Gleason score assignment is the sole responsibility of the pathologist

Varma, Murali; Berney, Daniel M.; Oxley, Jon; Trpkov, Kiril

doi:10.1111/his.13472

Cited by 14 publications

(9 citation statements)

References 11 publications

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“…Finally, even when pathologists agree on the grade, they may report the Gleason score differently. For example, when cores show different Gleason scores, contemporary practice varies with either the overall (global) or worst Gleason score recorded for each biopsy series [7, 23, 24].…”

Section: Discussionmentioning

confidence: 99%

Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry

et al. 2019

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Background Accurate grading at the time of diagnosis if fundamental to risk stratification and treatment decision making in patients with prostate cancer. Whilst previous studies have demonstrated significant pathological upgrading and downgrading following radical prostatectomy (RP), these were based on historical cohorts and do not reflect contemporary patient selection and management practices. The aim of this national, multicentre observational study was to characterise contemporary rates and risk factors for pathological upgrading after RP in the United Kingdom (UK). Methods All RP entries on the British Association of Urological Surgeons (BAUS) Radical Prostatectomy Registry database of prospectively entered cases undertaken between January 2011 and December 2016 were extracted. Those patients with full preoperative PSA, clinical stage, needle biopsy and subsequent RP pathological grade information were included. Upgrade was defined as any increase in Gleason grade from initial needle biopsy to pathological assessment of the entire surgical specimen. Statistical analysis and multivariate logistic regression were undertaken using R version 3.5 (R Foundation for Statistical Computing, Vienna, Austria). Results A total of 17,598 patients met full inclusion criteria. Absolute concordance between initial biopsy and pathological grade was 58.9% (n = 10,364), whilst upgrade and downgrade rates were 25.5% (n = 4489) and 15.6% (n = 2745) respectively. Upgrade rate was highest in those with D’Amico low risk compared with intermediate and high-risk disease (55.7% versus 19.1 and 24.3% respectively, P < 0.001). Although rates varied between year of surgery and geographical regions, these differences were not significant after adjusting for other preoperative diagnostic variables using multivariate logistic regression. Conclusions Pathological upgrading after RP in the UK is lower than expected when compared with other large contemporary series, despite operating on a generally higher risk patient cohort. As new diagnostic techniques that may reduce rates of pathological upgrading become more widely utilised, this study provides an important benchmark against which to measure future performance.

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Section: Discussionmentioning

confidence: 99%

Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry

et al. 2019

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“…The methodology to be used for providing a percentage of HG disease is contentious. The use of an overall or worst GS has previously been extensively debated in the literature . There is great variability in how GS is assigned in different centres and how it is interpreted by clinicians .…”

Section: Discussionmentioning

confidence: 99%

“…The use of an overall or worst GS has previously been extensively debated in the literature. [19][20][21] There is great variability in how GS is assigned in different centres and how it is interpreted by clinicians. 22 Some have advocated assigning a GS to every core and giving no overall score for the case.…”

Section: Discussionmentioning

confidence: 99%

The percentage of high‐grade prostatic adenocarcinoma in prostate biopsies significantly improves on Grade Groups in the prediction of prostate cancer death

et al. 2019

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Aims It has been recommended that the percentage of high‐grade (HG) Gleason patterns 4 and 5 should be quantified in prostate cancer. However, this has not been assessed in a cohort using prostate cancer death as an outcome, and there is debate as to whether the biopsy with the ‘worst’ percentage of HG disease or an ‘overall’ percentage of HG disease should be reported. Such data may assist in active surveillance decisions. Methods and results Men with clinically localised prostate cancer diagnosed by needle biopsy from 1990 to 2003 were included. The endpoint was prostate cancer death. Clinical variables included Gleason score (GS), prostate‐specific antigen level, age, clinical stage, and disease extent. Deaths were divided into those from prostate cancer and those from other causes, according to World Health Organization criteria. Nine hundred and eighty‐eight biopsy cases were centrally reviewed according to criteria agreed at the Chicago International Society of Urological Pathology conference in 2014. Cores were given individual GSs and Grade Groups (GGs), and a percentage of each grade was given for each core. Both the worst percentage of HG disease seen in a biopsy series and overall percentage of HG disease were calculated. The overall percentage of HG disease was highly significant, with a hazard ratio of 4.45 for the interquartile range (95% confidence interval 3.30–6.01, P < 2.2 × 10−16), and was similar to the percentage of HG disease seen in the worst core. In multivariate analysis, both were highly significant. GG2 cases with ≤5% Gleason pattern 4 showed similar survival to GG1 cases. Conclusions These data validate the use of percentage of HG disease to predict prostate cancer death. As both worst and overall percentage of HG disease are powerful predictors of outcome, either could be chosen to provide prognostic information.

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“…On the other hand, if the 4+4 core shows cribriform pattern 4, while other cores show only fused or poorly formed pattern 4, then the 4+4 core is more likely to represent a separate, higher grade tumour. It has been recommended that pathologists should also determine which is the most appropriate score for the individual case and record this as the ‘bottom line’ score 8. Published literature suggests that global GS and worst GS in needle biopsies are comparable in predicting the radical prostatectomy GS 9 10.…”

Section: Discussionmentioning

confidence: 99%

Contemporary prostate biopsy reporting: insights from a survey of clinicians’ use of pathology data

et al. 2018

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AimTo determine how clinicians use data in contemporary prostate biopsy reports.MethodsA survey was circulated to members of the British Association of Urological Surgeons and the British Uro-oncology Group.ResultsResponses were received from 114 respondents (88 urologists, 26 oncologists). Ninety-seven (94%) use the number of positive cores from each side and 43 (42%) use the % number of positive cores. When determining the number and percentage of positive cores, 72 (71%) would not differentiate between targeted and non-targeted samples. If multiple Gleason Scores (GS) were included in a report, 77 (78%) would use the worst GS even if present in a core with very little tumour, 12% would use the global GS and 10% the GS in the core most involved by tumour. Fifty-five (55%) either never or rarely used perineural invasion for patient management.ConclusionsThe number of positive cores is an important parameter for patient management but may be difficult to determine in the laboratory due to core fragmentation so the biopsy taker must indicate the number of biopsies obtained. Multiple biopsies taken from a single site are often interpreted by clinicians as separate cores when determining the number of positive cores so pathologists should also report the number of sites positive. Clinicians have a non-uniform approach to the interpretation of multiple GS in prostate biopsy reports so we recommend that pathologists also include a single ‘bottom-line’ GS for each case to direct the clinician’s treatment decision.

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Gleason score assignment is the sole responsibility of the pathologist

Cited by 14 publications

References 11 publications

Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry

Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry

The percentage of high‐grade prostatic adenocarcinoma in prostate biopsies significantly improves on Grade Groups in the prediction of prostate cancer death

Contemporary prostate biopsy reporting: insights from a survey of clinicians’ use of pathology data

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