The importance of histopathologic review of biopsies in patients with prostate cancer referred to a tertiary uro - oncology center

Abstract

Introduction: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a “second opinion” to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post - surgical histopathology. Material and methods: Retrospective study based on chart review of patients with PC that attended the Uro - oncology Department of Hospital das Clínicas - UNICAMP - Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis's Kappa concordance coefficient. Results: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post - surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041). Conclusion: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post - surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.

Digital Biopsy with Fluorescence Confocal Microscope for Effective Real-time Diagnosis of Prostate Cancer: A Prospective, Comparative Study

“…The ISUP 2014 update aimed to improve the reproducibility of grading; however, a certain degree of interobserver variability still persists and is similar to the one described for conventional Gleason scoring [18]. This is the basis for most of the second opinion requirement, which can lead to a degree of discrepancy close to 45% (K = 0.46) [20,21].…”

Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics

“…The limitations of this study are the small sample size and that the MRI-fused biopsies were overrepresented in the present data set with 50% of all biopsies taken. Detection of fused glands in ISUP grade 2 tumors remains challenging, which leads to a high rate of discrepancies in second opinion investigations [35,36]. Therefore, a higher rate of upgrading in the final histology is to be expected if fewer biopsies are examined intraoperatively than in the present study.…”

Diagnostic Performance of Ex Vivo Fluorescence Confocal Microscopy in the Assessment of Diagnostic Biopsies of the Prostate

“…While the first pattern usually causes little difficulty, detection of small foci of fused or poorly formed glands remains challenging and places high demands on the technical processing of the specimens and on the experience of the pathologists [24]. This is the basis for most of the second opinion requirement, which can lead to a degree of discrepancy close to 45% (K = 0.46) [25]. Although further training effects are to be expected for the FCM, it can be estimated that there remains a proportion of cases in which focal GLEASON 4 patterns within well differentiated carcinoma are not detected in the scans and only be diagnosed in downstream conventional histology.…”