Accuracy of gleason grading by practicing pathologists and the impact of education on improving agreement

Mikami, Yoshiki; Manabe, Toshiaki; Epstein, Jonathan I.; Shiraishi, Taizo; Furusato, Masakuni; Tsuzuki, Toyonori; Matsuno, Yoshihiro; Sasano, Hironobu

doi:10.1016/s0046-8177(03)00191-6

Cited by 44 publications

(46 citation statements)

References 22 publications

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“…6,9,11,14 First, the biologic spectrum of prostate cancer has shifted considerably over the last 20 years as a result of the introduction and increasing use of prostate-specific antigen (PSA) and transrectal needle biopsy in diagnosis, with a concomitant decrease in transurethral resection of the prostate (TURP). Second, there has been an increase in expertise among pathologists in the assignment of histologic grade because of increasing numbers of patients and various educational efforts 15,16 as well as the redefinition of some criteria on which such grading is based. 17 Recent studies have shown that reclassification of needle biopsy and TURP specimens leads to apparent improvements in prognosis.…”

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confidence: 99%

Trends in distribution and prognostic significance of Gleason grades on radical retropubic prostatectomy specimens between 1989 and 2001

Sengupta

Slezak

Blute

et al. 2006

Cancer

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BACKGROUNDThe objectives of the current study were to examine time trends in the prevalence of Gleason grades of prostate cancer on radical retropubic prostatectomy (RRP) specimens and to assess the resultant impact on prognosis.METHODSThe authors examined the prevalence over time of each grade and Gleason score (GS) on RRP specimens from 8750 patients who were treated between 1989 and 2001. Biochemical recurrence‐free survival (BRFS), which was estimated by using Kaplan–Meier methodology, was examined in subgroups of patients defined by tumor grade and era of surgery.RESULTSThe prevalence of Grade 3 prostate cancers increased (86% vs. 49% for primary Gleason grade and 71% vs. 47% for secondary Gleason grade; 1999–2001 vs. 1989–1990, respectively), whereas the prevalence of Grade 2 tumors decreased (0.4% vs. 38% for primary Gleason grade and 1.3% vs. 28% for secondary Gleason grade, respectively) over the study period, leading to fewer GS 4 and 5 tumors and more GS 6 and 7 tumors. BRFS improved over time for patients who had GS 5 tumors (hazards ratio [HR], 0.92 per year; P = .003) and GS 6 tumors (HR, 0.93; P<.001) but remained unchanged for GS 7 tumors (HR 0.99; P = .462) and GS 8–10 tumors (HR 1.02; P = .360). Patients who were treated in the recent era (1997–2001) had greater differentiation of BRFS based on GS or Gleason grade compared with patients who were treated earlier (1989–1991).CONCLUSIONSThe current results confirmed that there were changes in the prevalence of Gleason grades on RRP specimens between 1989 and 2001. A chronological change in pathologic grading classification is suggested by evolving prognostic implications, which must be accounted for when comparing outcomes from different eras. Cancer 2006. © 2006 American Cancer Society.

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Trends in distribution and prognostic significance of Gleason grades on radical retropubic prostatectomy specimens between 1989 and 2001

Sengupta

Slezak

Blute

et al. 2006

Cancer

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“…Si bien en nuestra serie tenemos adecuados niveles de concordancia tanto en forma global para el grupo de estudio y en forma separada para los grupos con y sin BPT eco-dirigida, la subgraduación es una de los principales difi cultades, mencionando la literatura como principales posibles causas de error en la graduación histológica a la obtención de muestras poco o no representativas de la lesión, y donde según algunos autores, la obtención de una mayor cantidad de tejido aplicando protocolos que consideran un mayor número de toma de muestras, permitiría controlar esta variable producto de la condición de heterogeneidad tumoral; aun cuando existen reportes en los cuales la mejoría en la correlación es despreciable al comparar esquemas por punción que consideran diferentes números de toma de muestra 9,[34][35][36] . El otro elemento a considerar es la correcta interpretación por parte del anatomopatólogo, existiendo trabajos que demuestran una mejor correlación cuando la graduación es realizada por patólogos especialistas en el área y tanto biopsia por punción como quirúrgica son examinados por el mismo patólogo o grupo de patólogos, suponiendo esto último la existencia de difusión de consensos locales y aplicación de protocolos validados en este tema 9,29,[35][36][37][38][39] . En nuestra serie, al analizar y comparar el grupo de tumores con puntaje de Gleason subgraduados y sin discordancia constatamos en los casos subgraduados un menor porcentaje promedio de tumor reportado en la biopsia por punción (35,89% vs 45,38%; p < 0,05) y un mayor porcentaje promedio de tumor reportado en la pieza quirúrgica (27,4% vs 20,9%; p < 0,001); en base a estos resultados la no concordancia en estos casos la atribuimos a la poca representatividad de la muestras obtenidas por punción.…”

