Diss. (sammanfattning) Stockholm : Karol. inst., 2000. / Härtill 7 uppsatser.

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Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

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Focal liver lesions are commonly encountered in clinical practice. To be able to differentiate potentially life-threatening lesions from clinically insignificant lesions, and to be able to treat them effectively are the two basic problems of a clinician who comes across such lesions. Percutaneous intervention of the liver with a needle enables a clinician to solve the above two problems in a minimally invasive manner. To date, there is a diversity of needle-related percutaneous interventional procedures that are applicable to the clinical management of patients with liver lesions, such as biopsy of focal lesions, drainage of abscesses, and ablation of tumors. Despite a reasonable safety and efficacy associated with these procedures, there are always grounds of further improvement in techniques and technology of needle-related percutaneous procedures to achieve an even better outcome. It was hypothesized that the application of needle-related interventional radiology to clinical management of focal liver lesions could be facilitated and extended with advancement and refinement in needle-related techniques and technology. This thesis was based on a series of nine studies that aimed to explore the potential of needle-related percutaneous interventions in the clinical management of focal liver lesions and to study the effect of the introduction of innovations in needle-related techniques and technology on such clinical applications. It was concluded that the hypothesis was confirmed. / Yu Chun Ho. / "April 2006." / Adviser: Anil Ahuja. / Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5176. / Thesis (M.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 219-235). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

O câncer da tireoide é a neoplasia endócrina mais comum, sendo responsável por cerca de 1 a 2% das neoplasias malignas da tireoide. Atualmente, a patogênese molecular do carcinoma papilífero da tireoide (CPT) tem sido relacionada à ativação aberrante da via de sinalização MAPK, desencadeada por mutações em diversos oncogenes. Destas, a mutação p.V600E do gene BRAF é a mais freqüente, sendo observada em 30%-80% dos casos. Numerosos estudos têm demonstrado que a presença dessa mutação está relacionada a uma maior agressividade do tumor e, conseqüentemente, a um prognóstico menos favorável, tornando-a um marcado importante no CPT. Contudo, poucos métodos utilizados na análise do gene BRAF em amostras de punção de nódulos tireoidianos foram satisfatórios em relação ao custo-tempo e sensibilidade do teste. Os objetivos deste estudo foram padronizar a extração de DNA a partir de amostras obtidas de PAAF guiada por ultrassom de nódulos tireoidianos; validar e determinar a eficiência e a relação custo-tempo da técnica de genotipagem por PCR em tempo real na detecção da mutação p.V600E do gene BRAF em amostras de PAAF de nódulos tireoidianos; analisar a prevalência da mutação p.V600E em pacientes com CPT; correlacionar à presença da mutação p.V600E com características clínicas e histopatológicas de maior agressividade e por fim analisar a sensibilidade, especificidade e acurácia do diagnóstico citológico em conjunto com a análise molecular da mutação p.V600E em material de PAAF. Nossa casuística foi composta por 224 pacientes, todos submetidos à tireoidectomia, cuja citologia pré-operatória foi indeterminada (Bethesda classes III a V) ou Bethesda VI (carcinoma papilífero). Foram avaliados dados clínicos e hormonais (TSH) e autoimunidade (anti-TPO e anti-TG), além das características ultrassonográficas (tamanho, estrutura, ecogenicidade, presença de microcalcificação e halo e vascularização). Os dados histológicos avaliados foram tamanho do tumor, variante histológica, invasão de cápsula, invasão vascular e linfática, extensão extratireoidiana, multicentricidade e presença de acometimento ganglionar à cirurgia. Os pacientes foram divididos em grupo benigno (n:122) e maligno (n:102), de acordo com o diagnóstico histológico final. O grupo maligno apresentou uma média de idade menor que o grupo benigno (48,9 vs 54,2 anos; p=0,008). Não observamos diferença entre os grupos com relação à dosagem sérica de TSH (p=0,467), anti-TPO (p=0,535) e anti-TG (p=0,730). Analisando as características ultrassonográficas, o tamanho e o volume dos