Intraductal and cribriform carcinoma of the prostate are increasingly recognized as independent prognosticators of poor outcome both in prostate biopsies and surgical specimens. We studied the concordance of biopsy and prostatectomy diagnosis for these two sub-pathologies, in relationship with pathological stage.
Mandatory synoptic reporting of intraductal and cribriform carcinoma in prostate biopsies and prostatectomy specimens was adopted by two academic institutions in November 2015. Synoptic reports of 245 biopsy and corresponding prostatectomy specimens were interrogated to determine the prevalence of intraductal and cribriform carcinoma. Sensitivity and specificity were determined with prostatectomy diagnosis as gold standard. Associations with pathological stage as primary outcome parameter were determined using univariable and multivariable logistic regression analysis.
Prevalence of the combination of intraductal and cribriform carcinoma was 26.9% in biopsies and 51.8% in prostatectomy specimens. Sensitivity and specificity at biopsy were 47.2% and 94.9%, respectively. Intraductal and cribriform carcinoma at biopsy were associated with advanced pathological stage independent of grade (p=0.013). Among patients with Grade Group 2 prostate cancer at biopsy, the more advanced pathological stage distribution was similar for those with a false negative and a true positive biopsy diagnosis of intraductal and cribriform carcinoma (p=0.29).
In spite of low sensitivity, intraductal and cribriform carcinoma at biopsy was strongly associated with advanced stage at radical prostatectomy. Since a false negative biopsy diagnosis was equally associated with advanced pathological stage, efforts should be undertaken to improve the sensitivity of biopsy diagnosis for intraductal and cribriform carcinoma. This article is protected by copyright. All rights reserved.
Histopathology. 2018 Aug 30 [Epub ahead of print]
Mehdi Masoomian, Michelle R Downes, Joan Sweet, Carol Cheung, Andrew Evans, Neil Fleshner, Manjula Maganti, Theodorus Van der Kwast
Departments of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Canada., Department of Anatomic Pathology, Sunnybrook Health Sciences Center, Toronto, Canada., Division of Urology, Department of Surgery, University Health Network, Toronto, Canada., Department of Biostatistics, University Health Network, Toronto, Canada.