Interobserver Reproducibility of Percent Gleason Grade 4/5 in Prostate Biopsies

Glaessgen, Axel; Hamberg, Hans; Pihl, Carl‐Gustaf; Sundelin, Birgitta; Nilsson, Bo; Egevad, Lars

doi:10.1097/01.ju.0000108198.98598.00

Cited by 34 publications

(20 citation statements)

References 14 publications

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“…We have previously shown that interobserver reproducibility of percentage Gleason grade 4/5 in prostatectomy specimens and needle biopsies is at least as good as that of the GS [11,12]. In the present study, according to kappa analysis, interobserver reproducibility of mGS in prostatectomy specimens was at least as good as that of the GS.…”

Section: Discussionsupporting

confidence: 42%

“…Several studies on interobserver variability of Gleason grading have been published [3,4,7,16], and, recently, we have shown that reproducibility of percentage Gleason grade 4/5 in prostatectomy specimens and prostate needle biopsies is at least as good as that of the GS [11,12]. However, to our knowledge, reproducibility of the mGS has not been reported previously.…”

Section: Introductionmentioning

confidence: 61%

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Interobserver reproducibility of modified Gleason score in radical prostatectomy specimens

et al. 2003

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The Gleason score (GS) of prostate cancer is calculated by adding primary and secondary Gleason grades with patterns occupying less than 5% of the tumour often not included despite their probable prognostic significance. A modified Gleason score (mGS) comprising primary and tertiary patterns of higher grade has been proposed, but its interobserver variability has yet to be elucidated. Slides from 69 consecutive prostatectomy specimens were circulated among four genitourinary pathologists. GS and mGS were assessed, and results were compared in pairs. Mean weighted kappa for GS and mGS were 0.56 (range 0.52-0.66) and 0.58 (range 0.49-0.74), respectively. The difference between GS and mGS was 0, 1 and 2 score units in 66%, 26% and 8%, respectively, mean 0.41 score units (range 0.24-0.51). The increment was greater for transition-zone tumours than for peripheral-zone tumours (0.63 and 0.35 score units, respectively, P=0.002). An odd mGS (5, 7 or 9) was more often given than an odd GS (77% and 62%, respectively, P<0.001). Disagreement between observers greater than 1 score unit was more common with mGS than GS (18% and 4%, respectively, P<0.001). In conclusion, overall mean weighted kappa for interobserver reproducibility of mGS is at least as high as that of GS. However, there is a clustering of mGS in odd scores, and severe disagreement is more commonly observed than with GS. Training of mGS assessment would possibly improve agreement. Tertiary Gleason patterns need to be better defined.

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Section: Discussionsupporting

confidence: 42%

Section: Introductionmentioning

confidence: 61%

Interobserver reproducibility of modified Gleason score in radical prostatectomy specimens

et al. 2003

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“…On the other hand, the subjective estimation of %GP 4/5 has been shown to be at least as reproducible as that of the GS. In an interobserver reproducibility study, 4 observers had a mean weighted kappa for biopsy GS and %GP 4/5 of 0.48 to 0.55 (overall mean 0.51) and 0.52 to 0.68 (overall mean 0.60), respectively [17]. However, it was found that we subjectively over estimate %GP 4/5 as compared to computerized calculation of the percentage.…”

Section: Discussionmentioning

confidence: 69%

Interactive digital slides with heat maps: a novel method to improve the reproducibility of Gleason grading

et al. 2011

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Our aims were to analyze reporting of Gleason pattern (GP) 3 and 4 prostate cancer with the ISUP 2005 Gleason grading and to collect consensus cases for standardization. We scanned 25 prostate biopsy cores diagnosed as Gleason score (GS) 6-7. Fifteen genitourinary pathologists graded the digital slides and circled GP 4 and 5 in a slide viewer. Grading difficulty was scored as 1-3. GP 4 components were classified as Type 1 (cribriform), 2 (fused) or 3 (poorly formed glands). A GS 5-6, 7 (3+4), 7 (4+3), 8-9 was given in 29%, 41%, 19% and 10% (mean GS 6.84,). In 15 cases, at least 67% of observers agreed on GS groups (consensus cases). Mean interobserver weighted kappa for GS groups was 0.43.Mean difficulty scores in consensus and non-consensus cases were 1.44 and 1.66 (p = 0.003).Pattern 4 Types 1, 2 and 3 were seen in 28%, 86% and 67% of GP 4. All three co-existed in 16% (11% and 23% in consensus and non-consensus cases, p = 0.03). Average estimated and calculated %GP 4/5 were 29% and 16%. After individual review, the experts met to analyze diagnostic difficulties. Areas of GP 4 and 5 were displayed as heat maps, which were helpful for identifying contentious areas. A key problem was to agree on minimal criteria for small foci of GP 4. In summary, the detection threshold for GP 4 in NBX needs to be better defined.This set of consensus cases may be useful for standardization.

