A grading dilemma; Gleason scoring system: Are we sufficiently compatible? A multi center study

Dere, Yelda; Çelik, Özgür; Celi̇k, Serkan; Ekmekçi, Sümeyye; Evcim, Gozde; Pehlivan, Fatma Seher; Ağalar, Anıl Aysal; Deliktaş, Hasan; Çulhacı, Nil

doi:10.4103/ijpm.ijpm_288_18

Cited by 6 publications

(2 citation statements)

References 18 publications

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“…Since the definition of an expert panel may occur in a closed circle and is subject to several biases (e.g., social network bias, implicit bias, situational bias and geographic bias), we also compared our conclusions with the conclusions of other geographically distinct studies, as listed in Table 1 . Studies by Al Nemer et al 18 and Dere et al 19 assessed biopsy slides, revealing different levels of concordance among Western Asian pathologists on the ISUP grade group system: Al Nemer found substantial agreement, while Dere reported a moderate level. Egevad et al 20 observed a high level of consensus on the ISUP grade group among pathologists from Europe, North and South America, Eastern Asia, Australia, and New Zealand.…”

Section: Discussionmentioning

confidence: 99%

Critical evaluation of artificial intelligence as a digital twin of pathologists for prostate cancer pathology

Eminaga,

Abbas,

Kunder

et al. 2024

Sci Rep

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Prostate cancer pathology plays a crucial role in clinical management but is time-consuming. Artificial intelligence (AI) shows promise in detecting prostate cancer and grading patterns. We tested an AI-based digital twin of a pathologist, vPatho, on 2603 histological images of prostate tissue stained with hematoxylin and eosin. We analyzed various factors influencing tumor grade discordance between the vPatho system and six human pathologists. Our results demonstrated that vPatho achieved comparable performance in prostate cancer detection and tumor volume estimation, as reported in the literature. The concordance levels between vPatho and human pathologists were examined. Notably, moderate to substantial agreement was observed in identifying complementary histological features such as ductal, cribriform, nerve, blood vessel, and lymphocyte infiltration. However, concordance in tumor grading decreased when applied to prostatectomy specimens (κ = 0.44) compared to biopsy cores (κ = 0.70). Adjusting the decision threshold for the secondary Gleason pattern from 5 to 10% improved the concordance level between pathologists and vPatho for tumor grading on prostatectomy specimens (κ from 0.44 to 0.64). Potential causes of grade discordance included the vertical extent of tumors toward the prostate boundary and the proportions of slides with prostate cancer. Gleason pattern 4 was particularly associated with this population. Notably, the grade according to vPatho was not specific to any of the six pathologists involved in routine clinical grading. In conclusion, our study highlights the potential utility of AI in developing a digital twin for a pathologist. This approach can help uncover limitations in AI adoption and the practical application of the current grading system for prostate cancer pathology.

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Section: Discussionmentioning

confidence: 99%

Critical evaluation of artificial intelligence as a digital twin of pathologists for prostate cancer pathology

Eminaga,

Abbas,

Kunder

et al. 2024

Sci Rep

View full text Add to dashboard Cite

show abstract

“…However, its benefit is still controversial, especially in the older men (≥70 or 75 years) or patients with limited life expectancy (<10 years) [ 23 ]. Gleason score is also a reliable grading system for the aggressiveness for PRAD and strongly predicts the prognosis of patients with PRAD [ 24 ]. The high-grade PRAD can be defined as Gleason score sum 7 or higher [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Identification of Prognostic Biomarkers Associated with Cancer Stem Cell Features in Prostate Adenocarcinoma

Zhang

et al. 2020

Med Sci Monit

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Diagnostic significance of reassessment of prostate biopsy specimens by experienced urological pathologists at a high-volume institution

et al. 2022

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In prostate cancer, accurate diagnosis and grade group (GG) decision based on biopsy findings are essential for determining treatment strategies. Diagnosis by experienced urological pathologists is recommended; however, their contribution to patient benefits remains unknown. Therefore, we analyzed clinicopathological information to determine the significance of reassessment by experienced urological pathologists at a high-volume institution to identify factors involved in the agreement or disagreement of biopsy and surgical GGs. In total, 1325 prostate adenocarcinomas were analyzed, and the GG was changed in 452/1325 (34.1%) cases (359 cases were upgraded, and 93 cases were downgraded). We compared the highest GG based on biopsy specimens, with the final GG based on surgical specimens of 210 cases. The agreement rate between the surgical GG performed and assessed in our institute and the highest biopsy GG assessed by an outside pathologist was 34.8% (73/210); the agreement rate increased significantly to 50% (105/210) when biopsy specimens were reevaluated in our institute (chi-square test, P < 0.01). Multivariate logistic regression analysis showed that only the length of the lesion in the positive core with the highest GG in the biopsy was a significant factor for determining the agreement between biopsy GG and surgical GG, with an odds ratio of 1.136 (95% confidence interval: 1.057–1.221; P < 0.01). Thus, reassessment by experienced urological pathologists at high-volume institutions improved the agreement rate. However, it should be noted there is a high probability of discordance between a small number of lesions or short lesions and surgical GG.

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A grading dilemma; Gleason scoring system: Are we sufficiently compatible? A multi center study

Cited by 6 publications

References 18 publications

Critical evaluation of artificial intelligence as a digital twin of pathologists for prostate cancer pathology

Critical evaluation of artificial intelligence as a digital twin of pathologists for prostate cancer pathology

Identification of Prognostic Biomarkers Associated with Cancer Stem Cell Features in Prostate Adenocarcinoma

Diagnostic significance of reassessment of prostate biopsy specimens by experienced urological pathologists at a high-volume institution

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