INTRODUCTION: We sought to determine if prostatic ductal adenocarcinoma is undersampled and/or underdiagnosed at transrectal ultrasound (TRUS)-guided biopsy. METHODS: With institutional review board approval, we searched our pathology database between 2008 and 2014 for patients with a diagnosis of ≥10% ductal adenocarcinoma on radical prostatectomy and available TRUS-guided needle biopsy specimens. Three blinded genitourinary pathologists independently examined the biopsy slides. The presence or absence of ductal adenocarcinoma was determined. Diagnostic accuracy was calculated using consensus diagnosis as the reference standard. Inter-observer agreement was assessed using Cohen's kappa coefficient. RESULTS: Based on consensus review, 66.7% (12/18) biopsy specimens demonstrated ductal adenocarcinoma and 33.3% (6/18) demonstrated conventional acinar prostatic adenocarcinoma. The sensitivity/specificity for each reader (R) was: 83/100% (R1), 100/83% (R2) and 58/83% (R3) and the inter-observer agreement was only fair (K=0.32). Only two of the original needle-biopsy reports correctly identified ductal adenocarcinoma (sensitivity = 17%). The main limitations of the study are the relatively small sample size and the potential for selection bias since we could only examine patients who underwent radical prostatectomy. CONCLUSIONS: Prostatic ductal adenocarcinoma may be undersampled at TRUS-guided biopsy and in this study was under-reported in routine clinical practice. This highlights the importance of increased awareness of ductal adeoncarcinoma and the need for clear diagnostic criteria. These findings have significant clinical impact especially when determining candidacy for active surveillance protocols.
INTRODUCTION: We sought to determine if prostatic ductal adenocarcinoma is undersampled and/or underdiagnosed at transrectal ultrasound (TRUS)-guided biopsy. METHODS: With institutional review board approval, we searched our pathology database between 2008 and 2014 for patients with a diagnosis of ≥10% ductal adenocarcinoma on radical prostatectomy and available TRUS-guided needle biopsy specimens. Three blinded genitourinary pathologists independently examined the biopsy slides. The presence or absence of ductal adenocarcinoma was determined. Diagnostic accuracy was calculated using consensus diagnosis as the reference standard. Inter-observer agreement was assessed using Cohen's kappa coefficient. RESULTS: Based on consensus review, 66.7% (12/18) biopsy specimens demonstrated ductal adenocarcinoma and 33.3% (6/18) demonstrated conventional acinar prostatic adenocarcinoma. The sensitivity/specificity for each reader (R) was: 83/100% (R1), 100/83% (R2) and 58/83% (R3) and the inter-observer agreement was only fair (K=0.32). Only two of the original needle-biopsy reports correctly identified ductal adenocarcinoma (sensitivity = 17%). The main limitations of the study are the relatively small sample size and the potential for selection bias since we could only examine patients who underwent radical prostatectomy. CONCLUSIONS:Prostatic ductal adenocarcinoma may be undersampled at TRUS-guided biopsy and in this study was under-reported in routine clinical practice. This highlights the importance of increased awareness of ductal adeoncarcinoma and the need for clear diagnostic criteria. These findings have significant clinical impact especially when determining candidacy for active surveillance protocols.
Authors: Amanda H Seipel; Brett Delahunt; Hemamali Samaratunga; Mahul Amin; Joel Barton; Daniel M Berney; Athanase Billis; Liang Cheng; Eva Comperat; Andrew Evans; Samson W Fine; David Grignon; Peter A Humphrey; Cristina Magi-Galluzzi; Rodolfo Montironi; Isabell Sesterhenn; John R Srigley; Kiril Trpkov; Theo van der Kwast; Murali Varma; Ming Zhou; Amar Ahmad; Sue Moss; Lars Egevad Journal: Histopathology Date: 2014-04-03 Impact factor: 5.087
Authors: Mahul B Amin; Daniel W Lin; John L Gore; John R Srigley; Hema Samaratunga; Lars Egevad; Mark Rubin; John Nacey; H Ballentine Carter; Laurence Klotz; Howard Sandler; Anthony L Zietman; Stuart Holden; Rodolfo Montironi; Peter A Humphrey; Andrew J Evans; Jonathan I Epstein; Brett Delahunt; Jesse K McKenney; Dan Berney; Thomas M Wheeler; Arul M Chinnaiyan; Lawrence True; Beatrice Knudsen; M Elizabeth H Hammond Journal: Arch Pathol Lab Med Date: 2014-08-05 Impact factor: 5.534
Authors: Nicholas J van As; Andrew R Norman; Karen Thomas; Vincent S Khoo; Alan Thompson; Robert A Huddart; Alan Horwich; David P Dearnaley; Christopher C Parker Journal: Eur Urol Date: 2008-03-07 Impact factor: 20.096
Authors: Nithesh Ranasinha; Altan Omer; Yiannis Philippou; Eli Harriss; Lucy Davies; Ken Chow; Paolo M Chetta; Andrew Erickson; Timothy Rajakumar; Ian G Mills; Richard J Bryant; Freddie C Hamdy; Declan G Murphy; Massimo Loda; Christopher M Hovens; Niall M Corcoran; Clare Verrill; Alastair D Lamb Journal: BJUI Compass Date: 2021-01-05