nódulos foram maiores no grupo benigno (3,0 vs 2,6 cm e 12,38 vs 14,5 cm3; p=0,008 e p<0,001, respectivamente). Os nódulos que apresentaram hipoecogenicidade, assim como os nódulos de composição sólida, a presença de microcalcificações, ausência de halo hipoecogênico e presença de vascularização central apresentaram estatisticamente maior freqüência de malignidade. Em modelo de regressão logística, maior idade, nódulo sólido, sem halo hipoecogênico e com microcalcificações foram variáveis que influenciaram conjuntamente na presença de malignidade. No diagnóstico citológico 78,6% (176/224) dos nódulos avaliados foram classe III, IV e V, sendo que destes 35,8% (63/176) apresentaram diagnóstico histológico final maligno. Identificamos a mutação p.V600E no material de PAAF em 67,7% (69/102) dos pacientes do grupo maligno, estando presente em 70,3% (45/64) dos carcinomas papiliferos variante clássica e em 69,7% (23/33) dos carcinomas papilíferos variante folicular, sendo todos os achados confirmados em 100% das amostras através seqüenciamento automático do material obtido do tecido nodular a fresco ou parafinado dos pacientes. Nos pacientes com diagnóstico histológico de CPT (n:98), comparamos os pacientes com e sem a mutação p.V600E com relação aos dados clínicos, histológicos de pior prognóstico, presença de metástase linfonodal, classificação TNM e estádio de acordo com AJCC. Apenas a presença de idade mais avançada apresentou associação estatisticamente significativa com a presença da mutação p.V600E (p=0,041). Comparamos o diagnóstico citológico baseado na classificação de Bethesda e a análise da mutação p.V600E com o diagnóstico histológico considerado o padrão ouro para o diagnóstico de CPT. A sensibilidade, especificidade, acurácia, valor preditivo positivo e negativo do diagnóstico citológico foi de 67,4%, 94,4%, 79,8%, 93,3% e 71,2% respectivamente. Análise da mutação p.V600E isoladamente apresentou resultados similares ao do diagnóstico citológico, porém observamos que a combinação do diagnóstico citológico com análise da mutação melhorou significativamente todos os parâmetros analisados. A presença da mutação p.V600E em nossa casuística, não mostrou ser um fator isolado associado à pior prognóstico de CPT. Um maior número de pacientes e acompanhamento a longo prazo, somando-se cuidadosa avaliação clínica-morfológica com a detecção de mutação p.V600E e utilizando análises multivariadas, são necessários para esclarecer o significado prognóstico independente desta mutação. Estudos semelhantes também são necessários para encontrar uma maneira de combinar as características clínicas e ultrassonográficas, com a detecção da mutação p.V600E no material da PAAF para decidir a melhor abordagem cirúrgica / Thyroid cancer is the most common endocrine malignancy, accounting for 1- 2% of thyroid malignancies. Currently, the molecular pathogenesis of papillary thyroid carcinoma (PTC) has been linked to aberrant activation of the MAPK signaling pathway, triggered by mutations in several oncogenes. Of these, the p.V600E mutation of BRAF gene is the most frequent, being observed in 30%-80% of cases. Several studies have shown that the presence of this mutation is associated with an increased aggressiveness of the tumor and, consequently, a less favorable prognosis, making it an important set PTC. However, few methods used for analyzing samples from fine needle aspiration (FNA) of thyroid nodules were satisfactory regarding cost, time and sensitivity. The objectives of this study were to standardize the DNA extraction from samples obtained from ultrasound (US)-guided FNA of thyroid nodules; validate and determine the efficiency and cost-time of real-time PCR genotyping technique to detect p.V600E mutation from samples of FNA of thyroid nodules, to assess the prevalence of the mutation p.V600E mutation in patients with PTC, correlate the presence of the p.V600E mutation with clinical and histopathological features of higher aggressiveness and finally analyze the sensitivity, specificity and accuracy of cytological diagnosis in conjunction with molecular analysis of the p.V600E mutation in FNA material. Our series consisted of 224 patients, all underwent thyroidectomy, whose preoperative cytology was indeterminate (Bethesda classes III to V) or Bethesda VI (papillary carcinoma). We evaluated clinical data and hormone (TSH) and autoimmunity (anti-TPO and anti-TG), and the sonographic features (size, structure, echogenicity, presence of microcalcifications and halo and vasculature). The