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MDA has some ‘splainin to do!

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Posted 3/6/2020 9:56 PM (GMT 0)
Just received this from MDA.

DIAGNOSIS
A. LEFT BASE (A):
PROSTATIC ADENOCARCINOMA IN PERINEURAL location, MINUTE MICROSCOPIC FOCUS (0.5 MM).
(SEE COMMENT)
COMMENT
The focus of carcinoma in part A is minute (0.5 mm) and located exclusively perineurally. In general, it is recommended to
avoid grading areas of perineural invasion as those frequently show complex glandular architecture (Gleason grade 4), as in
this case, which may not reflect the grade of the invasive carcinoma component. Therefore, when the tumor present in a
biopsy is located around a nerve, it is advisable to omit grading.
The diagnosis for part A has been changed to prostatic adenocarcinoma in perineural location.
The case has been re-reviewed by Drs. Czerniak, Guo, and Troncos
Posted 3/6/2020 11:12 PM (GMT 0)
So, if "it is recommended to avoid grading areas of perineural invasion," why did they do it the first time? Major *****p.

Poking around the internet: Patricia Troncoso's expertise is supposed to be PCa pathology. Did she approve the first report or was she only called in for the regrading? Makes you wonder about MDA's QC.

More poking: Confirmation that minute focus of tumor shouldn't be graded: "...for cases with minimal tumor on biopsy, the assigned Gleason score did not predict tumor stage. To properly convey this uncertainty to clinicians, a cautionary note should accompany Gleason scores derived from a minimal focus of carcinoma." Abstract, Should a Gleason Score Be Assigned to a Minute Focus of Carcinoma on Prostate Biopsy?, Am. J. Surgical Pathology, January 2001.

I'd love to hear Epstein's comment on MDA's regrading.
Posted 3/7/2020 12:52 AM (GMT 0)
Right. All three labs graded it and then MDA backed off. I find it quite odd.
Dr. Troncoso’s name was not on their original report.
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