Use of individual containers for prostate biopsy samples: Do we gain diagnostic performance?

ObjectiveProstate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness.We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumor subtypes in each of the 2 groups.Material and methodsA retrospective observational study was conducted of 2601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our center in the past.We then classified the cases according to the absence of neoplasia, insignificant tumor (involvement of just 1 cylinder, <5%, Gleason score <7), Gleason 6 or Gleason ≥7. A bivariate statistical analysis was performed using the chi-squared test.ResultsA total of 1777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P < 0.001).The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P = 0.03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P = 0.002). The same occurred with the Gleason score ≥7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P < 0.001).ConclusionsWe diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas.

ResumenObjetivoLos cilindros de próstata obtenidos en la biopsia transrectal suelen enviarse en viales separados para su procesamiento anatomopatológico. Aunque es una práctica frecuente, existen trabajos controvertidos sobre su utilidad.Se quiso comparar el porcentaje de diagnóstico de cáncer de próstata al procesar las muestras en 2 contenedores o en contenedores individuales, para comprobar si existen diferencias. Como objetivo secundario se han comprobado los porcentajes de diagnóstico de varios subtipos de tumores en cada uno de los 2 grupos.Material y métodosEstudio retrospectivo observacional sobre 2.601 casos de biopsias prostáticas. Se extrajeron 10 cilindros en cada biopsia. Dividimos la muestra en 2 grupos: envío de biopsia al servicio de anatomía patológica en 2 recipientes (lóbulo izquierdo y derecho) o en 10 (uno por cada cilindro), según diferente criterio utilizado en nuestro centro en varias épocas.Posteriormente se clasificaron los casos según ausencia de neoplasia, tumor insignificante (afectación de un solo cilindro, < 5%, Gleason < 7), Gleason 6, Gleason ≥ 7. Análisis estadístico bivariante mediante Chi-cuadrado.ResultadosSe incluyeron 1.777 sujetos en el grupo de 2 contenedores y 824 en el de 10. Se diagnosticaron un 32,4% de cánceres en el grupo de 2 recipientes y un 40% en el de 10, existiendo una diferencia estadísticamente significativa (p < 0,001).Los carcinomas insignificantes se diagnosticaban con más frecuencia en el grupo de 2 botes, el 6,4% frente al 4,3% en el de 10 (p = 0,03). Los Gleason 6 se diagnosticaban más en el grupo de 10 contenedores en comparación con el de 2 (11,9% frente al 8,1% [p = 0,002]). Lo mismo sucedía con los Gleason ≥ 7, el 23,8% en el grupo de 10 viales frente al 17,9% en el de 2 (p < 0,001).ConclusionesSe diagnostican más cánceres de próstata al enviar los cilindros biopsiados en botes individuales. Además, llevando a cabo esta maniobra, hemos observado en nuestra serie una disminución de los diagnósticos de carcinoma insignificante en detrimento de un mayor diagnóstico de carcinomas no insignificantes.