Preoperative histological and cytological diagnosis and DNA ploidy assessment of localized prostatic cancer. A comparison between findings in biopsies and total prostatectomy specimens.
The preoperative biopsy specimens of 49 men who underwent radical prostatectomy were compared with serially step-sectioned operative specimens, in order to evaluate diagnostic accuracy as regards the presence of cancer, its grade and its DNA ploidy. Both the FNAB and TRUS-GCB undergraded the cancer by one WHO grade in about 35-40% of cases. In cases where both biopsy types were available, the degree of undergrading was the same. Determination of DNA ploidy by the single-cell technique from FNAB had a sensitivity for detecting non-diploid DNA patterns of 59% whereas flow cytometric measurement of core biopsies had a sensitivity of 44.4% as regards non-diploid DNA, when compared with operative specimens. A comparison of ploidy in core biopsies versus ploidy in fine-needle aspirates revealed that more non-diploid DNA patterns were diagnosed in the fine-needle aspirates. These aneuploid patterns were not all confirmed by flow cytometric evaluation of the operative specimens, in which, however, more aneuploid patterns were diagnosed compared with the single-cell technique from FNAB. We conclude that the standard technique with 1-3 fine-needle aspirates or 1-3 TRUS-GCB has a pronounced tendency by both biopsy methods to underestimate the tumour grade. DNA ploidy analysis by FNAB and the single-cell cytometric method reveals aneuploid cell lines not found in the flow cytometric evaluation. In order to determine whether this reflects a methodological problem or a true discrimination between the ability of the two methods to find non-diploid cell lines further studies are needed. However, for a more correct preoperative assessment of tumour grade and DNA ploidy, more extensive sampling is required.
Department of Urology, University Hospital, Uppsala, Sweden.
M
M
Häggman
M
M
de la Torre
M
M
Norberg
C
C
Busch
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D011003:Ploidies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D014463:Ultrasonography