Limited Sampling of Radical Prostatectomy Specimens With Excellent Preservation of Prognostic Parameters of Prostate Cancer by ProQuest


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									                                                             Original Articles

 Limited Sampling of Radical Prostatectomy Specimens
 With Excellent Preservation of Prognostic Parameters of
                    Prostate Cancer
  Kyungeun Kim, MD; Pil June Pak, MS; Jae Y. Ro, MD, PhD; Dongik Shin, PhD; Soo-Jin Huh, PhD; Yong Mee Cho, MD, PhD

● Context.—The widespread use of the serum prostate-spe-                  (5) alternative slices plus peripheral 3-mm rim of the re-
cific antigen test has increased the early detection of pros-              maining prostate.
tate cancer and consequently reduced grossly definable                        Results.—Prostate cancers and their extraprostatic ex-
prostate cancers.                                                         tension and resection margin involvement were commonly
   Objective.—To find the most efficient gross sampling                     located in the right posterior portion of the prostate. Meth-
method for radical prostatectomy specimens not only pre-                  od 5 was most efficient, detecting all cases with extra-
serving important prognostic factors but also being cost                  prostatic extension and resection margin involvement and
                                                                          reducing 25% of paraffin blocks compared with the entire
                                                                          sampling of the prostate. The Gleason scores were retained
   Design.—We initially analyzed clinicopathologic fea-
                                                                          in most of cases, except reversal of the primary and sec-
tures of the entire prostate sections from 148 radical pros-              ondary Gleason grade component in only 2 cases (1%).
tatectomy specimens, which then were used to examine                      Only 4 cases (3%) were downstaged within the same T2
the impact of 5 partial sampling methods on tumor stage,                  stage.
Gleason score, extraprostatic extension, resection margin                    Conclusions.—These results demonstrate that sampling
status, and paraffin block numbers. The methods included                   of alternative slices plus peripheral rim of the remaining
submission of (1) alternative slices, (2) alternative slices              prostate is the most efficient partial sampling method for
plus biopsy-positive posterior quarters, (3) every posterior              radical prostatectomy specimens.
half, (4) every posterior half plus one midanterior half, and                (Arch Pathol Lab Med. 2009;133:1278–1284)

T   he incidence of prostate cancer is increasing world-
     wide, and prostate cancer is the most common cancer
in men in the United States.1 Widespread use of serum
                                                                          vides the important prognostic parameters; however, it de-
                                                                          mands labor, time, and expense, because 26 to 42 paraffin
                                                                          blocks are required when the entire sampling method is
prostate-specific antigen (PSA) screening test promotes                    used.3–5 According to a survey by the American Society of
early detection of nonpalpable small prostate cancers.                    Clinical Pathologists, only 12% of pathologists use the en-
Consequently, it has been difficult for pathologists to iden-              tire sampling method, and most pathologists adopt one of
tify prostate cancers during gross examination and to                     various partial sampling methods.6 There have been pre-
sample tissues for microscopic examination of important                   vious studies to propose the most efficient partial sam-
prognostic information, such as the Gleason score, stage,                 pling method.4,5,7–9 These partial sampling methods were
extraprostatic extension, and resection margin involve-                   able to reduce the number of paraffin blocks; however,
ment.2                                                                    they were at the expense of losing the important prog-
   Entire sampling of the prostate most accurately pro-                   nostic information, especially T stage, extraprostatic exten-
                                                                          sion, and resection margin involvement status.
                                                                             To find the most efficient gross sampling method that
   Accepted for publication October 16, 2008.                             is not only cost effective but also preserves the pathologic
   From the Department of Pathology (Drs Kim and Cho) and the Bio-        prognostic information, we first analyzed the clinicopath-
medical Engineering Department (Mr Pak and Drs Shin and Huh), Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Re-
                                                                          ologic features of 148 prostate cancers that were processed
public of Korea; and Department of Pathology, Cornell University          by the entire sampling method. We then simulated 5 dif-
Methodist Hospital, Houston, Texas (Dr Ro).                               ferent partial sampling methods using tumor maps to
   The authors have no relevant financial interest in the products or      compare their impact on the stage, Gleason score, extra-
companies described in this article.                                      prostatic extension, resection margin involvement, and
   The results presented in this paper have not been previously pub-      paraffin block numbers.
lished either in whole or in part, except in abstract form at the 59th
Annual Fall Meeting of the Korean Society of Pathologists, Seoul, South
Korea, 2007.                                                                              MATERIALS AND METHODS
   Reprints: Yong
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