48,454
edits
Difference between revisions of "Prostate cancer grading"
Jump to navigation
Jump to search
Prostate cancer grading (view source)
Revision as of 16:37, 10 October 2018
, 16:37, 10 October 2018→When to use/not to use
| (18 intermediate revisions by the same user not shown) | |||
| Line 16: | Line 16: | ||
**''Gleason score 3+4=7'' means: pattern 3 is present and dominant, pattern 4 is the remainder of the tumour - but present in a lesser amount than pattern 3. | **''Gleason score 3+4=7'' means: pattern 3 is present and dominant, pattern 4 is the remainder of the tumour - but present in a lesser amount than pattern 3. | ||
**''Gleason score 4+5=9'' means: pattern 4 is present and dominant, pattern 5 is present in a lesser amount that pattern 4. Pattern 3 may be present in a quantity less than pattern 4 or is absent. | **''Gleason score 4+5=9'' means: pattern 4 is present and dominant, pattern 5 is present in a lesser amount that pattern 4. Pattern 3 may be present in a quantity less than pattern 4 or is absent. | ||
**If a lower grade pattern is present and less than 5% it is ignored. | |||
***A biopsy with 98% Gleason pattern 4 and 2% Gleason pattern 3 would be graded as 8/10 (4+4). | |||
*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 | ====When to use/not to use==== | ||
The ''College of American Pathologist'' synoptic (''Cancer Protocol Template'') says:<ref>Srigley JR ''et al.'', "Protocol for the Examination of Specimens From Patients With Carcinoma of the Prostate Gland", College of American Pathologists, Version: 4.0.3.0. (June 2017), Accessed on: 10 October 2018.</ref> | |||
*Grade all prostate specimens with adenocarcinoma except those with prior treatment changes (e.g. radiation therapy changes or anti-androgen changes). | |||
** | |||
====Tertiary Gleason pattern==== | |||
*Unfortunately there is no consensus definition for ''tertiary Gleason pattern''.<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 that is of a higher grade than the two dominant patterns. | |||
**Koloffa ''et al''<ref name=Koloffa/> notes that some define it as: the third most prevalent pattern and most require that it is a higher grade than the two dominant patterns. | |||
***Parsed with the all the subtleties a working definition could be: The third most prevalent pattern ''and'' a higher grade than the two dominant patterns ''or'' a pattern that is seen in less than 5% of the tumour and of higher grade than one pattern that comprises >95% of the tumour. | |||
Significance: | |||
*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> | |||
Use: | |||
*It is only used for prostatectomies. | |||
====Examples==== | ====Examples==== | ||
| Line 31: | Line 42: | ||
*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. | ||
Based on various definitions of tertiary pattern:<ref name=Koloffa/> | Note: | ||
*A prostatectomy with 75% pattern 4, 15% pattern 3 and 10% pattern 5 could be reported as: | *Based on the 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 ''or'' 4+5=9. | |||
***As there is no consensus on this, it is probably best to report the percentages of the various patterns if this situation arises. | |||
===Gleason patterns (modified)=== | ===Gleason patterns (modified)=== | ||
| Line 218: | Line 229: | ||
The change in the order of the Gleason score components (3+4 on prostatectomy | The change in the order of the Gleason score components (3+4 on prostatectomy | ||
versus 4+3 on core biopsy) may be explained by sampling. | versus 4+3 on core biopsy) may be explained by sampling. | ||
</pre> | |||
====Separate nodule upgrades prostatectomy==== | |||
<pre> | |||
A tumour nodule in the left mid portion of the gland (1.2 cm) is predominantly 4+3; the Gleason score for the case is assigned on the basis of the tumour nodule as Gleason score 7/10 (4+3). | |||
Overall, Gleason pattern 3 represents 65% of the cancer in the prostate, and Gleason pattern 4 represents 35% of the cancer in the prostate. | |||
</pre> | </pre> | ||
==Prostate cancer grading system endorsed by the WHO== | ==Prostate cancer grading system endorsed by the WHO== | ||
*[[AKA]] ''WHO prostate cancer grading system'' or ''WHO system''. | *[[AKA]] ''WHO prostate cancer grading system'' or ''WHO system''. | ||
*[[AKA]] ''ISUP prostate grading''. | |||
*[[AKA]] ''grade groupings''. | *[[AKA]] ''grade groupings''. | ||
*[[AKA]] ''prognostic Gleason grade groupings''. | *[[AKA]] ''prognostic Gleason grade groupings''. | ||
*[[AKA]] ''a contemporary prostate cancer grading system'', abbreviated ''CPCGS''. | *[[AKA]] ''a contemporary prostate cancer grading system'', abbreviated ''CPCGS''. | ||
*[[AKA]] ''Gleason group''.<ref>URL: [http://www.cancer.net/cancer-types/prostate-cancer/stages-and-grades http://www.cancer.net/cancer-types/prostate-cancer/stages-and-grades]. Accessed on: May 1, 2017.</ref> | |||
This system has been proposed. Currently, it is not widely used. The name of the system is ''not'' completely settled. | |||
This system has been proposed. Currently, it is not widely used. The name of the system is ''not'' completely settled. | This system has been proposed. Currently, it is not widely used. The name of the system is ''not'' completely settled. | ||
| Line 274: | Line 295: | ||
| 11.7 | | 11.7 | ||
|} | |} | ||
===Sign out=== | |||
*The language is still evolving as this is relatively new. | |||
*As of 2017, many pathologists continue to predominantly use (modified) Gleason grading, and add a comment about (the equivalent grade in) the new grading system. | |||
====Reporting examples==== | |||
Within a synoptic report: | |||
<pre> | |||
Grade group: Grade Group 3, Gleason score 4+3=7. | |||
</pre> | |||
As a comment: | |||
<pre> | |||
The World Health Organization (WHO) grade is: 3 out of 5. Gleason pattern 3 represents 30% of the tumour, and Gleason pattern 4 represents 70% of the tumour. | |||
</pre> | |||
=====Alternates===== | |||
<pre> | |||
The World Health Organization (WHO) prostate cancer grade is: 3 out of 5. Gleason pattern 3 represents 30% of the tumour, and Gleason pattern 4 represents 70% of the tumour. | |||
</pre> | |||
<pre> | |||
Gleason pattern 3 represents 30% of the tumour, and Gleason pattern 4 represents 70% of the tumour. | |||
The World Health Organization (WHO) endorsed prostate cancer grade grouping is: 3 out of 5. | |||
</pre> | |||
==See also== | ==See also== | ||
*[[Prostate cancer]]. | *[[Prostate cancer]]. | ||
*[[Prostate cancer staging]]. | |||
*[[Cancer staging systems]]. | *[[Cancer staging systems]]. | ||
*[[Cribriform pattern within invasive prostate carcinoma]]. | |||
*[[Apparent diffusion coefficient]]. | |||
==References== | ==References== | ||