Interobserver reproducibility of Gleason grading of prostatic carcinoma: General pathologist

Allsbrook, William C.; Mangold, Kathy A.; Johnson, Maribeth H.; Lane, Roger B.; Lane, Cynthia G.; Epstein, Jonathan I.

doi:10.1053/hupa.2001.21135

Cited by 336 publications

(239 citation statements)

References 23 publications

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“…Glaessgen found a weak agreement as regards the diagnosis of the most aggressive patterns and considered that the difficulty in diagnosing them was big- ger than in determining their volume (14). The experience did not influence the agreement much because it was not higher between the more experienced observers, what contradicts some authors (15,16). Interobserver agreement of traditional Gleason score was slightly higher in the surgical specimen than in the needle biopsy.…”

Section: Commentsmentioning

confidence: 92%

“…At the end of this task, Gleason score was calculated (the sum of primary and secondary patterns) of each sextant separately (12). The score of the specimen was the highest score found among the evaluated sextants, therefore, the global score was not calculated (4,5,7,15). From the most aggressive Gleason pattern, the tertiary pattern was determined, whenever it was possible.…”

Section: Methodsmentioning

confidence: 99%

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Interobserver agreement of gleason score and modified gleason score in needle biopsy and in surgical specimen of prostate cancer

et al. 2007

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Introduction:Gleason score, which has a high interobserver variability, is used to classify prostate cancer. The most recent consensus valued the tertiary Gleason pattern and recommended its use in the final score of needle biopsies (modified Gleason score). This pattern is considered to be of high prognostic value in surgical specimens. This study emphasized the evaluation of the modified score agreement in needle biopsies and in surgical specimen, as well as the interobserver variability of this score. Materials and Methods: Three pathologists evaluated the slides of needle biopsies and surgical specimens of 110 patients, reporting primary, secondary and tertiary Gleason patterns and after that, traditional and modified Gleason scores were calculated. Kappa test (K) assessed the interobserver agreement and the agreement between the traditional and modified scores of the biopsy and of the surgical specimen. Results: Interobserver agreement in the biopsy was K = 0.36 and K = 0.35, and in the surgical specimen it was K = 0.46 and K = 0.36, for the traditional and modified scores, respectively. The tertiary Gleason grade was found in 8%, 0% and 2% of the biopsies and in 8%, 0% and 13% of the surgical specimens, according to observers 1, 2 and 3, respectively. When evaluating the agreement of the traditional and modified Gleason scores in needle biopsy with both scores of the surgical specimen, a similar agreement was found through Kappa. Conclusion:Contrary to what was expected, the modified Gleason score was not superior in the agreement between the biopsy score and the specimen, or in interobserver reproducibility, in this study.

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Section: Commentsmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Interobserver agreement of gleason score and modified gleason score in needle biopsy and in surgical specimen of prostate cancer

et al. 2007

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“…The Gleason scoring system is the most widely used method for grading prostate cancer and is one of the most important predictors of tumor behavior. 7,8 Heterogeneity of prostate cancer within and between separate tumor foci with respect to the Gleason pattern is well appreciated. 9 This heterogeneity along with sampling errors inherent in needle biopsies limits the accuracy of risk stratification, resulting in potential under-or overtreatment.…”

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confidence: 99%

PTEN losses exhibit heterogeneity in multifocal prostatic adenocarcinoma and are associated with higher Gleason grade

