Hubungan Jumlah Black Dots dalam Nuclei Terekspresi Argyrophilic Nucleolar Organizing Regions (Agnors) dan Grading Histopatologi Berdasarkan International Society of Urological Pathology (ISUP) Grading 2016 pada Adenokarsinoma Prostat

Abstract

Background: Prostate adenocarcinoma represents one of the leading causes of cancer-related death in men worldwide. Accurate histopathological grading is crucial for predicting prognosis and guiding therapy. The International Society of Urological Pathology (ISUP) 2016 grading system provides improved prognostic stratification compared with the traditional Gleason score. Argyrophilic nucleolar organizing region (AgNOR) staining quantifies cellular proliferative activity through visualization of nucleolar proteins and may complement conventional grading. Objective: To analyze the correlation between the number of AgNOR black dots and histopathological grading based on the 2016 ISUP system in prostatic adenocarcinoma. Methods: This analytical cross-sectional study involved 40 formalin-fixed paraffin-embedded prostate adenocarcinoma samples archived in the Department of Anatomical Pathology, Faculty of Medicine, Universitas Sumatera Utara. Each case was graded according to the ISUP 2016 system and subjected to AgNOR silver staining following Ploton et al. (1986). AgNORs were counted manually in 100 tumor cell nuclei under 1000× magnification. Mean AgNOR counts were compared across ISUP grade groups, and correlation was evaluated using Spearman’s test. Results: Mean AgNOR counts increased progressively with ISUP grade—from 2.12 ± 0.38 in Grade Group 1 to 6.71 ± 0.54 in Grade Group 5. A strong positive correlation was observed between AgNOR count and grade (r = 0.71, p < 0.001). Higher AgNOR counts reflected greater nucleolar activity and cellular proliferation. Conclusion: AgNOR quantification correlates significantly with ISUP histopathological grade in prostate adenocarcinoma and may serve as a simple, reliable marker of tumor aggressiveness, especially in resource-limited settings.