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→Gleason grading system
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===Gleason grading system=== | ===Gleason grading system=== | ||
*[[AKA]] ''modified Gleason grading system''. | |||
====Overview==== | ====Overview==== | ||
*This system is only one any one talks about and there is consensus on how it is done.<ref name=pmid16096414>{{Cite journal | last1 = Epstein | first1 = JI. | last2 = Allsbrook | first2 = WC. | last3 = Amin | first3 = MB. | last4 = Egevad | first4 = LL. | title = The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. | journal = Am J Surg Pathol | volume = 29 | issue = 9 | pages = 1228-42 | month = Sep | year = 2005 | doi = | PMID = 16096414 }}</ref> | *This system is only one any one talks about and there is consensus on how it is done.<ref name=pmid16096414>{{Cite journal | last1 = Epstein | first1 = JI. | last2 = Allsbrook | first2 = WC. | last3 = Amin | first3 = MB. | last4 = Egevad | first4 = LL. | title = The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. | journal = Am J Surg Pathol | volume = 29 | issue = 9 | pages = 1228-42 | month = Sep | year = 2005 | doi = | PMID = 16096414 }}</ref> | ||
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**It was studied in a paper by Kronz et al.<ref name=pmid11014569>{{Cite journal | last1 = Kronz | first1 = JD. | last2 = Silberman | first2 = MA. | last3 = Allsbrook | first3 = WC. | last4 = Bastacky | first4 = SI. | last5 = Burks | first5 = RT. | last6 = Cina | first6 = SJ. | last7 = Mills | first7 = SE. | last8 = Ross | first8 = JS. | last9 = Sakr | first9 = WA. | last10 = Tomaszewski | first10 = JE. | last11 = True | first11 = LD. | last12 = Ulbright | first12 = TM. | last13 = Weinstein | first13 = MW. | last14 = Yantiss | first14 = RK. | last15 = Young | first15 = RH. | last16 = Epstein | first16 = JI. | title = Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies. | journal = Hum Pathol | volume = 31 | issue = 9 | pages = 1044-50 | month = Sep | year = 2000 | doi = 10.1053/hupa.2000.16278 | PMID = 11014569 }}</ref> | **It was studied in a paper by Kronz et al.<ref name=pmid11014569>{{Cite journal | last1 = Kronz | first1 = JD. | last2 = Silberman | first2 = MA. | last3 = Allsbrook | first3 = WC. | last4 = Bastacky | first4 = SI. | last5 = Burks | first5 = RT. | last6 = Cina | first6 = SJ. | last7 = Mills | first7 = SE. | last8 = Ross | first8 = JS. | last9 = Sakr | first9 = WA. | last10 = Tomaszewski | first10 = JE. | last11 = True | first11 = LD. | last12 = Ulbright | first12 = TM. | last13 = Weinstein | first13 = MW. | last14 = Yantiss | first14 = RK. | last15 = Young | first15 = RH. | last16 = Epstein | first16 = JI. | title = Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies. | journal = Hum Pathol | volume = 31 | issue = 9 | pages = 1044-50 | month = Sep | year = 2000 | doi = 10.1053/hupa.2000.16278 | PMID = 11014569 }}</ref> | ||
====Examples==== | =====Examples===== | ||
*A biopsy with 80% pattern 4, 16% pattern 3 and 4% pattern 5... would be reported as: 4+5=9. | *A biopsy with 80% pattern 4, 16% pattern 3 and 4% pattern 5... would be reported as: 4+5=9. | ||
*A biopsy with 92% pattern 4, and 8% pattern 3... would be reported as: 4+3=7. | *A biopsy with 92% pattern 4, and 8% pattern 3... would be reported as: 4+3=7. | ||
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*A prostatectomy with 80% pattern 4, 16% pattern 3 and 4% pattern 5... would be reported as: 4+3=7 with tertiary pattern 5. | *A prostatectomy with 80% pattern 4, 16% pattern 3 and 4% pattern 5... would be reported as: 4+3=7 with tertiary pattern 5. | ||
====Gleason pattern 1 & 2==== | ====Grade groupings==== | ||
*[[AKA]] ''prognostic Gleason grade groupings''. | |||
Proposed new system and old (modified) Gleason score:<ref name=jhu2014>URL: [http://urology.jhu.edu/newsletter/2014/prostate_cancer_2014_19.php http://urology.jhu.edu/newsletter/2014/prostate_cancer_2014_19.php]. Accessed on: 28 March 2015.</ref> | |||
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto" | |||
! Prognostic group | |||
! Gleason score | |||
|- | |||
| I | |||
| 3+3 | |||