histological data were tumor size, histological variant, capsule invasion, lymphatic and vascular invasion, extrathyroidal extension, multicentricity and presence of malignant lymph nodes at surgery. Results: The patients were divided into benign (n:122) and malignant group (n:102), according to the final histological diagnosis. Malignant group had a mean age lower than the benign group (48.9 vs 54.2 years, p=0.008). There were no differences between groups regarding serum TSH (p=0.467), anti-TPO (p=0.535) and anti-TG (p=0.730). According to US characteristics, size and volume of the nodules were higher in the benign group (3.0 vs 2.6 cm and 12.38 cm 3 vs 14.5, p=0.008 and p<0.001, respectively). The nodules that showed hypoechogenicity, as well as the composition of solid nodules, the presence of microcalcifications, absence of hypoechoic halo and presence of central vascularization showed statistically higher frequency of malignancy. In the logistic regression model, older age, solid nodule without hypoechoic halo and microcalcifications were variables that influenced jointly in the presence of malignancy. In cytological diagnosis 78.6% (176/224) of nodules were evaluated as class III, IV and V, and of these 35.8% (63/176) had final histological diagnosis of malignant. The p.V600E mutation were identified in FNA material in 67.7% (69/102) of patients in malignant group, present in 70.3% (45/64) of papillary carcinoma classic variant and 69.7% (23/33) of follicular variant of papillary carcinoma, and all findings are confirmed in 100% of the samples through sequencing of the material obtained from the surgical tumor (fresh or paraffin). In patients with confirmed PTC (n:98), we compared patients with and without the mutation p.V600E according to clinical, histological poor prognosis, lymph node metastasis, and TNM stage according to AJCC. Only the presence of older age were significantly associated with the presence of the mutation p.V600E (p=0.041). We compared the cytological diagnosis based on the Bethesda classification and mutation analysis with the histological diagnosis p.V600E, the \"gold standard\" for diagnosis of PTC. Sensitivity, specificity, accuracy, positive and negative predictive value of cytological diagnosis was 67.4%, 94.4%, 79.8%, 93.3% and 71.2% respectively. Analysis of p.V600E mutation alone showed similar results to the cytological diagnosis, but we observed that the combination of cytological diagnosis with mutation analysis significantly improved all parameters analyzed. The presence of the mutation p.V600E in our series was not a single factor associated with worse prognosis of PTC. A larger number of patients and long term follow-up, adding to careful clinicalmorphological with p.V600E and mutation detection using multivariate analyzes are needed to clarify the independent prognostic significance of this mutation. Similar studies are also needed to find a combination among clinical and US, with p.V600E mutation detection in FNA material to decide the best surgical approach

O câncer da tireoide é a neoplasia endócrina mais comum, sendo responsável por cerca de 1 a 2% das neoplasias malignas da tireoide. Atualmente, a patogênese molecular do carcinoma papilífero da tireoide (CPT) tem sido relacionada à ativação aberrante da via de sinalização MAPK, desencadeada por mutações em diversos oncogenes. Destas, a mutação p.V600E do gene BRAF é a mais freqüente, sendo observada em 30%-80% dos casos. Numerosos estudos têm demonstrado que a presença dessa mutação está relacionada a uma maior agressividade do tumor e, conseqüentemente, a um prognóstico menos favorável, tornando-a um marcado importante no CPT. Contudo, poucos métodos utilizados na análise do gene BRAF em amostras de punção de nódulos tireoidianos foram satisfatórios em relação ao custo-tempo e sensibilidade do teste. Os objetivos deste estudo foram padronizar a extração de DNA a partir de amostras obtidas de PAAF guiada por ultrassom de nódulos tireoidianos; validar e determinar a eficiência e a relação custo-tempo da técnica de genotipagem por PCR em tempo real na detecção da mutação p.V600E do gene BRAF em amostras de PAAF de nódulos tireoidianos; analisar a prevalência da mutação p.V600E em pacientes com CPT; correlacionar à presença da mutação p.V600E com características clínicas e histopatológicas de maior agressividade e por fim analisar a sensibilidade, especificidade e acurácia do diagnóstico citológico em conjunto com a análise molecular da mutação p.V600E em material