Murali Varma1, Lars Egevad2, Ferran Algaba3, Daniel Berney4, Lukas Bubendorf5, Philippe Camparo6, Eva Comperat7, Andreas Erbersdobler8, David Griffiths1, Rainer Grobholz9, Andrea Haitel10, Christina Hulsbergen-van de Kaa11, Cord Langner12, Barbara Loftus13, Antonio Lopez-Beltran14, Nick Mayer15, Gabriella Nesi16, Pedro Oliveira17, Jon Oxley18, Nathalie Rioux-Leclercq19, Gerhard Seitz20, Jonathan Shanks21, Glen Kristiansen22. 1. Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK. 2. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. 3. Department of Pathology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain. 4. Department of Molecular Oncology, Queen Mary University Hospital, London, UK. 5. Institut fur Pathologie, Universitatsspital Basel, Basel, Switzerland. 6. Department of Pathology, Centre de Pathologie Amiens, Amiens, France. 7. Department of Pathology, Hôpital La Pitié-Salpêtrière, Paris, France. 8. Department of Pathology, Universität of Rostock, Rostock, Germany. 9. Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland. 10. Department of Clinical Pathology, Medizinische Universitat Wien, Wien, Austria. 11. Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands. 12. Institute of Pathology, Medical University Graz, Graz, Austria. 13. Department of Cellular Pathology, Tallaght Hospital, Dublin, Ireland. 14. Department of Pathology, Champalimaud Clinical Center, Lisbon, Portugal. 15. Department of Pathology, Cork University Hospital Group, Cork, Ireland. 16. Department of Pathological Anatomy, University of Florence, Florence, Italy. 17. Department of Pathology, Hospital Da Luz, Lisboa, Portugal. 18. Department of Cellular Pathology, Southmead Hospital, Bristol, UK. 19. Department of Pathology, Rennes Hospital, Rennes, France. 20. Institute of Pathology, Sozialstiftung Bamberg, Bamberg, Germany. 21. Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK. 22. Institute of Pathology, University Hospital Bonn, Bonn, Germany.
Abstract
BACKGROUND: It is unclear whether the reported variation in the diagnosis of intraductal carcinoma of the prostate (IDC-P) is due to variable interpretation of borderline morphology, use of different diagnostic criteria or both. AIMS: We sought to determine the degree of variation in the diagnostic criteria and reporting rules for IDC-P in prostate biopsies employed by expert uropathologists. METHODS: A questionnaire survey was circulated to 23 expert uropathologists from 11 European countries. RESULTS: Criteria used for diagnosis of IDC-P included solid intraductal growth (100%), dense cribriform (96%), loose cribriform/micropapillary with nuclear size >6× normal (83%) or comedonecrosis (74%) and dilated ducts >2× normal (39%). 'Nuclear size' was interpreted as nuclear area by 74% and nuclear diameter by 21%. Pure IDC-P in needle biopsies was reported by 100% and Gleason graded by 30%. All would perform immunohistochemistry in such cases to rule out invasive cancer. An IDC-P component associated with invasive cancer would be included in the determination of tumour extent and number of cores involved by 74% and 83%, respectively. 52% would include IDC-P component when grading invasive cancer. 48% would perform immunohistochemistry in solid or cribriform nests with comedonecrosis to exclude IDC-P (17% routinely, 30% if the focus appeared to have basal cells on H&E). 48% graded such foci as Gleason pattern 5 even if immunohistochemistry demonstrated the presence of basal cells. CONCLUSIONS: There is a need for more clarity in the definition of some of the diagnostic criteria for IDC-P as well as for greater standardisation of IDC-P reporting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: It is unclear whether the reported variation in the diagnosis of intraductal carcinoma of the prostate (IDC-P) is due to variable interpretation of borderline morphology, use of different diagnostic criteria or both. AIMS: We sought to determine the degree of variation in the diagnostic criteria and reporting rules for IDC-P in prostate biopsies employed by expert uropathologists. METHODS: A questionnaire survey was circulated to 23 expert uropathologists from 11 European countries. RESULTS: Criteria used for diagnosis of IDC-P included solid intraductal growth (100%), dense cribriform (96%), loose cribriform/micropapillary with nuclear size >6× normal (83%) or comedonecrosis (74%) and dilated ducts >2× normal (39%). 'Nuclear size' was interpreted as nuclear area by 74% and nuclear diameter by 21%. Pure IDC-P in needle biopsies was reported by 100% and Gleason graded by 30%. All would perform immunohistochemistry in such cases to rule out invasive cancer. An IDC-P component associated with invasive cancer would be included in the determination of tumour extent and number of cores involved by 74% and 83%, respectively. 52% would include IDC-P component when grading invasive cancer. 48% would perform immunohistochemistry in solid or cribriform nests with comedonecrosis to exclude IDC-P (17% routinely, 30% if the focus appeared to have basal cells on H&E). 48% graded such foci as Gleason pattern 5 even if immunohistochemistry demonstrated the presence of basal cells. CONCLUSIONS: There is a need for more clarity in the definition of some of the diagnostic criteria for IDC-P as well as for greater standardisation of IDC-P reporting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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