et al. 2013

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Prostatic adenocarcinoma is an epithelial malignancy characterized by marked histological heterogeneity. It most often has a multifocal distribution within the gland, and different Gleason grades may be present within different foci. Data from our group and others have shown that the genomic deletion of the phosphatase and tensin homolog deleted on chromosome 10 (PTEN) tumor suppressor gene and the disruption of the ETS gene family have a central role in prostate cancer and are likely to be associated with Gleason grade. In this study, prostate cancer samples were systematically analyzed to determine whether there was concordance between PTEN losses and TMPRSS2-ERG fusion rearrangements, within or between foci in multifocal disease, using well-annotated tissue microarrays (TMAs) consisting of 724 cores derived from 142 radical prostatectomy specimens. Three-color fluorescence in situ hybridization analysis of both the PTEN deletion and the TMPRSS2-ERG fusion was used to precisely map genetic heterogeneity, both within and between tumor foci represented on the TMA. PTEN deletion was observed in 56 of 134 (42%) patients (hemizygous ¼ 42 and homozygous ¼ 14). TMPRSS2-ERG fusion was observed in 63 of 139 (45%) patients. When analyzed by Gleason pattern for a given TMA core, PTEN deletions were significantly associated with Gleason grades 4 or 5 over grade 3 (Po0.001). Although TMPRSS2-ERG fusions showed a strong relationship with PTEN deletions (P ¼ 0.007), TMPRSS2-ERG fusions did not show correlation with Gleason grade. The pattern of genetic heterogeneity of PTEN deletion was more diverse than that observed for TMPRSS2-ERG fusions in multifocal disease. However, the marked interfocal discordance for both TMPRSS2-ERG fusions and PTEN deletions was consistent with the concept that multiple foci of prostate cancer arise independently within the same prostate, and that individual tumor foci can have distinct patterns of genetic rearrangements.

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“…21 However, this system does have limitations. For example, the inter and intraobserver reproducibility varies among pathologists 22,23 and the correlation between Gleason scores from biopsy and prostatectomy has been questioned in some previous studies. Exact concordance was found in 28% to 74% of the specimens from prostatectomy, while the biopsies undergraded the prostatectomy score in 24 to 60% and overgraded in 5 to 32% [8][9][10][11][12][13][14][15][16][17][18][19] of the cases (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…24 Prostate cancer has high morphological heterogeneity: over half of prostatectomy specimens contain cancer of at least three different Gleason grades, and cancer of a single grade is present in only 10-16% of specimens. [19][20][21][22][23][24] Therefore, lack of representativeness is evi-dently a potential problem in prostate biopsy grading. Some of the discordance between biopsies also arises from intra and interobserver variability, as we mentioned before.…”

Section: Discussionmentioning

confidence: 99%

Well-differentiated prostate cancer in core biopsy specimens may be associated with extraprostatic disease

2008

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CONTEXT AND OBJECTIVE: Accurate determination of the Gleason score in prostate core biopsy specimens is crucial in selecting the type of prostate cancer treatment, especially for patients with well-differentiated tumors (Gleason score 2 to 4). For such patients, an inaccurate biopsy score may result in a therapeutic intervention that is too conservative. We evaluate the role of Gleason score 2-4 in prostate core-needle biopsies for predicting the final pathological staging following radical prostatectomy. DESIGN AND SETTING: Retrospective study at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: We analyzed the medical records of 120 consecutive patients who underwent radical retropubic prostatectomy to treat clinical localized prostate cancer at our institution between December 2001 and July 2006. Thirty-two of these patients presented well-differentiated tumors (Gleason score 2 to 4) in biopsy specimens and were included in the study. The Gleason scores of the core-needle biopsies were compared with the pathological staging of the surgical specimens. RESULTS: Sixteen of the 32 patients (50%) presented moderately differentiated tumors (Gleason score 5 to 7) in surgical specimens. Eighteen patients (56%) had tumors with involvement of the prostate capsule and ten (31%) had involvement of adjacent organs. Evaluating the 16 patients that maintained Gleason scores of 2 to 4 in the pathological staging of the surgical specimens, 11 (68.7%) had focal invasion of the prostate capsule and five (31.25%) had organ-confined disease. CONCLUSION: Well-differentiated tumors (Gleason score 2 to 4) seen in biopsies are not predictive of organ-confined disease.

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Interobserver reproducibility of Gleason grading of prostatic carcinoma: General pathologist

Cited by 336 publications

References 23 publications

Interobserver agreement of gleason score and modified gleason score in needle biopsy and in surgical specimen of prostate cancer

Interobserver agreement of gleason score and modified gleason score in needle biopsy and in surgical specimen of prostate cancer

PTEN losses exhibit heterogeneity in multifocal prostatic adenocarcinoma and are associated with higher Gleason grade

Well-differentiated prostate cancer in core biopsy specimens may be associated with extraprostatic disease

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