de PAAF. Nossa casuística foi composta por 224 pacientes, todos submetidos à tireoidectomia, cuja citologia pré-operatória foi indeterminada (Bethesda classes III a V) ou Bethesda VI (carcinoma papilífero). Foram avaliados dados clínicos e hormonais (TSH) e autoimunidade (anti-TPO e anti-TG), além das características ultrassonográficas (tamanho, estrutura, ecogenicidade, presença de microcalcificação e halo e vascularização). Os dados histológicos avaliados foram tamanho do tumor, variante histológica, invasão de cápsula, invasão vascular e linfática, extensão extratireoidiana, multicentricidade e presença de acometimento ganglionar à cirurgia. Os pacientes foram divididos em grupo benigno (n:122) e maligno (n:102), de acordo com o diagnóstico histológico final. O grupo maligno apresentou uma média de idade menor que o grupo benigno (48,9 vs 54,2 anos; p=0,008). Não observamos diferença entre os grupos com relação à dosagem sérica de TSH (p=0,467), anti-TPO (p=0,535) e anti-TG (p=0,730). Analisando as características ultrassonográficas, o tamanho e o volume dos nódulos foram maiores no grupo benigno (3,0 vs 2,6 cm e 12,38 vs 14,5 cm3; p=0,008 e p<0,001, respectivamente). Os nódulos que apresentaram hipoecogenicidade, assim como os nódulos de composição sólida, a presença de microcalcificações, ausência de halo hipoecogênico e presença de vascularização central apresentaram estatisticamente maior freqüência de malignidade. Em modelo de regressão logística, maior idade, nódulo sólido, sem halo hipoecogênico e com microcalcificações foram variáveis que influenciaram conjuntamente na presença de malignidade. No diagnóstico citológico 78,6% (176/224) dos nódulos avaliados foram classe III, IV e V, sendo que destes 35,8% (63/176) apresentaram diagnóstico histológico final maligno. Identificamos a mutação p.V600E no material de PAAF em 67,7% (69/102) dos pacientes do grupo maligno, estando presente em 70,3% (45/64) dos carcinomas papiliferos variante clássica e em 69,7% (23/33) dos carcinomas papilíferos variante folicular, sendo todos os achados confirmados em 100% das amostras através seqüenciamento automático do material obtido do tecido nodular a fresco ou parafinado dos pacientes. Nos pacientes com diagnóstico histológico de CPT (n:98), comparamos os pacientes com e sem a mutação p.V600E com relação aos dados clínicos, histológicos de pior prognóstico, presença de metástase linfonodal, classificação TNM e estádio de acordo com AJCC. Apenas a presença de idade mais avançada apresentou associação estatisticamente significativa com a presença da mutação p.V600E (p=0,041). Comparamos o diagnóstico citológico baseado na classificação de Bethesda e a análise da mutação p.V600E com o diagnóstico histológico considerado o padrão ouro para o diagnóstico de CPT. A sensibilidade, especificidade, acurácia, valor preditivo positivo e negativo do diagnóstico citológico foi de 67,4%, 94,4%, 79,8%, 93,3% e 71,2% respectivamente. Análise da mutação p.V600E isoladamente apresentou resultados similares ao do diagnóstico citológico, porém observamos que a combinação do diagnóstico citológico com análise da mutação melhorou significativamente todos os parâmetros analisados. A presença da mutação p.V600E em nossa casuística, não mostrou ser um fator isolado associado à pior prognóstico de CPT. Um maior número de pacientes e acompanhamento a longo prazo, somando-se cuidadosa avaliação clínica-morfológica com a detecção de mutação p.V600E e utilizando análises multivariadas, são necessários para esclarecer o significado prognóstico independente desta mutação. Estudos semelhantes também são necessários para encontrar uma maneira de combinar as características clínicas e ultrassonográficas, com a detecção da mutação p.V600E no material da PAAF para decidir a melhor abordagem cirúrgica / Thyroid cancer is the most common endocrine malignancy, accounting for 1- 2% of thyroid malignancies. Currently, the molecular pathogenesis of papillary thyroid carcinoma (PTC) has been linked to aberrant activation of the MAPK signaling pathway, triggered by mutations in several oncogenes. Of these, the p.V600E mutation of BRAF gene is the most frequent, being observed in 30%-80% of cases. Several studies have shown that the presence of this mutation is associated with an increased aggressiveness of the tumor and, consequently, a less favorable prognosis, making it an important set PTC. However, few methods used for analyzing samples from fine needle aspiration (FNA) of thyroid nodules were satisfactory regarding