Section: Discussionunclassified

Puntaje de Gleason en cáncer de próstata: Correlación de la biopsia por punción y prostatectomía radical

Roa

et al. 2011

Rev. méd. Chile

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“…Prostat spesifik antijen (PSA) yüksekliği ve şüpheli rektal muayene bulguları ile oluşan ön tanı sonrası yapılan doku örneklemesi sonucu prostat kanseri tanısı konulur (2). Prostat kanseri tedavisinde seçilecek yöntemi belirlemede hastanın yaşı, komorbiditeleri, hastanın beklentileri, prostat biyopsisinde alınan materyalde tümörün yaygınlığı ve gleason skoru (GS) önemli rol oynamaktadır (3,4).…”

Section: Introductionunclassified

Is There a Concordance Between the Gleason Scores of Needle Biopsy and Radical Prostatectomy Specimens in Prostatic Carsinoma?

Özgör¹,

Küçüktopçu²,

Şahan³

et al. 2016

Haseki

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ÖzAmaç: Prostat biyopsi ve radikal prostatektomi örneklerinin Gleason skorları (GS) arasındaki uyumu değerlendirmektir. Yöntemler: Haseki Eğitim ve Araştırma Hastanesi, ÜrolojiKliniği'nde 2008 ile 2012 yılları arasında prostat kanseri ön tanısıyla 1135 hastaya prostat biyopsisi yapıldı. Bu hastalardan 366'sına prostat kanseri tanısı konuldu. Radikal prostatektomi operasyonu 73 hastaya yapıldı ve bu hastaların biyopsi ve prostatektomi örneklerinden elde edilen GS'si karşılaştırıldı. Hastalar D'amico sınıflamasına göre düşük, orta, yüksek risk olmak üzere 3 sınıfa ayrıldı.Bulgular:Hastaların yaş ortalaması 64,2±6,1 (aralık: 54-73) idi. Hastaların serum prostat spesifik antijen seviyeleri ortalaması 20,34 ng/mL olarak bulundu. Hastaların core biyopsi sayısı ortalaması 12±0,58 idi. Hastaların %65,7'sinde biyopsi sonrası ve radikal prostatektomi sonrası GS'nin değerlerinin uyumlu olduğu görüldü ve istatiksel olarak anlamlı olduğu saptandı (p<0,01). Biyopsi sonrası yapılan değerlendirmede düşük risk grubunda olan 40 hastanın radikal prostatektomi sonrasında gerçekte sekizinin (%20) orta risk grubunda, birinin de (%2,5) yüksek risk grubunda olduğu görüldü.Sonuç:Hastalara doğru tedavi yaklaşımını belirlemede biyopsi ve prostatektomi sonrasındaki GS arasındaki uyum önemlidir.Anahtar Sözcükler: Adenokanser, radikal prostatektomi, transrektal biyopsi Abs tractAim:To evaluate the concordance between the Gleason Scores (GS) of prostate biopsy and radical prostatectomy specimens. Methods:Prostate biopsy was performed in 1135 patients with the suspicion of prostate cancer in our clinic between 2008 and 2012. A total of 366 patients were diagnosed with prostate cancer. Radical prostatectomy was performed in 73 of these patients and GS of pathology specimens were included in this study for comparison. The patients were divided into three groups (low intermediate-and high-risk patients) according to the D'amico risk classification for prostate cancer.Results:The median age of the patients was 64.2±6.1 years (54-73). The mean prostate specific antigen level was 20.34 ng/mL and the mean biopsy core number was 12±0.58. A statistically significant concordance was detected between the GS of biopsy specimens and radical prostatectomy materials in 65.7% of patients (p<0.01). There were 40 patients in the low-risk group, however, 8 (20%) of them were identified to be intermediate-risk patients and one (2.5%) was found to be a high-risk patient after radical prostatectomy. Conclusion:Concordance between the GS of prostate biopsy and radical prostatectomy materials are important for selection of the appropriate treatment.

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Accuracy of gleason grading by practicing pathologists and the impact of education on improving agreement

Cited by 44 publications

References 22 publications

Trends in distribution and prognostic significance of Gleason grades on radical retropubic prostatectomy specimens between 1989 and 2001

Trends in distribution and prognostic significance of Gleason grades on radical retropubic prostatectomy specimens between 1989 and 2001

Puntaje de Gleason en cáncer de próstata: Correlación de la biopsia por punción y prostatectomía radical

Is There a Concordance Between the Gleason Scores of Needle Biopsy and Radical Prostatectomy Specimens in Prostatic Carsinoma?

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