Handling and Reporting of Prostate Needle Biopsies Rajal Shah and Ming Zhou

Processing and Reporting of Prostate Needle Biopsies Processing of prostate needle biopsy specimens Ideally, each biopsy core, or cores from each anatomic site, should be submitted in separate container and processed separately to preserve the information of the anatomic location of the biopsy cores. This information would be important for prognosis, therapy planning, and possible subsequent re-biopsy [1]. In addition, limited number of cores in one cassette reduces possible fragmentation and allows optimal sectioning of the biopsy cores. However, this may increase the pathology charge significantly. If this becomes urologist and patient's overriding concern, pathologist and urologist should discuss the issue and come up the best possible way to submit the prostate biopsy specimens. One example is to submit biopsies from each side (left and right) in separate containers, or to ink prostate cores in different colors and then submit cores from right and left sides in different containers. At least 3 levels (25%, 50% and 75% through the block) per biopsy core should be examined in order to minimize the possibility of overlooking the clinically relevant histological features [2, 3, 4]. It is not necessary to serially section through the biopsy cores. We also advocate the collection of intervening unstained slides for potential immunohistochemistry for basal cell markers and AMACR, as minute focus of cancer may not survive deeper sectioning into the block. One or two unstained slides may be collected. It has shown that the use of intervening unstained slides was critical to establish a definitive diagnosis in 2.8% of prostate biopsies [5]. Each laboratory must decide whether this small benefit justifies the added cost. Reporting of prostate biopsy The information provided in the surgical pathology report of a prostate needle biopsy is critical in the management and prognostification of patients with prostate cancer. In order to promote the communications between pathologists, urologists, radiation oncologists, other health professionals and researchers, prostate biopsy report should use the standardized terminology and convey all the information important for diagnosis, prognosis and therapy-decision making. Table 7 summarizes the recent consensus opinion sponsored by several world leading uropathology organizations [1]. Table 7: Diagnostic reporting of prostate needle biopsy specimens. Benign Benign prostatic glands and stroma Optional: Benign mimickers of cancer Chronic and acute inflammation Granulomatous prostatitis Atypical adenomatous hyperplasia (adenosis) Severe atrophy High-grade prostatic intraepithelial neoplasia (HGPIN) Optional: Extent of HGPIN (focal vs. multifocal, # of cores involved, laterality- unilateral vs. bilateral) Atypical glands, suspicious for cancer, malignancy cannot be excluded Adenocarcinoma of prostate Location and distribution of tumor (site of biopsy if specified) Histopathologic type Gleason score, including primary and secondary patterns Extent of involvement Local invasion Seminal vesicle (cancer involving specimen directed at and/or containing seminal vesicle) Extraprostatic extension (tumor in periprostatic adipose tissue) Lymphovascular invasion (report if identified) Therapy-related changes (if clinical history of radiation or hormonal therapy) Perineural invasion (report if identified) Optional: Extent (focal, multifocal) Caliber of nerve bundles References: Amin, M., et al., Prognostic and predictive factors and reporting of prostate carcinoma in prostate needle biopsy specimens. Scand J Urol Nephrol Suppl, 2005(216): p. 20-33. Lane, R.B., Jr., et al., Needle biopsies of the prostate: what constitutes adequate histologic sampling? Arch Pathol Lab Med, 1998. 122(9): p. 833-5. Brat, D.J., et al., How often are diagnostic features missed with less extensive histologic sampling of prostate needle biopsy specimens? Am J Surg Pathol, 1999. 23(3): p. 257-62. Renshaw, A.A., Adequate tissue sampling of prostate core needle biopsies. Am J Clin Pathol, 1997. 107(1): p. 26-9. Green, R. and J.I. Epstein, Use of intervening unstained slides for immunohistochemical stains for high molecular weight cytokeratin on prostate needle biopsies. Am J Surg Pathol, 1999. 23(5): p. 567-70.