Prostate cancer diagnosed after initial biopsy with atypical small acinar proliferation suspicious for malignancy is similar to cancer found on initial biopsy

Iczkowski, Kenneth A.; Chen, Helen M.; Yang, Ximing J.; Beach, Robyn A

doi:10.1016/s0090-4295(02)01981-7

Cited by 73 publications

(36 citation statements)

References 14 publications

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“…The diagnosis of such indeterminate cases concerns 1.5-9% of prostatic biopsies. 9 One feature distinguishing benign cancer mimics from cancer and prostate cancer is that benign glands contain basal cells that are absent in cancerous glands, and pathologists often use immunohistochemical markers to label basal cells. 2 In the presence of an ambiguous lesion, pathologists could use immunohistochemistry retrieval with anti-CK high-molecularweight antibody CK 903 to prove the absence of basal cells.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of a p63/α-methyl-CoA-racemase (p504s) cocktail in atypical foci in the prostate

et al. 2004

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Prostatic needle biopsy is the preferred method for diagnosing early prostate cancer, providing specific information. In cases of histological cancer mimics, a diagnosis of atypical small acinar proliferation suspected of but not diagnosed as malignancy can be made. In such cases, and in small focus carcinomas, pathologists use 34bE12, cytokeratin (CK) 5/6 or p63 immunostaining to label basal cells, and a-methylacyl-CoA racemase (AMACR/p504s) immunostaining as a positive prostate cancer marker on two distinct slides. However, in cases of small foci, ambiguous lesions might disappear. The purpose of our study was to improve the sensitivity of a cocktail of two antibodies (p63/p504s) with a sample incubation on 260 prostatic specimens, in order to help make a decision in conjunction with standard histology and CK 5/6 immunostaining. We tested 101 small focus prostatic cancers, 104 atypical small acinar proliferation, 19 high-grade prostatic intraepithelial neoplasia, two atypical adenomatous hyperplasia and 34 benign mimics of cancer. After p63/p504s immunostaining, the final diagnoses retained were as follows: 154 prostatic cancers, 14 atypical small acinar proliferation, 30 high-grade prostatic intraepithelial neoplasia, three atypical adenomatous hyperplasia and 62 benign mimics of cancer. To differentiate malignant from benign lesions, we used the criteria of greater sensitivity to p504s/p63 (95%) than to CK 5/6 (57%) or p63 (86%), and higher specificity for p504s/p63 (95%) than for CK 5/6 (88%) or p63 (81%). With the p504s/p63 cocktail, 89% of the ambiguous lesions were classified vs 53% for CK 5/6. Combined use of the two antibodies, one (p504s) as a positive marker and the other (p63) as a negative marker, with a simple immunostaining procedure, may improve diagnostic performance, sensitivity and specificity, leading to a reduction in the risk of false negatives; this technique in cases of atypical small acinar proliferation should reduce the percentage of residual ambiguous lesions and the need for additional biopsies.

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Section: Discussionmentioning

confidence: 99%

Diagnostic utility of a p63/α-methyl-CoA-racemase (p504s) cocktail in atypical foci in the prostate

et al. 2004

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“…Accurate targeting of specifi c prostate locations is most important when suspicious foci are identifi ed with other imaging modalities, such as magnetic resonance (MR) imaging or positron emission tomography (PET), or are based on abnormal histologic fi ndings of a previous biopsy (3)(4)(5)(6). The 3D transrectal US systems have been developed ( 3,12-16 ) to improve on the perguided 3D transrectal US, with the probability of performing a successful biopsy of a clinically important 0.5-cm 3 volume reaching 100%.…”

Section: Discussionmentioning

confidence: 99%

“…The region-based biopsy approach is the only option for patients in whom the location of potential tumors is unknown; however, abnormal fi ndings from a previous biopsy or from other imaging modalities could help to localize an occult neoplasm ( 3,4 ). Forty-fi fty percent of men who have a fi nding of atypical small acinar proliferation from a prior biopsy will have prostate adenocarcinoma from the same anatomic location at repeat biopsy ( 5,6 ). Repeat biopsy is limited, as 15% of all prostate adenocarcinoma diagnoses are made at the second biopsy, while 8% require three or more procedures ( 7 ).…”

