Improving the Reproducibility of the Gleason Scores in Small Foci of Prostate Cancer - Suggestion of Diagnostic Criteria for Glandular Fusion

Helpap, B.; Kristiansen, Glen; Beer, M. Graf-de; Köllermann, Jens; Oehler, U; Pogrebniak, A; Fellbaum, C

doi:10.1007/s12253-011-9484-6

Cited by 17 publications

(19 citation statements)

References 28 publications

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“…Therefore, we have studied the interobserver reproducibility of glandular fusion (with the options yes or no) in cases of prostate carcinomas GS 6 (pattern 3 + 3) and 7 (pattern 3 + 4) by uropathologically specialized and non-specialized pathologists with the ĸ statistic method similar to other studies [17,18,28,29,30,31]. …”

Section: Resultsmentioning

confidence: 99%

“…score 6 and 7 (3 + 4) [18,22]. However, the diagnosis of low-grade (low-risk) carcinoma (GS 6) is very important for therapeutic options such as AS.…”

Section: Discussionmentioning

confidence: 99%

“…The interobserver study of reproducibility of glandular fusions combined with different GS 6 and 7 (pattern 3 + 4) was evaluated by the free marginal ĸ test according to Randolph, Brennan and Prediger. ĸ values >0.7 were regarded as adequate consensus [17,18]. …”

Section: Methodsmentioning

confidence: 99%

“…The specialities of architecture and histology of the well-known Gleason grading with the loss of glandular differentiation, glandular fusions and those of the combined histological and cytological grading have been described [5,17,18,19,20,21,22,23,24,25,26,27]. …”

Section: Methodsmentioning

confidence: 99%

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Significance of Gleason Grading of Low-Grade Carcinoma of the Prostate with Therapeutic Option of Active Surveillance

et al. 2012

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Introduction: Active surveillance needs a precise grading diagnosis of a low-grade carcinoma of the prostate (Gleason score (GS) 6) within a small organ-confined tumor. However, how accurate is the gold standard of GS 6 in predicting a small pT2 carcinoma? To answer this question, we have analyzed grading systems in this study. Methods: Prostatic carcinomas in biopsy and corresponding radical prostatectomy (RP) specimens of 960 patients were graded by the Gleason system in which glandular fusions and nucleolar stage (prominence and location) were considered. Results: Using the modified Gleason grading, a high upgrading rate from the biopsy to RP specimens (GS 6–7) and in even 30% a non-organ-confined growth pattern (pT3) of GS 6 carcinoma in RP was found. When considering glandular fusion and the incorporation of the state of nucleoli within the Gleason grading, the agreement of score 6 between biopsy and RP specimens as well as the prediction of a pT2a tumor increased from about 80 to 90%. Conclusion: The combination of Gleason grading and grading of the nuclear and nucleolar features may help to identify patients eligible for active surveillance.

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Section: Resultsmentioning

confidence: 99%

“…score 6 and 7 (3 + 4) [18,22]. However, the diagnosis of low-grade (low-risk) carcinoma (GS 6) is very important for therapeutic options such as AS.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Significance of Gleason Grading of Low-Grade Carcinoma of the Prostate with Therapeutic Option of Active Surveillance

et al. 2012

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“…The "fused glands" subpattern is relatively well defined 12 and has substantial to excellent interobserver agreement. 13 Practically all cribriform glands are now considered GP4. 5 The GP4 "poorly formed glands" subpattern, however, suffers definitional ambiguity.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of “Poorly Formed Glands” Gleason Pattern 4 Prostatic Adenocarcinoma on Needle Biopsy

Zhou

Liu

et al. 2015

American Journal of Surgical Pathology

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Accurate recognition of Gleason pattern (GP) 4 prostate carcinoma (PCa) on needle biopsy is critical for patient management and prognostication. "Poorly formed glands" are the most common GP4 subpattern. We studied the diagnostic reproducibility and the quantitative threshold of grading GP4 "poorly formed glands" and the criteria to distinguish them from tangentially sectioned GP3 glands. Seventeen urologic pathologists were first queried for the definition of "poorly formed glands" using cases representing a spectrum of PCa glandular differentiation. Cancer glands with no or rare lumens, elongated compressed glands, and elongated nests were considered "poorly formed glands" by consensus. Participants then graded a second set of 23 PCa cases that potentially contained "poorly formed glands" with a fair interobserver agreement (κ = 0.34). The consensus diagnoses, defined as agreement by > 70% participants, were then correlated with the quantitative (≤ 5, 6 to 10, >10) and topographic features of poorly formed glands (clustered, immediately adjacent to, and intermixed with other well-formed PCa glands) in each case. Poorly formed glands immediately adjacent to other well-formed glands regardless of their number and small foci of ≤ 5 poorly formed glands regardless of their location were not graded as GP4. In contrast, large foci of >10 poorly formed glands that were not immediately adjacent to well-formed glands were graded as GP4. Grading "poorly formed glands" is challenging. Some morphologic features are, however, reproducible for and against a GP4 diagnosis. This study represents an important step in standardization of grading of "poorly formed glands" based on quantitative and topographic morphologic features.

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Automated approach for estimation of grade groups for prostate cancer based on histological image feature analysis

et al. 2019

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Background: There is low reproducibility of the grade group of prostate cancer due to the intra-and interobserver variability among pathologists. This study aimed to develop an automated approach for estimating prostate cancer grade groups based on features obtained from histological image analysis. Methods: Fifty-nine patients who underwent radical prostatectomy were selected under the approval of the institutional review board of our university hospital. For estimation, we followed the grade group criteria provided by the International Society of Urological Pathology in 2014. One hundred eight specimen slides obtained from the patients were digitized to extract 110 regions of interest (RO I) from hematoxylin and eosin stained histological images using a digital whole slide scanner at 20× magnification with pixel size of 0.4 μm. Each color pixel value in the ROI was decomposed into six intensities corresponding to the RGB (red, green, and blue) and HSV (hue, saturation, and value) color models. Image features were extracted by histological image analysis, obtaining 54 features from the ROI based on histogram and texture analyses in the six types of decomposed histological images. Then, 40 representative features were selected from the 324 histological image features based on statistically significant differences (p < 0.05) between the mean image feature values for high (≥ 3, Gleason score ≥ 4 + 3) and low (≤ 2, Gleason score ≤ 3 + 4) grade groups. The relationship between grade groups and the most representative image feature (i.e., complexity) was approximated using regression to estimate real-number grade groups defined by continuous numerical grading. Finally, the grade groups were expressed as the conventional grade groups (i.e., integers from 1 to 5) using a piecewise step function. Results: The grade groups were correctly estimated by the proposed approach without errors on training (70 ROIs) and validation (40 ROIs) data Conclusions: Our results suggest that the proposed approach may support pathologists during evaluation of grade groups for prostate cancer, thus mitigating intra-and inter-observer variability.

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Improving the Reproducibility of the Gleason Scores in Small Foci of Prostate Cancer - Suggestion of Diagnostic Criteria for Glandular Fusion

Cited by 17 publications

References 28 publications

Significance of Gleason Grading of Low-Grade Carcinoma of the Prostate with Therapeutic Option of Active Surveillance

Significance of Gleason Grading of Low-Grade Carcinoma of the Prostate with Therapeutic Option of Active Surveillance

Diagnosis of “Poorly Formed Glands” Gleason Pattern 4 Prostatic Adenocarcinoma on Needle Biopsy

Automated approach for estimation of grade groups for prostate cancer based on histological image feature analysis

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