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Most tissue microarray studies have used a single 0.6-mm tissue core perdonor tissue. It has been suggested that multiple cores per donor can increasethe representativity of tissue microarray studies. To estimate the potential benefitof multiple cores, we analyzed Ki67 and p53 in triplet cores taken from threedifferent areas of 3,261 prostate cancer tissue blocks. Both p53 and Ki67 labelingindex were linked to advanced tumor stage (p&lt;0.0001 each), Gleason score (p&lt;0.0001),and early PSA recurrence (p&lt;0.0001) independently of whether the 3 tissue spotswere analyzed separately or combined for a consensus result. The rate of positivefindings increased with the amount of analyzed tissue. The average Ki67 labelingindex was higher in tumors with 3 interpretable spots (5.3±5.6) as compared totwo (4.1±4.7) or one interpretable spot (4.1±4.2, p&lt;0.0001). For p53, tumorswith three interpretable spots were positive in 3.8% of cases, and tumors with1 or 2 interpretable spots in 1.9% only (p=0.003). These data demonstrate thatusing multiple cores in a tissue microarray does not necessarily increase theability to identify associations of biomarkers with tumor phenotype and prognosisbut has always the disadvantage of additional work and tissue requirements. Multiplecores may even lead to statistical problems if unequal amounts of tissue are analyzedper tumor.

The impact of the number of cores on tissue microarray studies investigating prostate cancer biomarkers