High-grade prostatic intraepithelial neoplasia with adjacent small atypical glands on prostate biopsy

Kronz, Joseph D.; Shaikh, Ali A.; Epstein, Jonathan I.

doi:10.1053/hupa.2001.23522

Cited by 79 publications

(29 citation statements)

References 13 publications

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“…A diagnostic problem is that the basal cell layer of HGPIN may be patchy and occasionally absent around small outpouchings of a larger PIN gland. 21 Hence, for the assessment of single atypical glands where the differential diagnosis is between HGPIN and invasive carcinoma, the value of immunohistochemistry is limited and the diagnosis should mainly be based on routine stained sections. An overwhelming majority (92%) consequently would use immunohistochemistry in less than 20% of HGPIN cases.…”

Section: Discussionmentioning

confidence: 99%

Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists

2006

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The criteria for diagnosing prostatic intraepithelial neoplasia (PIN) and lesions suspicious for cancer are described in the literature. However, it is unknown how these are applied in practice by experts in genitourinary (GU) pathology. A questionnaire was sent to 93 GU pathologists in countries around the world with the purpose of surveying current practices. The response rate was 69% including 40 North American pathologists and 24 from other continents. For preneoplastic lesions, the term PIN was universally endorsed by the respondents. PIN was graded by 83%, usually as low/high-grade PIN (LGPIN/HGPIN) or as HGPIN only. Most respondents would usually not report lesions that may qualify for LGPIN. A majority (81%) did not specify architectural patterns of PIN. With both HGPIN and invasive cancer present, 69% would still mention HGPIN. Among the diagnostic criteria for HGPIN were any nucleoli visible (52%), or nucleoli seen in at least 10% of cells (33%). However, 56% would diagnose HGPIN in the absence of prominent nucleoli, most commonly based on prominent pleomorphism, marked hyperchromasia or mitotic figures. The number of cores involved with HGPIN was specified by 50%. Lesions suspicious for but not diagnostic of carcinoma were reported by 45% as atypia, atypical glands or suspicious for cancer and by 42% as atypical small acinar proliferation. The degree of suspicion was further defined by 41%. Our survey data may serve as a guideline to general pathologists on how to diagnose and report atypia and PIN in prostate biopsies. Keywords: prostatic neoplasms; prostatic intraepithelial neoplasia; pathology; male; human We have recently surveyed current practices of Gleason grading of prostate cancer among experts in genitourinary (GU) pathology. 1 On some issues, there was a high level of consensus among respondents, while on others, there was a significant disagreement, calling for standardization. There are reasons to believe that diagnosis and reporting of prostatic intraepithelial neoplasia (PIN) and lesions suspicious for cancer may also suffer from lack of uniformity. Over the last decades there has been a shift in nomenclature for these diagnoses. Lesions that used to be diagnosed as atypical hyperplasia or dysplasia are now known as PIN. 2 For lesions suspicious of cancer, the term atypical small acinar proliferation (ASAP) has been suggested. 3,4 It is unclear to what extent new terminology has been adopted worldwide. Criteria for diagnosing PIN have also evolved in recent years, and definitions have focused on nucleolar prominence. 5 Grading of preneoplastic lesions has moved from a three-tier system (PIN 1-3) to a two-tier system (LGPIN and HGPIN). 5 The purpose of this study was to survey current practice among GU pathologists of diagnosing and reporting PIN and lesions suspicious of but not diagnostic for prostatic carcinoma.

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Section: Discussionmentioning

confidence: 99%

Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists

2006

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“…HGPIN was considered as precursor of PCa and a predictor of PCa on subsequent biopsies, especially in the era of sextant biopsy and repeat biopsy has become a standard of care for HGPIN for almost a decade (Kronz et al, 2001Moore et al, 2005) The incidence of HGPIN shows marked variation in the literature ranging from 0% to 24.6%; the mean reported incidence is 7.7% (median 5.2%) . In a study with a large, community based prostate biopsy population, the incidence of HGPIN was reported as 3.0% in 42,667 patients (Girasole et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

What is the fate of repeat biopsies after diagnosis of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation?

Bostanci¹,

Özden²,

Yakupoğlu³

et al. 2013

jecm

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“…7,13 Indeed, many studies have reported a high predictive value of HGPIN in identifying pCA utilizing sextant biopsy schemes, but in some reports using extended biopsy schemes, HGPIN was not predictive of the presence of pCA reported a high predictive value of HGPIN in identifying prostatic adenocarcinoma. 7,[13][14][15][16][17][18] Thus, attempts to determine the predictive ability of crystalloids in benign biopsy specimens are challenged by the low incidence of patients with crystalloids in benign biopsy specimens and the increased sampling efficiency afforded by extended biopsy schemes. To conclude that crystalloids do indeed represent a significant risk factor for a subsequent diagnosis of prostate cancer, will require a prospective investigation with standardized biopsy schemes and a large cohort to identify sufficient number of patients with crystalloids on benign biopsies.…”

Section: Crystalloids and Prostatic Adenocarcinoma Rs Svatek Et Almentioning

confidence: 99%

Intraluminal crystalloids are highly associated with prostatic adenocarcinoma on concurrent biopsy specimens

Svatek

Karam

Rogers

et al. 2007

Prostate Cancer Prostatic Dis

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Prostatic crystalloids are intraluminal eosinophilic structures with variable size and shape. Their presence has been described in conjunction with the occurrence of prostatic adenocarcinoma (pCA). We herein report the association of crystalloids and pCA in a prospective trial utilizing an extended multi-site transrectal ultrasound-guided (TRUS) prostate biopsy protocol. Three hundred and fortyfour consecutive patients were prospectively enrolled at the Dallas Veterans Administration Hospital from November 2002 to September 2003. Indications for biopsy included a prostatespecific antigen (PSA) X4 ng/ml and/or abnormal digital rectal exam. A single pathologist evaluated all biopsy cores and documented the presence or absence of significant histopathologic features. Univariate and multivariate logistic regression analysis were applied to test the association of these features with the presence of pCA on concurrent biopsy. Median number of core biopsies per patient was 12 (range 3-36). Overall cancer detection rate was 42.7%. pCA was diagnosed in 66 (81.5%) of 81 patients with crystalloids, 70 (69.3%) of 101 patients with high-grade prostatic intraepithelial neoplasia (HGPIN), and 32 (84.2%) of 38 patients with both HGPIN and crystalloids on biopsy. Multivariate analysis identified crystalloids (RR 4.53, 95% CI 2.30-8.88) and HGPIN (RR 3.20, 95% CI 1.84-5.57) as independent predictors of the presence of cancer on concurrent biopsy (Po0.001). In this prospective analysis, crystalloids were significantly associated with pCA on concurrent biopsy and more predictive of the presence of pCA than HGPIN. These findings suggest that the presence of crystalloids alone or in combination with HGPIN in prostate biopsies may be a more compelling indication for repeat biopsy than HGPIN alone.

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High-grade prostatic intraepithelial neoplasia with adjacent small atypical glands on prostate biopsy

Cited by 79 publications

References 13 publications

Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists

Current practice of diagnosis and reporting of prostatic intraepithelial neoplasia and glandular atypia among genitourinary pathologists

What is the fate of repeat biopsies after diagnosis of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation?

Intraluminal crystalloids are highly associated with prostatic adenocarcinoma on concurrent biopsy specimens

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