Pathologica 4-07.pdf - Pacini Editore
Pathologica 4-07.pdf - Pacini Editore
Pathologica 4-07.pdf - Pacini Editore
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244<br />
Quick (3 hours) histologic diagnosis on<br />
prostate biopsies<br />
M. Freschi, L. Nava * , P. Rigatti * , G. Guazzoni * , C. Doglioni<br />
Department of Pathology, Scientific Institute “San Raffaele”<br />
H, Milano; * “San Raffaele Turro” Urology<br />
Introduction. Aim of this study was to prospectively evaluate<br />
the efficacy and reproducibility of quickly processing<br />
prostate core needle biopsies with RHS1 ® , an automated microwave-vacuum<br />
processor.<br />
Methods. From July 2004 to June 2007 a total of 914 consecutive<br />
prostate biopsies were performed for Pca detection in<br />
men with PSA levels between 2.5 and 14 ng/ml. The biopsies<br />
(mean core number 20, range 12-25) were stretched between<br />
two sponges in tissue cassettes, fixed in formalin, processed<br />
with RHS1 ® (xylene-free), embedded in paraffin, cut at 3 µ<br />
and then stained with H.E. Processing time, as well as time<br />
to final histological report, detection rate and percentage of<br />
further evaluations required were recorded; furthermore those<br />
results were prospectively compared with those registered<br />
in a concomitant series of 813 prostate biopsies performed in<br />
a similar series of patients, with the same sample technique,<br />
in the same period, but processed with the traditional method.<br />
<strong>Pathologica</strong>l evaluations were performed by a single pathologist.<br />
Results. The overall detection rate for both groups (RHS1®<br />
vs. traditionally processed biopsies) was similar for both<br />
group, 40% of Pca vs. 39.5%, 20% of HGPIN vs. 18.6%, 2%<br />
of ASAP vs. 3%. A comparable quality evaluation of histologic<br />
slides was given for both groups. No differences in core<br />
lengths were recorded in the two groups. The automatic processing<br />
time was 75 minutes vs. 14 hours, whereas the time<br />
to the definitive diagnosis was 190 minutes (range 145-260)<br />
vs. 24 hours. A quick diagnosis was performed in 887/914 pts<br />
(96%). In 37 pts additional immunohistochemical evaluations<br />
(p63, racemase, HMWCK) were successively performed,<br />
singly or with double stain, without any modification of<br />
routinely used methods.<br />
Conclusions. This experience confirms the validity of new<br />
automated microwave-vacuum device to process in a short time<br />
prostate biopsies. RHS1 ® , as other rapid processing tools<br />
now available, resulted at least as effective as the traditional<br />
processing method and could guarantee a new time effective<br />
standard to spare time, costs and stress for the patients. Being<br />
a xylene-free method, handling of the specimens is simplified<br />
and safer. RHS1 ® allows a better quality of service with<br />
a one-day diagnosis.<br />
Tab. I. Percentuali di ricorrenza e progressione del CU in relazione alla categoria FISH.<br />
Performance del test FISH nel monitoraggio<br />
del carcinoma uroteliale<br />
R. Bandelloni, S. Casazza, L. Turbino, A. Pastorino, M.<br />
Dezzana, G. Capponi * , M. Maffezzini *<br />
S.C. Anatomia Patologica; * S.C. Urologia; E.O. Ospedali<br />
“Galliera”, Genova<br />
Introduzione. Il carcinoma vescicale uroteliale (CU) è caratterizzato<br />
da percentuali di ricorrenza e di progressione pari,<br />
rispettivamente, al 70% e a circa il 15%. L’uretro/cistoscopia<br />
e la citologia urinaria su urine spontanee rappresentano gli<br />
strumenti “standard” per la diagnosi e il monitoraggio della<br />
neoplasia.<br />
L’impiego della indagine FISH, eseguita su campioni di urine,<br />
ha permesso di migliorare sensibilità e specificità nella<br />
diagnosi di CU, l’esame FISH inoltre, rispetto alla citologia,<br />
fornisce utili informazioni prognostiche per meglio quantificare<br />
il rischio di ricorrenza e di progressione della malattia.<br />
Lo scopo del nostro studio è valutare se l’esame FISH permette<br />
di categorizzare i pazienti affetti da CU in relazione al<br />
rischio di ricorrenza e progressione della malattia.<br />
Metodi. Dal maggio 2003 al dicembre 2006 sono state eseguite<br />
indagini FISH (UroVysion Vysis) per la ricerca di aneuploidie<br />
a carico dei cromosomi 3, 7 e 17 e della perdita omozigotica<br />
del locus 9p21, su 164 pazienti affetti da CU (età<br />
media 67,1 aa), 127 maschi (77,4%) e 37 femmine (22,6%).<br />
I pazienti sono stati seguiti con follow-up trimestrale comprendente<br />
uretro/cistoscopia e citologia urinaria, per i primi 2<br />
aa e semestrale successivamente, associati a Rx urografia annuale.<br />
I pazienti sono stati suddivisi in 3 categorie in base ai risultati<br />
FISH: FISH negativa, FISH positiva a “basso rischio” e<br />
FISH positiva ad “alto rischio” 1 . Sono state valutate per ciascuna<br />
categoria la ricorrenza e la progressione della malattia.<br />
Risultati. I risultati sono riportati in Tabella I.<br />
FISH negativa: pattern cromosomico disomico.<br />
FISH “basso rischio”: perdita omozigotica 9p21 solo o associato<br />
ad aberrazioni cromosomiche singole in meno del 10%<br />
delle cellule esaminate.<br />
FISH “alto rischio”: perdita omozigotica 9p21 associate ad<br />
aberrazioni cromosomiche multiple in oltre 10% delle cellule<br />
esaminate.<br />
Conclusioni. Lo studio dimostra come la positività alla FISH<br />
sia predittiva di ricorrenza e progressione del CU.<br />
Bibliografia<br />
1 Bollmann M, et al. BJU Int 2005;95:1219-25.<br />
Follow-up negativo Ricorrenza Progressione Totale<br />
FISH negativa 41 (60,3%) 24 (35,3%) 3 (4,4%) 68<br />
FISH “basso rischio” 19 (44,2%) 20 (46,5%) 4 (9,3%) 43<br />
FISH “alto rischio” 16 (30,2%) 25 (47,2%) 12 (22,6%) 53<br />
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