|- | |||
| II | |||
| 3+4 | |||
|- | |||
| III | |||
| 4+3 | |||
|- | |||
| IV | |||
| 8 (4+4, 3+5, 5+3) | |||
|- | |||
| V | |||
| 9 or 10 (4+5, 5+4, 5+5) | |||
|} | |||
Rationale: | |||
*Patients won't be told they have 6 out of 10 cancer, and then think it is an intermediate grade cancer that is worrisome. Instead, they will be told they have 1 out of 5 cancer.<ref name=jhu2014>URL: [http://urology.jhu.edu/newsletter/2014/prostate_cancer_2014_19.php http://urology.jhu.edu/newsletter/2014/prostate_cancer_2014_19.php]. Accessed on: 28 March 2015.</ref> | |||
====Gleason patterns (modified)==== | |||
=====Gleason pattern 1 & 2===== | |||
*Use strongly discouraged by a number of GU pathology experts. | *Use strongly discouraged by a number of GU pathology experts. | ||
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**Generally, should '''not''' be diagnosed on core biopsies.<ref name=pmid20006878>{{Cite journal | last1 = Epstein | first1 = JI. | title = An update of the Gleason grading system. | journal = J Urol | volume = 183 | issue = 2 | pages = 433-40 | month = Feb | year = 2010 | doi = 10.1016/j.juro.2009.10.046 | PMID = 20006878 }}</ref> | **Generally, should '''not''' be diagnosed on core biopsies.<ref name=pmid20006878>{{Cite journal | last1 = Epstein | first1 = JI. | title = An update of the Gleason grading system. | journal = J Urol | volume = 183 | issue = 2 | pages = 433-40 | month = Feb | year = 2010 | doi = 10.1016/j.juro.2009.10.046 | PMID = 20006878 }}</ref> | ||
====Gleason pattern 3==== | =====Gleason pattern 3===== | ||
*Glands smaller than normal prostate glands + loss of epithelial folding. | *Glands smaller than normal prostate glands + loss of epithelial folding. | ||
*Can draw a line around each gland. | *Can draw a line around each gland. | ||
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*All ''cribriform'' is now, generally, classified as Gleason pattern 4.<ref name=pmid20006878>{{cite journal |author=Epstein JI |title=An update of the Gleason grading system |journal=J. Urol. |volume=183 |issue=2 |pages=433–40 |year=2010 |month=February |pmid=20006878 |doi=10.1016/j.juro.2009.10.046 |url=}}</ref> | *All ''cribriform'' is now, generally, classified as Gleason pattern 4.<ref name=pmid20006878>{{cite journal |author=Epstein JI |title=An update of the Gleason grading system |journal=J. Urol. |volume=183 |issue=2 |pages=433–40 |year=2010 |month=February |pmid=20006878 |doi=10.1016/j.juro.2009.10.046 |url=}}</ref> | ||
====Gleason pattern 4==== | =====Gleason pattern 4===== | ||
*Loss of gland lumina. | *Loss of gland lumina. | ||
*Gland fusion. | *Gland fusion. | ||
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*One gland is not enough to call Gleason 4. | *One gland is not enough to call Gleason 4. | ||
=====Images===== | ======Images====== | ||
<gallery> | <gallery> | ||
Image:Prostate_cancer_with_Gleason_pattern_4_low_mag.jpg | Gleason pattern 4 - cribriform. (WC) | Image:Prostate_cancer_with_Gleason_pattern_4_low_mag.jpg | Gleason pattern 4 - cribriform. (WC) | ||
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*[http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f9.html#figure-title Glomeruloid pattern (nature.com)]. | *[http://www.nature.com/modpathol/journal/v17/n3/fig_tab/3800050f9.html#figure-title Glomeruloid pattern (nature.com)]. | ||
====Gleason pattern 5==== | =====Gleason pattern 5===== | ||
*Sheets. | *Sheets. | ||
**Must be differentiated from [[intraductal carcinoma of the prostate|intraductal growth]] (which like in the breast are well circumscribed nests). | **Must be differentiated from [[intraductal carcinoma of the prostate|intraductal growth]] (which like in the breast are well circumscribed nests). | ||
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</ref> | </ref> | ||
=====Images===== | ======Images====== | ||
<gallery> | <gallery> | ||
Image:Gleason_4_and_5_intermed_mag.jpg | Gleason pattern 4 - small glands (left) & Gleason pattern 5 - single cells (right). (WC) | Image:Gleason_4_and_5_intermed_mag.jpg | Gleason pattern 4 - small glands (left) & Gleason pattern 5 - single cells (right). (WC) | ||