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A brief outline of Luke. For other Commentaries on Luke, see Text Index. Voice Bible Studies. The Synoptic Problem. Ephesians chapter 2. Ephesians 2: 1-10. Ephesians 2 - EE. Ephesians chapter 3. Ephesians 3: 19. Ephesians 4: 17-31. Ephesians chapter 5. Ephesians 6: 10-24. Now unto Him that is. Dealing with the ABC's of life. A word from God to your family. Clarion 2 2 way. Faith and love at work. Fill 'er up Lord. Five things that make or break. Outline is a VPN software that makes it easy for organizations to set up their own VPN service, in order to protect their communications and access the open internet. Outline, created by Jigsaw, is open source, has been audited by a third party, and uses modern a protocol and encryption. Love Worth Finding PO Box 38300, Memphis, TN 38183 800-274-5683.
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- Gleason score is the sum of the two most prevalent Gleason grades: primary and secondary, designated according to separate rules for biopsy and prostatectomy
- If only one pattern is present, the primary and secondary patterns are given the same grade (ex: 3+3=6)
- Systematic needle biopsy sets contain cores from different anatomically designated sites
- Gleason score should be assigned separately for each anatomically designated site
- Highest score may serve as a basis to determine treatment
- Additional reporting of a global (case level) Gleason score is optional (2019 consensus) and global scoring may show a marginal benefit over using highest score according to Trpkov et al. (Am J Surg Pathol 2018;42:1522)
- Any glands showing perineural invasion must be excluded in assigning Gleason grading because perineural invasion distorts gland morphology such that Gleason 3 glands resemble Gleason 4
- Grading rules:
- Recommendations are based on three International Society of Urological Pathology (ISUP) grading consensus conferences: in 2005 (Am J Surg Pathol 2005;29:1228; reviewed, J Urol 2010;183:433), 2014 and 2019 (Nice, France; publication pending)
- Some specimens may show a pattern that is the third most prevalent; this is called a minor pattern
- In radical prostatectomy:
- Gleason score should be based on the primary and secondary patterns; if a minor pattern constitutes < 5%, the pattern should be mentioned as a minor (tertiary) pattern (Eur Urol 2018;73:674); any higher grade minor pattern ≥ 5% should be incorporated into the Gleason score and ISUP group as the secondary pattern (2019 consensus)
- Ex: Gleason pattern 3=96% and pattern 4=4%, Gleason score=3+3=6 with minor (tertiary) 4
- Ex: Gleason pattern 3=95% and pattern 4=5%, Gleason score=3+4=7
- In needle biopsy:
- The most prevalent pattern is graded as primary and any amount of a worst pattern is graded as secondary
- Ex: Gleason pattern 3=96% and pattern 4=4%, Gleason score=3+4=7
- Ex: Gleason pattern 3=95% and pattern 4=5%, Gleason score=3+4=7
- For multiparametric MRI targeted biopsies: Gleason scores should be given for the aggregate of cores from each individual biopsy site but not for each core (2019 consensus); this method of reporting is by research by Gordetsky et al. (Hum Pathol 2018;76:68); benign histologic changes (chronic inflammation, acute inflammation, atrophy) should be reported in high suspicion lesions (PI-RADS 4 and 5) that are negative for cancer (2019 consensus)