Utility of seriated sections in prostate biopsies

Abstract

Introduction

With the routine use of prostate specific antigen, focal carcinomas and atypical small acini proliferation (ASAP) are currently detected more frequently. The number of sections per cylinder needed to detect most of them is still unknown.

Methods

We reviewed 250 sextant prostate biopsies in the 2008–2011 period. The average number of cylinders per biopsy was 14. In each case, in addition to the original sections with three histological levels, three more sections were performed with three levels (total: 12 levels). Biopsies with focal lesion were analyzed immunohistochemically. The frequency of focal lesions was compared to a previous study of 1000 biopsies in which a single section was made with three histological levels. The main clinical and laboratory data were recorded.

Results

There were 16 focal lesions (6.4%). Seven (2.8%) corresponded to focal carcinomas and nine (3.6%) to atypical proliferation. In the previous study, thirteen (1.3%) focal carcinomas and 29 (2.9%) cases with atypical proliferation were found.

Conclusions

There was an increase of 4.2–6.4% of focal lesions carcinomas increased from 1.3% to 2.8%. Making additional sections in all biopsies may have practical drawbacks. However, they could be performed in patients with high clinical suspicion of carcinoma (especially in young patients), or when there is a history of atypical glandular proliferations consistent with carcinoma in previous biopsies.

Resumen

Introducción

Con el empleo rutinario del antígeno prostático específico, se detectan con mayor frecuencia carcinomas focales y proliferaciones atípicas de acinos pequeños (ASAP, siglas en inglés). El número de cortes por cilindro que debe practicarse para detectar la mayoría de ellos se desconoce.

Métodos

Revisamos 250 biopsias prostáticas por sextantes en el periodo 2008–2011. El promedio de cilindros por biopsia fue de 14. En cada caso se practicaron además del corte original con tres niveles histológicos, otros tres cortes con tres niveles (total: 12 niveles). En las biopsias con lesiones focales se practicó estudio inmunohistoquímico La frecuencia de lesiones focales se comparó con un estudio previo de mil biopsias donde se realizó un solo corte con tres niveles histológicos. Se anotaron los datos clínicos y de laboratorio.

Resultados

Hubo 16 lesiones focales (6.4%); siete (2.8%) correspondieron a carcinomas focales y nueve a (3.6%) proliferaciones atípicas. En el estudio previo se encontraron trece (1.3%) carcinomas focales y 29 (2.9%) casos con proliferaciones atípicas.

Conclusiones

Hubo un aumento de 4.2% a 6.4% de lesiones focales y un incremento de carcinomas del 1.3% a 2.8%. Aunque realizar cortes adicionales rutinariamente tiene inconvenientes prácticos, podría realizarse en pacientes con alta sospecha clínica de carcinoma (en particular jóvenes) o en los que existan antecedentes de proliferaciones glandulares atípicas compatibles con carcinoma.