Digital quantification of five high-grade prostate cancer patterns, including the cribriform pattern, and their association with adverse outcome

Abstract

Proper grading of the cribriform prostate cancer pattern has not previously been supported by outcome-based evidence. Among 153 men who underwent radical prostatectomy, 76 with prostate-specific antigen (PSA) failure (≥0.2 ng/mL [0.2 μg/L]) were matched to 77 without failure. Frequencies of high-grade patterns included fused small acini, 83.7%; papillary, 52.3%; large cribriform, 37.9%; small (≤12 lumens) cribriform, 17.0%; and individual cells, 22.9%. A cribriform pattern was present in 61% (46/76) of failures but 16% (12/77) of nonfailures (P < .0001). Multivariate analysis showed the cribriform pattern had the highest odds ratio for PSA failure, 5.89 (95% confidence interval, 2.53-13.70; P < .0001). The presence of both large and small cribriform patterns was significantly linked to failure. The cumulative odds ratio of failure per added square millimeter of cribriform pattern was 1.173 (P = .008), higher than for any other pattern. All 8 men with a cribriform area sum of 25 mm(2) or more had failure (range, 33-930). Regrading cribriform cancer as Gleason 5 improved the grade association with failure, although half of all cases with individual cells also had a cribriform pattern, precluding a precise determination of the independent importance of the latter. The cribriform pattern has particularly adverse implications for outcome.

Image 1

Nine histologic prostate cancer patterns were annotated in the study (H&E, ×100). A, The S pattern, single, small separate acini. B, The B pattern, luminal blue mucin–containing single, separate acini. C, The U pattern, undulating, branched, or angulated larger acini that are not truly papillary—no bridging or stromal cores. D, The F pattern, fused small acini. E, The P pattern, true papillary with stromal cores or bridging across acinar spaces. F, The SC pattern, small cribriform, defined as rounded acinar spaces with ≤12 lumens and no solid area. G, The LC pattern, large cribriform, with more sprawling, cribriform to focally solid formations. H, The I pattern, individual cells. I, The M pattern, mucinous/colloid carcinoma without fusion or individual cells.

Image 2

A sample virtual slide is shown after annotation of histologic cancer patterns (H&E, ×3).