Correlação anatomopatológica entre a amostragem por agulha e a amostragem cirúrgica no câncer de próstata: variabilidade interobservador

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Prostatic adenocarcinoma has variable clinical evolution and the Gleason grading is its main prognostic factor. Diagnosis and classification are done through anatomic pathological testing which, although used to diagnose the neoplasia, can also show other present histological lesions. As a test, it needs reliability which is evaluated by the interobserver agreement. In the study, three pathologists reviewed the biopsy slides and prostatic surgical specimens of 110 patients previously diagnosed as suffering from prostate cancer and who were referred to radical prostatectomy. All three observers filled in a histological protocol which dealt with prostatic neoplastic lesions and benign ones. Data were analyzed as for the interobserver agreement and as for the agreement between both specimens by the same observer, by the Kappa statistic. The reproducibility of the method was variable. In the biopsy, good agreement was found in the diagnosis of cancer (K=0,75). Moderate agreement was found in the most aggressive Gleason grade (K=0,45), in the tumor tissue proportion (K=0,44), in the presence of perineural invasion in the tumors (K=0,42), in inflammatory infiltration (K=0,44) and in a significant biopsy (K=0,43). The primary Gleason grade showed bad reproducibility (K=0,37). The worst agreement was in the diagnosis of PIN of high grade (K=0,11) and in the secondary Gleason grade (K=0,20). In the surgical tissue, the best reproducibility was in the cancer diagnosis (K=0,59), followed by the primary grade (K=0,47) and the most aggressive Gleason grade (K=0,45), the presence of perineural invasion (K=0,52) and NIP of high grade (K=0,36). The secondary Gleason grade had a bad agreement (K= 0,25) and the agreement was even worse in the diagnosis of inflammatory infiltration (K=0,08) and in the presence of benign prostatic hyperplasia (K=-0,05). In the surgical specimen, the Gleason score (K=0,46) obtained a better agreement than the modified Gleason score (K=0,36). In the needle biopsy, both scores were similar (K=0,36 and K=0,35, respectively). Comparing the three areas of the needle biopsies (apex, mid-prostate and base) with the respective areas of the surgical tissue, there is a good agreement between the primary and the most aggressive Gleason grade. It is clear that the isolated morphological analysis of specific criteria is based on low reproducibility criteria. Subjective components used in an anatomic pathological evaluation are not efficiently assessed by statistic methods. Improvement, not only in the methodology but also in the anatomic pathological criteria adopted worldwide, urges to be carried out systematically.

ASSUNTO(S)

neoplasias prostáticas/classificação decs variações dependentes do observador decs patologia geral teses. reprodutibilidade dos testes decs prostatectomia/estatística &dados numéricos decs dissertação da faculdade de medicina ufmg adenocarcinoma decs biópsia por agulha/estatística &dados numéricos decs neoplasias prostáticas/patologia decs neoplasias prostáticas/diagnóstico decs dissertações acadêmicas decs

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