Histopathological re-evaluations of biopsies in prostate cancer: a nationwide observational study

Santvoort, B W H van; Leenders, Geert J.L.H. van; Kiemeney, Lambertus A.; Oort, Inge M. van; Wieringa, S E; Jansen, Hanneke; Vernooij, Robin W.M.; Kaa, Christina A. Hulsbergen‐van de; Aben, Katja K.H.

doi:10.1080/21681805.2020.1806354

Cited by 3 publications

(6 citation statements)

References 33 publications

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“…Previous studies have already established interobserver variability in prostate cancer grading [7,8,10,12]. Allsbrook et al found a moderate kappa of 0.435 for the Gleason grading system, and Ozkan et al established considerable interobserver variability after the ISUP 2014 alterations (concordance of 51.7% and kappa = 0.39 for ISUP Grade) [7,10,12].…”

Section: Discussionmentioning

confidence: 99%

“…Santvoort et al studied all revised pathology reports in The Netherlands from October 2015 until April 2016. They found that 25% of reports were up-or downgraded on revision, but the number of patients with re-evaluations was low (172 versus 5042 cases without re-evaluation, 3% and 97%, respectively) [8].…”

Section: Discussionmentioning

confidence: 99%

“…It is therefore likely that grading variation has had a serious impact on treatment choice and thereby perhaps patient outcome. Van Santvoort et al suggested that for one out of eight patients with localized PCa, grade re-evaluation might change treatment strategy [8]. No recommendations currently exist in the Dutch and EAU guidelines regarding grading re-evaluations.…”

Section: Discussionmentioning

confidence: 99%

“…Accuracy, consistency, and reproducibility in PCa grading by pathologists are essential for identifying patients who can benefit from active treatment or adjuvant oncological systemic therapy. Considerable interobserver variation has already been shown in smaller studies [7][8][9][10][11][12]. However, most did not reflect real-life grading in daily clinical practice.…”

Section: Introductionmentioning

confidence: 96%

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Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands

Flach

Willemse

Suelmann

et al. 2021

Cancers

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Purpose: Our aim was to analyze grading variation between pathology laboratories and between pathologists within individual laboratories using nationwide real-life data. Methods: We retrieved synoptic (n = 13,397) and narrative (n = 29,377) needle biopsy reports from the Dutch Pathology Registry and prostate-specific antigen values from The Netherlands Cancer Registration for prostate cancer patients diagnosed between January 2017 and December 2019. We determined laboratory-specific proportions per histologic grade and unadjusted odds ratios (ORs) for International Society of Urological Pathologists Grades 1 vs. 2–5 for 40 laboratories due to treatment implications for higher grades. Pathologist-specific proportions were determined for 21 laboratories that consented to this part of analysis. The synoptic reports of 21 laboratories were used for analysis of case-mix correction for PSA, age, year of diagnosis, number of biopsies and positive cores. Results: A total of 38,321 reports of 35,258 patients were included. Grade 1 ranged between 19.7% and 44.3% per laboratory (national mean = 34.1%). Out of 40 laboratories, 22 (55%) reported a significantly deviant OR, ranging from 0.48 (95% confidence interval (CI) 0.39–0.59) to 1.54 (CI 1.22–1.93). Case-mix correction was performed for 10,294 reports, altering the status of 3/21 (14%) laboratories, but increasing the observed variation (20.8% vs. 17.7%). Within 15/21 (71%) of laboratories, significant inter-pathologist variation existed. Conclusion: Substantial variation in prostate cancer grading was observed between and within Dutch pathology laboratories. Case-mix correction did not explain the variation. Better standardization of prostate cancer grading is warranted to optimize and harmonize treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands

Flach

Willemse

Suelmann

et al. 2021

Cancers

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“…In Dutch PCa practice, re-evaluations are rarely performed, as only 1262 reports (<4% of all reports, data not shown) were marked as a re-evaluation report. This has not improved after 2015–2016, as in the ProZIB cohort, 3% of all patients with PCa received a re-evaluation 28. Especially for patients for whom grade could be the determining factor, a re-evaluation could have implications for both treatment strategy and patient outcome.…”

