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[1554] Experience with Prostate Needle Biopsies (PNB) in a Specialized Urologic Pathology Laboratory (Condo Laboratory)

J Furman. Jaime Furrman MD. P.A, San Antonio, TX

Background: New models of practices have appeared in different medical specialties. In pathology, along with traditional private and academic settings, new joint ventures in which physicians groups share in profits for pathology services exist. These types of practices are referred to as condo laboratories. National pathology associations have expressed concerns about the quality of pathology services provided in these laboratories.The aim of this study was to examine the results of objective parameters for PNB in a condo laboratory compared to earlier published data in the pathology literature.
Design: This is a retrospective study evaluating the results of prostate carcinoma detection of 12 biopsies obtained by TRUS performed by 40 urologists in five practices during the period from July 2005 to July 2006 evaluated in a specalized urologic pathology lab. The PNB were taken from the peripheral zones of the right and left lobes.The biopsy results were compared to the incidence of Prostatic Carcinoma (PC), High Grade Prostatic Intraepithelial Neoplasia (HGPIN), Acinar Atypia (AA) and Benign. The diagnosis results were also compared to second opinion consultations requested by clinicians/patients and submitted to outside institutions.
Results: In this study a total of 2608 cases of PNB and 62,123 slides were examined. The results were the following : 972 PC (37.2%), 398 HGPIN (15.2%), 49 AA (2.0%),1189 benign (45.6%). A total of 110 cases (4.2%) were requested for second opinion. Agreement was seen in 91% of the consultations. Disagreement was seen in 9 cases (9.1%). Of the cases of disagreement 6 cases were cases of HGPI vs benign, 1 was a case of AA vs HGPIN and 2 cases between AA and PC. In these two cases our initial DX of carcinoma were confirmed by a second PNB and a third outside opinion respectively.Our number of carcinomas detected (37.2%) was higher than in most publications, but was similar to studies with 12 PNB, were (38.6%) of patients show PC.Our incidence of AA is lower than 5% reported. HGPIN is higher from the mean of 7.6% published but still within the numbers of 15% and 16% reported by other centers.
Conclusions: The number of PC, AA and benign DX are in accordance with results in the literature. HGPIN is higher than the mean. A 12 core biopsy strategy for TRUS-guided biopsy of the prostate gland improves detection and histologic grading of prostate carcinoma. The parameters did not show marked discrepancies between the condo lab and other institutions. There is agreement on most of the second opinions.
Category: Quality Assurance

Tuesday, March 27, 2007

Poster # 201, Tuesday Afternoon