842 Is Grading of Small Volume of High Grade Prostatic Adenocarcinoma on Needle Biopsy Accurate? Correlation with Radical Prostatectomy Findings
Recommended Citation
Lira Diaz A, Agarwal P, Hassan O, Al-Obaidy K, Alhamar M, Dadhania V, Gupta N. 842 Is Grading of Small Volume of High Grade Prostatic Adenocarcinoma on Needle Biopsy Accurate? Correlation with Radical Prostatectomy Findings. Lab Invest 2025; 105(3).
Document Type
Conference Proceeding
Publication Date
3-24-2025
Publication Title
Lab Invest
Keywords
adult, cancer grading, conference abstract, controlled study, human, human tissue, lymph node metastasis, lymph vessel metastasis, major clinical study, needle, needle biopsy, prostate adenocarcinoma, radical prostatectomy, retrospective study, tumor volume
Abstract
Disclosures: Antonio Lira Diaz: None; Priti Agarwal: None; Oudai Hassan: None; Khaleel Al-Obaidy: None; Mohamed Alhamar: None; Vipulkumar Dadhania: None; Nilesh Gupta: None Background: Grading of prostatic adenocarcinoma (PCa) is recommended on needle biopsies (Nbx) for tumors of any given volume. Highest tumor grade on needle core set plays a critical role in subsequent patient management. High grade PCa is often associated with high volume disease and involves multiple biopsy cores. In such scenarios, correlation with final radical prostatectomy (RP) score is excellent. Our aim in this study was to determine the correlation of grades assigned to high grade PCa when present in low volumes on Nbx with the final grade and other adverse parameters on RP. Design: All consecutive NBx from 2012 to 2019 were reviewed for patients showing 1 or 2 positive cores in the biopsy set with Grade Group (GG) 3 and higher grades. Only cases with subsequent RP were included. 55 cases met our inclusion criteria. Cases were divided into four groups: 1 positive (+) core with < 10% tumor length (TL)involvement ; 1 + core with 10%-50% TL; 1 + core with > 50% TL; 2 + positive cores with any TL. Tumor grade, stage, margin status, presence or absence of lymphovascular invasion (LVI) and lymph node metastasis (LNM) were recorded from RP. Results: Needle biopsy and RP findings are summarized in the Table below. 55 cases of high grade PCa were identified, 11 cases were identified in the smallest tumor volume group (1+ core < 10%). These cases showed least incidence (27%) of extraprostatic extension (EPE) compared to groups with higher tumor volumes (43-64%). The likelihood of downgrade in GG was highest amongst this group (64%) compared to 33% in cases with 1 + core with 10 - 50% TL or 2 + cores and 18% downgrade in cases with 1+ core with > 50% TL. The correlation of biopsy grade with Final RP (No change in final grade) improved as the sampled %TL increased in the core ranging from 48-55% in these groups. No significant correlation was found between these groups and SVI, LVI, and LNM. Margin positivity did not show an increasing trend as the Nbx % TL increased with 18-19% M+ in up to 50% TL involvement vs 33-45% M+ when >50% or 2 cores were involved. [Formula presented] Conclusions: Grading performed on small foci of PCa especially < 10% TL does not correlate with the final RP grade with significant downgrade rate. This data is also supported by lower incidence of EPE and margin positivity in these cases compared to those seen in similar grade tumors with higher volumes on single cores. In such scenarios, we suggest that pathologists add a disclaimer in the report to alert the urologist regarding this lack of correlation and high likelihood of downgrade of the final grade at RP.
Volume
105
Issue
3
