粗针4区11点穿刺诊断前列腺癌临床病理研究

Four Regions 11-core Systermic Prostate Biopsy for Diagnosis of Prostate Cancer:a Clinicopathological Study

目的探讨4区11点粗针穿刺(needle core biopsy,NCB)前列腺组织诊断前列腺癌的临床病理特证,Gl-eason分级,免疫表型特点及鉴别诊断。方法对138例临床疑似前列腺癌患者行粗针4区11点穿刺取活检,进行组织病理学观察及免疫组化Envision两步法检测前列腺特异性抗原(PSA)、高分子细胞角蛋白(CK34βE12)、P63、α-甲酰基-辅酶A消旋酶(P504S)表达。结果 138例穿刺标本中,84例为前列腺增生,8例伴慢性前列腺炎;前列腺低级别上皮内瘤(LGPIN)6例;前列腺高级别上皮内瘤(HGPIN)4例;筛检43例前列腺癌,其中高分化4例,中分化29例,低分化10例;1例前列腺间叶源性肉瘤。免疫组化结果:前列腺癌基底细胞消失,CK34βE12、P63为阴性;前列腺增生症,LGPIN,HGPIN和前列腺癌中PSA表达率分别为90.5%、83.3%、100%、86.0%,前列腺各种病变表达率差异无统计学意义(P>0.05),而P504S表达率分别为5.9%、66.7%、75%、76.7%,前列腺增生与其它三种病变差异有统计学意义(P<0.05)。结论前列腺4区11点穿刺诊断前列腺癌临床病理诊断准确率高,但需仔细进行病理分析并结合免疫组化诊断,还需进行准确病理分级。

Objective To explore the clinicopathological features,the Gleason grading,immunohistochemical features and the differential diagnosis of four region 11-core systermic prostate bispsy for diagnosis of prostate cancer.Methods 138 cases of clinically suspected prostate cancer were using four regions 11-core systermic prostate biopsy,and analyzed by means of clinicopathologic and immunohistochemistry.Results Among 138 cases,84 cases were benign prostatic hyperplasia,of which 8 cases were Chronic prostatitis accompanying;6 cases were low grade prostatic intraepithelial neoplasia（LGPIN）;4 cases were high prostatic intraepithelial neoplasia（HGPIN）;43 prostate cancer were detected,of which 4 cases were well-differentiated（cleason score≤5）,29 cases were moderately differentiated（cleason score6-7）;10 cases were poorly differentiated（cleason score≥8）;1 case was prostate mesenchymal sarcoma.Immunohistochemically,expression of CK34βE12、P63 in prostate cancer was not detected.Expression of PSA in benign prostatic hyperplasia,LGPIN,HGPIN,and prostate cancer was 90.5%,83.3%,100% and 86.0%,respectively.There no difference in those prostate diseases.Expression of P504S in benign prostatic hyperplasia,LGPIN,HGPIN,and prostate cancer was 5.9%,66.7%,75% and 76.7%,respectively.There were significant difference in benign prostatic hyperplasia and other disease.Conclusion Four regions 11-core systermic prostate biopsy have a high prostate cancer detection rate.Since needle biopsy specimens is limited and lesion is not obviously,it may be missed diagnosis or over-diagnosed and must carefully pathological examine and collaborate with immunohistochemistry and histopathological grading.