Korean J Urol.  2015 Oct;56(10):710-716. 10.4111/kju.2015.56.10.710.

Discordance between location of positive cores in biopsy and location of positive surgical margin following radical prostatectomy

• Kim JW
• Park HK
• Kim HG
• Ham DY
• Paick SH
• Lho YS
• Choi WS

• KMID: 2344114
• DOI: http://doi.org/10.4111/kju.2015.56.10.710

Abstract

PURPOSE
We compared location of positive cores in biopsy and location of positive surgical margin (PSM) following radical prostatectomy.
MATERIALS AND METHODS
This retrospective analysis included patients who were diagnosed as prostate cancer by standard 12-core transrectal ultrasonography guided prostate biopsy, and who have PSM after radical prostatectomy. After exclusion of number of biopsy cores <12, and lack of biopsy location data, 46 patients with PSM were identified. Locations of PSM in pathologic specimen were reported as 6 difference sites (apex, base and lateral in both sides). Discordance of biopsy result and PSM was defined when no positive cores in biopsy was identified at the location of PSM.
RESULTS
Most common location of PSM were right apex (n=21) and left apex (n=15). Multiple PSM was reported in 21 specimens (45.7%). In 32 specimens (69.6%) with PSM, one or more concordant positive biopsy cores were identified, but 14 specimens (28%) had no concordant biopsy cores at PSM location. When discordant rate was separated by locations of PSM, right apex PSM had highest rate of discordant (38%). The discordant group had significantly lower prostate volume and lower number of positive cores in biopsy than concordant group.
CONCLUSIONS
This study showed that one fourth of PSM occurred at location where tumor was not detected at biopsy and that apex PSM had highest rate of discordant. Careful dissection to avoid PSM should be performed in every location, including where tumor was not identified in biopsy.

Keyword

Biopsy; Pathology; Prostate neoplasms; Prostatectomy

MeSH Terms

Aged
Biopsy, Large-Core Needle/methods
Humans
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Prostatectomy/*methods
Prostatic Neoplasms/*pathology/*surgery/ultrasonography
Retrospective Studies
Ultrasonography, Interventional/methods

Figure

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  Fig. 1 Locations of standard 12-core transrectal ultrasonography guided prostate biopsy.

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  Fig. 2 Geometrically concordant biopsy cores according to each positive surgical margin location. Blue tetragon is the location of positive surgical margin, and red ellipse is concordant biopsy cores of each positive surgical margin.

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