The impact of core biopsy fragmentation in prostate cancer. Prostate MRI: update and current roles. Adapted from Freedland SJ et al.
Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Reis et al. Babaian et al. Site-specific positive margins at radical prostatectomy: assessing cancer-control benefits of wide excision of the neurovascular bundle on a side with cancer on biopsy.
In a study of patients who underwent RP for clinically localized cancer diagnosed using individually labeled sextant cores, Tombal et al. The authors concluded that packaging cores in individual define sextant biopsy in Lancashire is substantially more expensive than packaging samples in just two containers without providing much clinical benefit.
Because the entire apex is composed of peripheral zone, biopsies performed at the apex or lateral apex might not sample the anterior apex.
Corresponding Author: Peter A. However, the number and topography of positive sextants and the percentage of positive cores correlated almost linearly, suggesting on first analysis that identifying the exact position of the biopsy has no benefit. Sextant prostate biopsies predict side and sextant site of extracapsular extension of prostate cancer.
The pathology literature suggests that increasing the number of cores in a specimen jar leads to increased tissue fragmentation, tangling of cores, and reduced tissue sampling, which can reduce CDRs and increase the likelihood of equivocal diagnoses such as atypical small acinar proliferation.
These findings provide a strong rationale for the conduct of randomized clinical trials to determine the effect of targeted biopsy on clinical outcomes. BJU Int.
The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Apical sampling provides reliable data regarding cancer location and can suggest a greater likelihood of EPE.
Stamey TA. Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens. Expert Recommendations Expert panels in the United States, Canada, and Italy generally recommend initial prostate transrectal ultrasound TRUS -guided biopsy protocols involving 10—12 cores in men with an abnormal digital rectal examination DRE finding or a high prostate-specific antigen PSA level.