[Quality score in pathological report of prostate biopsies improve professional practice]. / La mention systématique d'un indice de qualité dans les comptes rendus de biopsies prostatiques influence les pratiques professionnelles.

OBJECTIVE: Evaluate the influence on professional practices of a systematic indication of a quality score (IGap) in the conclusion of the pathologic reports (CRFS) of prostatic biopsies (PB). MATERIALS AND METHOD: Prospective study carried over 339 consecutive 10 core extended standardized PB performed by two urologists over a period of 22 months. The CRFS were computerized. The conclusion included an IGap ranking from 0 to 1, automatically computed from three criteria: the average length of the PB, the number of PB with identified capsules or periprostatic tissues and the average number of fragments per PB. The quality was best when the index is close to 1. A quarterly monitoring of the average of IGap was performed for the two urologists. The student t test was used to compare the averages. RESULTS: The average of IGap of the urologists A and B was, respectively, of 0.57 (s=0.1; n=184) and 0.66 (s=0.1; n=155): p<0.001. At quarter 1, the averages of IGap of the urologists A and B are, wads of respectively, of 0.47 (s=0.14; n=25) and 0.7 (s=0.12; n=14) (p<0.001). The significant difference of the average of IGap of the urologists A and B observed on quarter 1 progressively decline to disappear from the quarter 4. CONCLUSIONS: At equivalent protocols, the urologists do not necessarily perform PB of comparable quality. A systematic indication of an IGap in the pathological reports of PB seems to prompt the urologists to modify their practices toward an improvement of the score.

[Length of needle and size of prostatic biopsies influence identification of capsular and extracapsular elements]. / La longueur des biopsies prostatiques conditionne l'identification des éléments capsulaires et périprostatiques.

OBJECTIVE: To evaluate the influence of the length of prostate biopsies (PB) on identification of prostatic capsule and periprostatic tissue. MATERIALS AND METHOD: A prospective study was carried out in one center by two urologists during 22 months on 339 consecutive protocols of standardized ten-needle PB (PSA<10ng/ml regardless of digital rectal examination). Pathologic reports were standardized. The conclusion of the pathologic report included the average length of the ten-needle PB (Lm) and the number of prostatic core biopsies on which pathologist identified prostatic capsule and periprostatic tissue (BCI). Protocols of PB were spread in 16 groups depending on the value of Lm in millimeter: [0-1], [1-2], [2-3]... [15-16]. Relationship between Lm's and BCI's was evaluated using the linear regression and the correlation coefficient (r). RESULTS: Average Lm=10.7 (2.1-15.7; s=2.3) (n=339). Average BCI=6.6 (0-10; s=2.3) (n=339). The value of IGap increased when the value of Lm increased (r=0.89). CONCLUSIONS: The pathologists better identify the capsule of the prostate and the periprostatic tissue when the PB's are of large size. PB's of small size are of poor quality either for samplings of the prostatic gland or samplings of the capsule and the periprostatic tissues.

[Development of a pathological quality score of prostate biopsies]. / Elaboration d'un indice de qualité anatomopathologique des biopsies prostatiques.

OBJECTIVES: Develop a score allowing the pathologist to objectively report on the overall quality of extended standardized prostatic biopsy (EPB). METHODS: A prospective study was carried out on 339 consecutive protocols of 10 core EPB (PSA<10 ng/ml). Reports are standardized and computerized. The conclusion of the reports includes an estimate of the overall quality of the EPB based on three items to classify the protocols in three groups: protocol of "good" quality (group 1), "medium" quality (group 2) and "poor" quality (group 3). The score (IGap) is automatically computed from three objective criteria also shown on the conclusion of the report: the average length of the 10 biopsies (LM), the number of biopsies on which capsular elements can be identified (BCI) and the average number of fragment per biopsy (Fm). The IGap index rank from 0 to 1. The average IGap of the three groups is computed using the t-test. RESULTS: The average IGaps of the groups 1, 2 and 3 are respectively of 0,65 (0,37-0,89 ; n=250), 0,52 (0,36-0,71 ; n=69) and 0,43 (0,22-0,6 ; n=20), (p<0,001). CONCLUSION: IGap is a pertinent score reporting objectively of the overall quality of EPB. An IGap close to one indicates a good quality of EPB. An IGap close to zero indicate a poor quality of EPB.

[Extensive Hirschsprung's disease associated with intestinal malrotation]. / Maladie de Hirschsprung à forme iléocolique associée à une malrotation intestinale.

Hirschsprung's disease (HD) involves the entire colon in less than 5% of cases, and the association of extensive HD with intestinal malrotation is very rare. This association of symptoms may delay both diagnosis and treatment. An infant presented with an intermittent occlusive syndrome that began neonatally. Intestinal malrotation was diagnosed radiologically, and treated surgically when the child was 2 months old. However, a chronic occlusion persisted. Biopsies of the rectum and the appendix demonstrated an absence of neurons in intestinal plexi. When the child was 17 months old, ileostomy and surgical excision of the segment affected by HD (the colon and terminal ileum) were performed. An ileoanal anastomosis was performed at the age of 29 months, with favorable outcome. The persistence of symptoms of intestinal occlusion after attempted treatment of intestinal malrotation must therefore suggest the possibility of associated HD in a young child.