cost, time and sensitivity. The objectives of this study were to standardize the DNA extraction from samples obtained from ultrasound (US)-guided FNA of thyroid nodules; validate and determine the efficiency and cost-time of real-time PCR genotyping technique to detect p.V600E mutation from samples of FNA of thyroid nodules, to assess the prevalence of the mutation p.V600E mutation in patients with PTC, correlate the presence of the p.V600E mutation with clinical and histopathological features of higher aggressiveness and finally analyze the sensitivity, specificity and accuracy of cytological diagnosis in conjunction with molecular analysis of the p.V600E mutation in FNA material. Our series consisted of 224 patients, all underwent thyroidectomy, whose preoperative cytology was indeterminate (Bethesda classes III to V) or Bethesda VI (papillary carcinoma). We evaluated clinical data and hormone (TSH) and autoimmunity (anti-TPO and anti-TG), and the sonographic features (size, structure, echogenicity, presence of microcalcifications and halo and vasculature). The histological data were tumor size, histological variant, capsule invasion, lymphatic and vascular invasion, extrathyroidal extension, multicentricity and presence of malignant lymph nodes at surgery. Results: The patients were divided into benign (n:122) and malignant group (n:102), according to the final histological diagnosis. Malignant group had a mean age lower than the benign group (48.9 vs 54.2 years, p=0.008). There were no differences between groups regarding serum TSH (p=0.467), anti-TPO (p=0.535) and anti-TG (p=0.730). According to US characteristics, size and volume of the nodules were higher in the benign group (3.0 vs 2.6 cm and 12.38 cm 3 vs 14.5, p=0.008 and p<0.001, respectively). The nodules that showed hypoechogenicity, as well as the composition of solid nodules, the presence of microcalcifications, absence of hypoechoic halo and presence of central vascularization showed statistically higher frequency of malignancy. In the logistic regression model, older age, solid nodule without hypoechoic halo and microcalcifications were variables that influenced jointly in the presence of malignancy. In cytological diagnosis 78.6% (176/224) of nodules were evaluated as class III, IV and V, and of these 35.8% (63/176) had final histological diagnosis of malignant. The p.V600E mutation were identified in FNA material in 67.7% (69/102) of patients in malignant group, present in 70.3% (45/64) of papillary carcinoma classic variant and 69.7% (23/33) of follicular variant of papillary carcinoma, and all findings are confirmed in 100% of the samples through sequencing of the material obtained from the surgical tumor (fresh or paraffin). In patients with confirmed PTC (n:98), we compared patients with and without the mutation p.V600E according to clinical, histological poor prognosis, lymph node metastasis, and TNM stage according to AJCC. Only the presence of older age were significantly associated with the presence of the mutation p.V600E (p=0.041). We compared the cytological diagnosis based on the Bethesda classification and mutation analysis with the histological diagnosis p.V600E, the \"gold standard\" for diagnosis of PTC. Sensitivity, specificity, accuracy, positive and negative predictive value of cytological diagnosis was 67.4%, 94.4%, 79.8%, 93.3% and 71.2% respectively. Analysis of p.V600E mutation alone showed similar results to the cytological diagnosis, but we observed that the combination of cytological diagnosis with mutation analysis significantly improved all parameters analyzed. The presence of the mutation p.V600E in our series was not a single factor associated with worse prognosis of PTC. A larger number of patients and long term follow-up, adding to careful clinicalmorphological with p.V600E and mutation detection using multivariate analyzes are needed to clarify the independent prognostic significance of this mutation. Similar studies are also needed to find a combination among clinical and US, with p.V600E mutation detection in FNA material to decide the best surgical approach

