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Difference between revisions of "Prostate cancer grading"
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*Reported as on prostatectomies as: (primary pattern) + (secondary pattern) = sum, (tertiary pattern) | *Reported as on prostatectomies as: (primary pattern) + (secondary pattern) = sum, (tertiary pattern) | ||
*Tertiary Gleason pattern - definition: a pattern that is seen in less than 5% of the tumour (volume) ''or'' the third most prevalent and a higher grade than the two dominant patterns ''or'' the one pattern that is present in >95% of the tumour. | *Tertiary Gleason pattern - definition: | ||
**Unfortunately there is no consensus definition.<ref name=Koloffa>{{Cite journal | last1 = Koloffa | first1 = ZB | last2 = Hamstrab | first2 = DA | last3 = Weia | first3 = JT | last4 = Montgomerya | first4 = JS ''et al''| title = Impact of tertiary Gleason pattern 5 on prostate cancer aggressiveness: Lessons from a contemporary single institution radical prostatectomy series | journal = Asian Journal of Urology | volume = 2 | issue = 1| pages = 53–58 | month = | year = 2015 | doi = 10.1016/j.ajur.2015.04.007 | PMID = | PMC = | url = http://www.sciencedirect.com/science/article/pii/S2214388215000302 }}</ref> | |||
***The Foundation series GU book (1st Ed.) defines ''Tertiary Gleason pattern'' as:<ref name=Ref_GUP72>{{Ref GUP|72}}</ref> a pattern that is seen in less than 5% of the tumour (volume), that is higher grade than the two dominant patterns. | |||
***Adapted from Koloffa ''et al''<ref name=Koloffa/>: a pattern that is seen in less than 5% of the tumour (volume) ''or'' the third most prevalent and a higher grade than the two dominant patterns ''or'' the one pattern that is present in >95% of the tumour. | |||
**The presence of a tertiary patterns adversely affect the prognosis; however, the prognosis is not as bad as when the tertiary pattern is the secondary pattern, i.e. 3+4 tertiary 5 has a better prognosis than 3+5 (with some small amount of pattern 4).<ref name=Ref_GUP72>{{Ref GUP|72}}</ref> | **The presence of a tertiary patterns adversely affect the prognosis; however, the prognosis is not as bad as when the tertiary pattern is the secondary pattern, i.e. 3+4 tertiary 5 has a better prognosis than 3+5 (with some small amount of pattern 4).<ref name=Ref_GUP72>{{Ref GUP|72}}</ref> | ||
**It is only used for prostatectomies. | **It is only used for prostatectomies. | ||
====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. | ||
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*A biopsy with 98% pattern 4, and 2% pattern 3... would be reported as: 4+4=8. | *A biopsy with 98% pattern 4, and 2% pattern 3... would be reported as: 4+4=8. | ||
*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. | ||
*A prostatectomy with 75% pattern 4, 15% pattern 3 and 10% pattern 5 | |||
Based on various definitions of tertiary pattern:<ref name=Koloffa/> | |||
*A prostatectomy with 75% pattern 4, 15% pattern 3 and 10% pattern 5 could be reported as: | |||
**4+3=7 with tertiary pattern 5. | |||
**4+5=9. | |||
===Gleason patterns (modified)=== | ===Gleason patterns (modified)=== | ||