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“…In many studies that have been conducted subsequently, the presence of a tertiary pattern has been found to be associated with poor histopathological results and increased PSA recurrence. [11] Modified Gleason score (mGS) is a scoring system that is defined by taking into consideration the primary and high-grade tertiary pattern. [9][10][11][12][13] Recently some, modifications to the prostatic adenocarcinoma grading system have been proposed, and the presence of a high tertiary component (Gleason pattern 4 or 5) is reported to be correlated with the pathological stage and progression rates.…”

Section: Introductionmentioning

confidence: 99%

“…[11] Modified Gleason score (mGS) is a scoring system that is defined by taking into consideration the primary and high-grade tertiary pattern. [9][10][11][12][13] Recently some, modifications to the prostatic adenocarcinoma grading system have been proposed, and the presence of a high tertiary component (Gleason pattern 4 or 5) is reported to be correlated with the pathological stage and progression rates. [3,6] In addition, it is known that the heterogeneity of the histomorphological image of the carcinoma of the prostate can cause inconsistency between the scores of prostate needle biopsy and radical prostatectomy materials.…”

Section: Introductionmentioning

confidence: 99%

The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

Sönmez¹,

Haliloğlu²,

Demirelli³

et al. 2012

Turkish Journal of Urology

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ÖZETAmaç: Bu çalışmada amaç, radikal prostatektomi (RP) spesmenlerinde yüksek tersiyer patern bulunması-nın histopatolojik sonuçlar ve PSA progresyonu üzerine etkisini değerlendirmektir. Gereç ve yöntemler:Çalışmada kliniğimizde ocak 2007-ocak 2011 tarihleri arasında klinik lokalize prostat kanseri tanısı ile radikal prostatektomi operasyonu uygulanmış ve günümüze kadar takibe düzenli olarak gelmiş olan, gleason skoru 5-8 (5 ve 8 dahil) olan, 71 hastanın spesmenleri tek patolog tarafından tekrar incelenmiştir. Hastalar yüksek tersiyer gleason patern (gleason 4 veya 5) bulunması açısından değerlendi-rildi. Tersiyer paternin bulunmasının histopatolojik sonuçlar ve PSA progresyonu üzerine etkisi araştırıldı. Hastalar ilk iki yıl 3 ayda bir, sonraki 2 yıl 6 ayda 1, sonrasında yılda bir serbest ve total PSA ölçümü ve dijital rektal muayene yapılarak takip edildi. PSA progresyonu serum total PSA değerinin 0.2 ng/mL ve ABSTRACT Objective: The aim of this study was to analyze the effect of a high-grade tertiary pattern in radical prostatectomy (RP) specimens on the histopathological results and PSA progression. Material and methods:In this study, specimens from 71 patients with clinically localized prostate cancer who underwent RP between January 2007 and January 2011 in our department, who regularly attended their follow-up visits and who had a Gleason score of 5-8 (5 and 8 included) were reanalyzed by a single pathologist. The patients were evaluated for the presence of a high-grade tertiary Gleason pattern (Gleason 4 or 5). We investigated the effect of the tertiary pattern on the histopathological results and PSA progression. The patients were followed with testing for the free and total levels of PSA and given a digital rectal examination quarterly for the first two years, semiannually for the next 2 years, and annually for the remaining period. An increase in the serum total PSA count of 0.2 ng/mL or more was considered to represent PSA progression. The statistical analysis in this study was performed with SPSS for Windows Version 15.0 (Inc., Chicago, IL). p<0.05 was accepted as significant. Results:The incidence of a high-grade tertiary pattern in RP specimens was found to be 15.4%. The patients were categorized into groups that were positive or negative for a tertiary pattern. When compared with the other group, the tertiary pattern positive group had higher preoperative PSA levels (p= 0.469), more frequent extracapsular extension (p= 0.031), more frequent lymph node (p= 0.05) and seminal vesicle invasion (p= 0.022) and more advanced disease in terms of the pathological stage (p= 0.005). The patients were followed up for an average of 36,3 months postoperatively. PSA recurrence was found to be significantly higher in the tertiary pattern positive group (p= 0.001), and the PSA progression time was shorter (p= 0.001). There was no statistically significant difference between the two groups in terms of preoperative age, clinical stage, Gleason score and surgical margin positivity. When we investigated the effects o...

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Interobserver Reproducibility of Percent Gleason Grade 4/5 in Prostate Biopsies

Cited by 34 publications

References 14 publications

Interobserver reproducibility of modified Gleason score in radical prostatectomy specimens

Interobserver reproducibility of modified Gleason score in radical prostatectomy specimens

Interactive digital slides with heat maps: a novel method to improve the reproducibility of Gleason grading

The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

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