<p>Angiogenesis is necessary for the growth and spread of solid tumors. In these studies angiogenesis was measured in childhood malignancies in general and in Wilms’ tumor in particular, and cutting needle biopsy (CNB) specimens were evaluated for diagnosis in childhood renal tumors. </p><p>In 33 patients with Wilms’ tumor, tumor capillaries were quantified, expression of angiogenic growth factors in tumor tissue investigated, and concentrations of angiogenic growth factors in serum measured. Reference values for angiogenic growth factors were obtained in 80 healthy adults (fibroblast growth factor 2 [FGF-2], vascular endothelial growth factor A [VEGF-A]) and 94 healthy children (angiogenin [ANG], epidermal growth factor [EGF], FGF-2, hepatocyte growth factor [HGF], tumor necrosis factor alpha [TNFA] and VEGF-A) aged 0.5-18 years. These reference values were compared with values in sera taken at diagnosis in 268 children with tumors and leukemias. CNB specimens were evaluated in 25 children with renal tumors.</p><p>A large number of capillaries was an independent prognostic factor for a poor outcome in Wilms’ tumor. Angiogenic growth factors were expressed in Wilms’ tumor tissue, and elevated concentrations of HGF and VEGF-A were found in both benign and malignant tumors. HGF was increased in leukemia, and TNFA was increased in leukemia, lymphoma and neuroblastoma. CNB, which proved to be a safe procedure, had a sensitivity of 76%. </p><p>These studies have demonstrated that quantification of capillaries is a prognostic factor in Wilms’ tumor and that HGF, TNFA and VEGF-A are frequently elevated in sera from children with cancer. Quantification of capillaries in tumor tissue and of circulating angiogenic growth factors would therefore seem to be of clinical relevance in managing children with cancer.</p>

Angiogenesis is necessary for the growth and spread of solid tumors. In these studies angiogenesis was measured in childhood malignancies in general and in Wilms’ tumor in particular, and cutting needle biopsy (CNB) specimens were evaluated for diagnosis in childhood renal tumors. In 33 patients with Wilms’ tumor, tumor capillaries were quantified, expression of angiogenic growth factors in tumor tissue investigated, and concentrations of angiogenic growth factors in serum measured. Reference values for angiogenic growth factors were obtained in 80 healthy adults (fibroblast growth factor 2 [FGF-2], vascular endothelial growth factor A [VEGF-A]) and 94 healthy children (angiogenin [ANG], epidermal growth factor [EGF], FGF-2, hepatocyte growth factor [HGF], tumor necrosis factor alpha [TNFA] and VEGF-A) aged 0.5-18 years. These reference values were compared with values in sera taken at diagnosis in 268 children with tumors and leukemias. CNB specimens were evaluated in 25 children with renal tumors. A large number of capillaries was an independent prognostic factor for a poor outcome in Wilms’ tumor. Angiogenic growth factors were expressed in Wilms’ tumor tissue, and elevated concentrations of HGF and VEGF-A were found in both benign and malignant tumors. HGF was increased in leukemia, and TNFA was increased in leukemia, lymphoma and neuroblastoma. CNB, which proved to be a safe procedure, had a sensitivity of 76%. These studies have demonstrated that quantification of capillaries is a prognostic factor in Wilms’ tumor and that HGF, TNFA and VEGF-A are frequently elevated in sera from children with cancer. Quantification of capillaries in tumor tissue and of circulating angiogenic growth factors would therefore seem to be of clinical relevance in managing children with cancer.

Orientador: Athanase Billis / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T07:48:22Z (GMT). No. of bitstreams: 1 Guimaraes_MarbeleSantos_M.pdf: 9766799 bytes, checksum: 89baad38db3ebd410ea20926179eb1b9 (MD5) Previous issue date: 2007 / Resumo: Há evidências mostrando que a graduação de Gleason para carcinoma da próstata é um dos mais importantes fatores prognósticos de comportamento biológico e um dos mais influentes fatores para determinar o tratamento do câncer da próstata. Este trabalho tem por finalidade comparar: a graduação de Gleason nas biópsias de agulha com a graduação nas prostatectomias radicais correspondentes; correlacionar a graduação de Gleason nas biópsias de agulha com a extensão tumoral nas prostatectomias radicais correspondentes; correlacionar a graduação de Gleason na prostatetomia radical com extensão tumoral, margens cirúrgicas comprometidas e estádio patológico; e, comparar a progressão bioquímica (PSA) da moléstia (recorrência e/ou metástase) pós-prostatectomia radical entre pacientes com: Gleason grau baixo/intermediário (contagem final < 7) vs grau alto (contagem final=7); contagem final 3+4 vs 4+3; e, grau predominante 4 ou 5 vs grau predominante menor que 4. Trata-se de um estudo retrospectivo baseado em 200 espécimes de prostatectomias radicais e de