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Atypical cribriform lesions on prostate biopsy
J D Kronz1, A A Shaikh, J I Epstein
1Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21231, USA.
The American Journal of Surgical Pathology
|February 15, 2001
Summary
Diagnosing cribriform lesions on prostate biopsies is challenging. Certain features like detached glands and positive digital rectal exams indicate a higher risk of prostate cancer.
Area of Science:
- Uropathology
- Oncology
- Diagnostic Pathology
Background:
- Atypical cribriform lesions in prostate needle biopsies present diagnostic challenges.
- Distinguishing between cribriform high-grade prostatic intraepithelial neoplasia (PIN) and infiltrating cribriform carcinoma is critical.
Purpose of the Study:
- To evaluate clinicopathologic features associated with atypical cribriform lesions.
- To identify predictors of prostate cancer in patients with these challenging biopsy findings.
Main Methods:
- Retrospective review of 23 consult cases with differential diagnosis of cribriform high-grade PIN versus cribriform carcinoma.
- Analysis of architectural and cytologic features of cribriform glands.
- Correlation of findings with follow-up biopsy results and clinical outcomes.
Main Results:
- 55% of patients with atypical cribriform lesions were diagnosed with prostate cancer on follow-up.
- Predictive factors for cancer included positive digital rectal examination (DRE), positive transrectal ultrasound, bilateral atypical cribriform glands, and detached cribriform glands.
- High prebiopsy prostate-specific antigen (PSA) and presence of ordinary high-grade PIN were also noted.
Conclusions:
- Atypical cribriform lesions require careful evaluation due to their association with prostate cancer.
- Specific architectural features and clinical findings can help predict malignancy and guide further management.