Zusammenfassung
In mehreren Konferenzen der „International Society of Uropathology“ (ISUP) wurde das Gleason-Grading der Routinediagnostik von Stanzbiopsien aus der Prostata angepasst. Die wesentlichen Ergebnisse sind die Dokumentation aller vorkommenden Muster (primär, sekundär und tertiär) und eine Verschiebung der maximalen Gleason-Scores bei Biopsien von 6 nach 7a(3+4), bei radikalen Prostatektomien von 6 und 7 nach 7a und 7b(4+3). Die Übereinstimmung zwischen Biopsien und radikalen Prostatektomien beträgt >80%. Score-2- bis -4-Karzinome gibt es nicht in der Peripherie. pT2-Karzinome der Prostata mit guter Prognose haben nach dem modifizierten Grading einen maximalen Score von 7a, pT3-Karzinome mit schlechterer Prognose einen solchen von 7b und höher. Hieraus ist zu folgern, dass der prognostische Wert von Gleason-Score 6 und 7a ähnlich ist, sodass die Grenze von Low- zu High-grade-Karzinomen wahrscheinlich zwischen Gleason-Score 7a und 7b liegt. Bei den verschiedenen Therapieoptionen sollten die Gleason-Scores nach dem modifizierten Gleason-Ggrading berücksichtigt werden.
Abstract
In several consensus conferences of the International Society of Urological Pathology (ISUP), the Gleason grading system of prostatic carcinomas was modified and adapted to the routine histological diagnostics of specimens of core needle biopsies and radical prostatectomies. The main results are the documentation of all histological patterns (primary, secondary, tertiary) and a shifting of the maximal Gleason score of biopsies from 6 to 7a (3+4) and of radical prostatectomies from 6 and 7 to7a and 7b (4+3). Score 2 to 4 carcinomas do not exist in the peripheral prostate. pT2 prostatic carcinomas with good prognosis have a maximal score of 7a; pT3 carcinomas with poor prognosis have a most frequent score of 7b. The agreement of the Gleason scores of core needle biopsies and radical prostatectomy specimens is more than 80%. Inter- and intraobserver reproducibility is better than after the conventional Gleason grading. The prognostic value of scores 6 and 7a may be similar. The border between low- and high-grade prostatic carcinoma may be probably Gleason score 7a and 7b. The prognostic value of score 6 should be changed to score 7a in the different therapeutic options for prostatic carcinomas.
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Helpap, B., Egevad, L. Die Wertigkeit des 2005 modifizierten Gleason-Gradings in der urologischen Diagnostik von Prostatakarzinomen. Urologe 46, 59–62 (2007). https://doi.org/10.1007/s00120-006-1238-9
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DOI: https://doi.org/10.1007/s00120-006-1238-9