biópsias correspondentes provenientes de pacientes operados no Hospital das Clínicas da FCM-Unicamp no período de 1997 a 2004. A extensão tumoral foi estimada por um método semiquantitativo de contagem de pontos. A progressão bioquímica (recorrência e/ou metástase) da moléstia pós-prostatectomia radical estabelecida pelo Serviço de Urologia do Hospital das Clínicas da Unicamp é o valor de PSA igual ou maior que 0,5 ng/mL. Os dados foram analisados estatisticamente utilizando Statistica 5.5 (StatSoft,Inc., Tulsa, OK, USA). Foi considerado significante o valor de p =0,05. Houve exata correspondência em 47,1% dos casos quando comparada contagem final de Gleason na biópsia de agulha com a contagem final na prostatectomia correspondente. A contagem de Gleason foi subestimada em 40,6% dos casos e superestimada em 12,3% nas biópsias de agulha. A correlação entre contagem final de Gleason nas biópsias de agulha com a extensão tumoral nas prostatectomias radicais correspondentes mostrou-se altamente significante (p<0.001). A correlação da graduação histológica de Gleason na prostatectomia radical foi altamente significante com extensão tumoral (p<0,001), margens cirúrgicas positivas (p<0,001) e estádio patológico (p<0,001). O tempo de recorrência bioquímica (PSA) livre de doença comparando pacientes com Gleason contagem final < 7 vs contagem final >7 (log-rank, p=0,2674); contagem final 3+4 vs 4+3 (log-rank, p=0. 3207); e, grau predominante 4 ou 5 vs grau predominante menor que 4 (log-rank, p=0,1759) não foi estatisticamente significante. Contagens finais maiores na graduação de Gleason na prostatetomia radical se correlacionam com maior extensão tumoral, margens cirúrgicas comprometidas e estádio patológico mais avançado. A maioria dos pacientes mostraram igual ou maior contagem final comparando a contagem final de Gleason na prostatectomia com a biópsia de agulha correspondente. Em nosso estudo, não houve diferença estatisticamente significante em relação à progressão bioquímica quando comparados contagem final <7 vs =7, contagem final 3+4=7 vs 4+3=7 e grau predominante <4 vs =4. predominante 4 ou 5 vs grau predominante menor que 4 (log-rank, p=0,1759) não foi estatisticamente significante / Abstract: There are evidences showing that Gleason grading of prostatic adenocarcinoma is one of the most powerful predictors of biological behavior and one of the most influential factors used to determine treatment for prostate cancer. The aim of the current report was to compare Gleason score on needle biopsy to Gleason score in the correspondent surgical specimen, correlate Gleason score on needle biopsy to tumor extent in surgical specimen, correlate Gleason score in the specimens to several clinicopathologic variables, and compare biochemical (PSA) progression following surgery between patients with Gleason low-grade vs high-grade, Gleason score 3+4 vs 4+3 and Gleason predominant grade <4 or >4. The study population consisted of 200 consecutive patients submitted to radical prostatectomy. Tumor extent was evaluated by a point-count method. Biochemical progression was defined as PSA = 0.5ng/mL. Time to PSA progression was studied using the Kaplan-Meier product-limit analysis. There was exact correspondence in 47.1% of cases, when Gleason score on the biopsy was compared to the correspondent surgical specimen. Gleason score was higher in the specimen in 40.6% of cases and lower in 12.3%. High-grade Gleason score on the biopsy significantly correlated to higher tumor extent (p<0.001). High-grade Gleason score in the surgical specimen significantly correlated to more extensive tumors (p<0.001), positive margins (p<0.001) and extraprostatic extension (pT3a/pT3b) (p<0.001). Time of biochemical (PSA) progression-free survival comparing patients with Gleason score <7 vs =7 (log-rank, p=0.2674), Gleason score 3+4=7 vs 4+3=7 (log-rank, p=0.3207) and Gleason predominant grade <4 vs >4 (log-rank, p=0.1759) was not statistically significant. High-grade Gleason score significantly correlates with more extensive tumors in the surgical specimen, positive margins, and more advanced pathologic staging. Most of the patients show either an exact Gleason score or a higher score in the surgical specimen comparing to the needle biopsy. In our study, time of biochemical (PSA) progression-free survival between patients with Gleason score <7 vs =7, Gleason score 3+4=7 vs 4+3=7 and Gleason predominant grade <4 or >4 was not statistically significant / Mestrado / Anatomia Patologica / Mestre em Ciências Médicas