsetty KC, Greenfield J, Corman JM, Lynch B, Porter CR. Increasing the number of biopsy cores improves the concordance of biopsy Gleason score to prostatectomy Gleason score. BJU international. 2005;96(3):324-7.
Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. 2015;68(3):438-50.