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. 2021 Oct 29;13(21):5454.
doi: 10.3390/cancers13215454.

Contemporary Grading of Prostate Cancer: The Impact of Grading Criteria and the Significance of the Amount of Intraductal Carcinoma

Vasiliki Tzelepi  1   2 , Ioanna Maria Grypari  1   2 , Souzana Logotheti  1 , Stavros Kontogiannis  3 , Panagiotis Kallidonis  3 , Maria Melachrinou  1   2 , Vasiliki Zolota  1   2
Affiliations

Contemporary Grading of Prostate Cancer: The Impact of Grading Criteria and the Significance of the Amount of Intraductal Carcinoma

Vasiliki Tzelepi et al. Cancers (Basel). .

Abstract

(1) Background: Prognostic grade group (PGG) is an important prognostic parameter in prostate cancer that guides therapeutic decisions. The cribriform pattern and intraductal carcinoma (IDC) are two histological patterns, that have additional prognostic significance. However, discrepancies exist regarding the handling of IDC according to the guidelines published by two international genitourinary pathology societies. Furthermore, whether, in addition to its presence, the amount of IDC is also of importance has not been studied before. Lastly, the handling of tertiary patterns has also been a matter of debate in the literature. (2) Methods: A total of 129 prostatectomy cases were retrieved and a detailed histopathologic analysis was performed. (3) Results: Two cases (1.6%) upgraded their PGG, when IDC was incorporated in the grading system. The presence and the amount of IDC, as well as the presence of cribriform carcinoma were associated with adverse pathologic characteristics. Interestingly, in six cases (4.7%) there was a difference in PGG when using the different guidelines regarding the handling of tertiary patterns. In total, 6.2% of the cases would be assigned a different grade depending on the guidelines followed. (4) Conclusions: These findings highlight a potential area of confusion among pathologists and clinicians and underscore the need for a consensus grading system.

Keywords: Gleason Score; cribriform pattern; intraductal carcinoma; prognostic grade group.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representative histologic images from the different patterns that were assessed, (A). Single glands corresponding to Gleason pattern 3, (B). Poorly formed and fused glands, (C). Small cribriform formations, (D). Large cribriform formations (original magnification ×100), (E). Glomeruloid pattern, (F). Papillary pattern Images (B–E) correspond to Gleason pattern 4, (G). Solid nests, (H). Single cells and cords, Images (G,H) correspond to Gleason pattern 5, (I). Intraductal carcinoma: ((A,B,D,E,G–I): original magnification ×100; (C): original magnification ×40; (F): original magnification ×200).
Figure 2
Figure 2
Representative images of the two cases that had a change in PGG when IDC was incorporated into grading: (A–D) A case with a high amount of IDC and an invasive carcinoma PGG2. Incorporation of IDC into grade will change the grade to 3. (E–H) A case with extensive IDC with comedo necrosis. Invasive carcinoma is PGG2 (7 3 + 4). Incorporation of IDC into grading will result in a significant upgrade to PGG5. ((A,E): original magnification ×20; (B,F): original magnification ×40; (C,G,H): original magnification ×100; (H):original magnification ×200; (D,H): immunohistochemical staining with the basal cell marker 34bE12 cytokeratin).
Figure 3
Figure 3
A case with extensive cribriform formations of large caliber. IHC staining for basal cell marker 34bE12 showed that most of the cribriform formations represented IDC. Invasive carcinoma was of a high grade, and thus, PGG would not change if IDC was incorporated into it. ((A,B): original magnification ×20; (C): original magnification ×100).
Figure 4
Figure 4
Box plot graphs of the correlation of IDC and Cribriform with T and N stage.
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