Section: Patient Selection and Prostate Biopsy Simulatormentioning

confidence: 99%

Repeat Prostate Biopsy Accuracy: Simulator-based Comparison of Two- and Three-dimensional Transrectal US Modalities

Cool

Connolly²,

Sherebrin³

et al. 2010

Radiology

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Purpose:To compare the accuracy of biopsy with two-dimensional (2D) transrectal ultrasonography (US) with that of biopsy with conventional three-dimensional (3D) transrectal US and biopsy with guided 3D transrectal US in the guidance of repeat prostate biopsy procedures in a prostate biopsy simulator. Materials and Methods:The institutional review board approved this retrospective study. Five residents and fi ve experts performed repeat biopsies with a biopsy simulator that contained the transrectal US prostate images of 10 patients who had undergone biopsy. Simulated repeat biopsies were performed with 2D transrectal US, conventional 3D transrectal US, and guided 3D transrectal US (an extension of 3D transrectal US that enables active display of biopsy targets). The modalities were compared on the basis of time per biopsy and how accurately simulated repeat biopsies could be guided to specifi c targets. The probability for successful biopsy of a repeat target was calculated for each modality. Results:Guided 3D transrectal US was signifi cantly ( P , .01) more accurate for simulated biopsy of repeat targets than was 2D or 3D transrectal US, with a biopsy accuracy of 0.86 mm 6 0.47 (standard deviation), 3.68 mm 6 2.60, and 3.60 mm 6 2.57, respectively. Experts had a 70% probability of sampling a prior biopsy target volume of 0.5 cm 3 with 2D transrectal US; however, the probability approached 100% with guided 3D transrectal US. Biopsy accuracy was not signifi cantly different between experts and residents for any modality; however, experts were signifi cantly ( P , .05) faster than residents with each modality. Conclusion:Repeat biopsy of the prostate with 2D transrectal US has limited accuracy. Compared with 2D transrectal US, the biopsy accuracy of both experts and residents improved with guided 3D transrectal US but did not improve with conventional 3D transrectal US.q RSNA, 2010Supplemental material: http://radiology.rsna.org/lookup /suppl

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“…1, 2) has gained acceptance as a legitimate way for pathologists to describe minute foci of small prostatic acini that raise the suspicion of carcinoma but that fail to attain the requisite diagnostic threshold for carcinoma (Fadare et al, 2004). Studies have demonstrated that LSC is diagnosed in 1.5% to 9% of prostatic biopsies and that it predicts definite prostate cancer in about 45% of repeat biopsies (Iczkowski et al, 1997;Iczkowski et al, 1998;Iczkowski & Bostwick, 2000;Iczkowski et al, 2002). Since 1997, there have been efforts to stratify risk in cases of LSC into three categories: likely benign, uncertain, and likely carcinoma (Iczkowski et al, 1997).…”

Section: Lesion Suspicious For Cancer (Lsc)mentioning

confidence: 99%

Prostate Cancer Precursor Diseases

Papatsoris¹,

Kostopoulos²,

Migdalis³

et al. 2012

Intraepithelial Neoplasia

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Prostate cancer diagnosed after initial biopsy with atypical small acinar proliferation suspicious for malignancy is similar to cancer found on initial biopsy

Cited by 73 publications

References 14 publications

Diagnostic utility of a p63/α-methyl-CoA-racemase (p504s) cocktail in atypical foci in the prostate

Diagnostic utility of a p63/α-methyl-CoA-racemase (p504s) cocktail in atypical foci in the prostate

Repeat Prostate Biopsy Accuracy: Simulator-based Comparison of Two- and Three-dimensional Transrectal US Modalities

Prostate Cancer Precursor Diseases

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