Gleason score on biopsy: is it reliable for predicting the final grade on pathology?

Abstract

Objective To assess the correlation of the Gleason score on biopsy and the final pathology after radical prostatectomy (RP) for prostate adenocarcinoma. Patients and methods In a retrospective analysis within a tertiary-care centre, the charts of 537 patients who had undergone radical prostatectomy from April 1989 to November 2000 were reviewed. The RPs were undertaken in one institution; 167 biopsies were taken and interpreted in the referring centres, and 355 were taken and interpreted in the authors' institution by up to 15 pathologists. All the final pathology specimens were interpreted by the same group of pathologists. The main outcome measures were: the pathological report of the biopsy including the primary and secondary Gleason grade; the final pathological grade (primary and secondary); the margin status; and the identification of the pathologist for the biopsy and final pathology. Results In all, 390 patients had inclusion criteria (the Gleason grade before and after RP) available. For the individual scores 38.2% of tumours were undergraded, 32.6% overgraded and only 29.2% had identical grading in preoperative biopsies and final specimens. When grouped into more meaningful categories (Gleason 2-4, 5-6, 7 and 8-10) the correlation improved, with 48.5% of patients remaining in the same group after RP. For 39 patients the same pathologist assessed the biopsy and final specimen; in these cases individual scores were identical in 49% and group scores were identical in 64%. Conclusion Gleason grading of the prostate biopsy remains a poor predictor of pathological outcome. Assessment by the same pathologist reduces the discrepancy but over half the patients are under-or overgraded on final pathology. Clinicians should be aware of these limitations when using the biopsy Gleason grade in decision making.

FTIR-based spectroscopic analysis in the identification of clinically aggressive prostate cancer

“…Gleason grading of CaP biopsies is subject to both intra-and interobserver variability, which reduces any prognostic value arising from the grading system (Latouf and Saad, 2002). Fourier transform infrared vibrational spectroscopy determines the chemical profile of a specimen by measuring the entire chemical spectrum by means of absorbance of specific wavenumbers of IR light, which relate to specific chemical bonds.…”

“…To reduce the variability in Gleason grades between specimens, we graded our specimens using a single histopathologist to assign Gleason scores to CaP tissue sections. Latouf and Saad (2002) reported that there was only 29.2% agreement in the assignment of Gleason score to biopsy and radical prostatectomy samples when assessment was made by multiple pathologists. However, the same study showed that when samples were assessed by a single pathologist, the agreement rose to 48.7%.…”

“…In particular, there are many theoretically low-grade/'low-biopotential' tumours, which show evidence of progression and in addition, there is considerable inter-and intra-observer error in the assignation of the final tumour grade. In a study of 390 patients, identical grades were assigned to only 29.2% of tumours (Latouf and Saad, 2002), and a UK-based study using 81 CaP slides found that on first readings the consensus score was only 78% .…”

Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

“…1-3 TRUSbiopsy can lead to inaccurate grading of 32% to 42% of cancers, [4][5][6] and may fail to detect 30% to 50% of cancers, particularly tumours in the anterior portion of the prostate. [7][8][9][10][11][12] The improvement in multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer has led to its recommendation in high-risk patients following a negative TRUS biopsy.…”

Effect of substrate choice and tissue type on tissue preparation for spectral histopathology by Raman microspectroscopy

“…For CaP this is called the Gleason grading system and in a study of 390 patients identical grades were assigned to only 29.2% of the tumours by different histopathologists 5 . Pathological discrepancies are reported to occur in up to 43% of specimens assessed via histopathology 6 .…”