Section: Discussionmentioning

confidence: 99%

Interlaboratory Gleason grading variation affects treatment: a Dutch historic cohort study in 30 509 patients with prostate cancer

et al. 2022

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AimSubstantial variation in Gleason grading (GG) of prostate cancer (PCa) exists between Dutch pathology laboratories. This study investigates its impact on treatment strategies.MethodsPathology reports of prostate needle biopsies and clinical data of patients with PCa diagnosed between 2017 and 2019 were retrieved from the Dutch nationwide network and registry of histopathology and cytopathology and The Netherlands Cancer Registry. We investigated the impact of grading variation on treatment strategy for patients whose grade was decisive in treatment choice. First, we evaluated the effect of grading practice (low, average or high grading) on active treatment (AT) versus active surveillance in patients with prostate-specific antigen (PSA) <10 ng/mL and cT1c/cT2a disease. Second, we assessed the association of grading practice with performance of pelvic lymph node dissection (PLND) in patients with PSA 10–20 ng/mL or cT2b disease. We used multivariable logistic regression to analyse the relation between laboratories’ grading practices and AT or PLND.ResultsWe included 30 509 patients. GG was decisive in treatment strategy for 11 925 patients (39%). AT was performed significantly less often in patients diagnosed by laboratories that graded lower than average (OR=0.77, 95% CI 0.68 to 0.88). Conversely, patients received AT significantly more often when diagnosed in high-grading laboratories versus average-grading laboratories (OR=1.21, 95% CI 1.03 to1.43). PLND was performed significantly less often in patients diagnosed by low-grading versus average-grading laboratories (OR=0.66, 95% CI 0.48 to 0.90).ConclusionOur study shows that the odds that a patient undergoes AT or PLND, depends on laboratories’ grading practices in a substantial number of patients. This likely influences patient prognosis and outcome, necessitating standardisation of GG to prevent suboptimal patient outcome.

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Diagnostic concordance between traditional and digital workflows. A study on 1427 prostate biopsies

Torresani,

Gentilini,

Grassi

et al. 2023

Pathologica

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Summary Objective To evaluate intra-observer diagnostic reproducibility using traditional slides (TS) versus whole slide images (WSI). Methods TS and WSI of 1427 prostatic biopsies (107 consecutive patients) were evaluated by a single pathologist. Agreement between readings was evaluated with Gwet’s Agreement coefficient (AC) and Landis and Koch benchmark scale. Results The positive/negative agreement between the readings was almost perfect (0.962 AC, 0.949-0.974 95% CI), with method independent distribution of discrepancies. Among positive biopsies, 212 had identical Gleason score (GS) on TS and WSI and discordant GS in 69 cases (AC = 0.932 (0.907-0.956 95% CI). Concordant negative and positive patient classification was observed in 39 and 64 cases, respectively. Two cases were assigned to the positive group on TS and 2 on WSI. Gwet’s AC, was 0.929 (0.860-0.998 95% CI), i.e.: almost perfect agreement. ISUP Grade group (ISUP GG) agreement was evaluated in the 60 concordantly positive cases: in 45 cases it was identical on TS and WSI; in 10 biopsies the discrepancy implied a modification of the assigned ISUP GG of ≤ 1 class and in 5 the discrepancy implied a modification of 2 classes. Gwet’s agreement coefficient was 0.898 (0.834-0.962 95% CI), i. e.: almost perfect agreement. Conclusions Our data show almost perfect agreement between digital and traditional diagnostic activity in a routine setting, confirming that digital pathology can be safely introduced into routine workflows.

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Histopathological re-evaluations of biopsies in prostate cancer: a nationwide observational study

Cited by 3 publications

References 33 publications

Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands

Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands

Interlaboratory Gleason grading variation affects treatment: a Dutch historic cohort study in 30 509 patients with prostate cancer

Diagnostic concordance between traditional and digital workflows. A study on 1427 prostate biopsies

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