The potential impact of reproducibility of gleason grading in men with early stage prostate cancer managed by active surveillance: A multi-institutional study

Jesse K. McKenney, Jeff Simko, Michael Bonham, Lawrence D. True, Dean Troyer, Sarah Hawley, Lisa F. Newcomb, Ladan Fazli, Lakshmi P. Kunju, Marlo M. Nicolas, Funda Vakar-Lopez, Xiaotun Zhang, Peter R. Carroll, James D. Brooks

Research output: Contribution to journalArticlepeer-review

68 Scopus citations

Abstract

Purpose: We evaluated the reproducibility of Gleason grading as relevant to the clinical treatment of men on active surveillance. Materials and Methods: Three sets of digital images of prostatic adenocarcinoma in biopsies were reviewed and assigned Gleason scores by a total of 11 pathologists from 7 institutions. Interobserver and intra-observer reproducibility were assessed for assignment of the highest Gleason pattern (3 vs 4 or higher). We also identified 97 consecutive patients on active surveillance. Prostate biopsy glass slides from 82 of the patients were available for re-review and the frequency of carcinoma requiring the distinction of tangentially sectioned Gleason pattern 3 from 4 was determined. Results: Interobserver reproducibility for classic Gleason patterns was substantial (Light's κ 0.76). Interobserver reproducibility for the histological distinction of tangentially sectioned Gleason pattern 3 from Gleason pattern 4 was only fair (Light's κ 0.27). Intra-observer reproducibility ranged from 65% to 100% (mean 81.5%). Of the 82 patients on active surveillance 61 had carcinoma and 15 (24.5%) had a set of biopsies with at least 1 focus in which the distinction between tangentially sectioned Gleason pattern 3 and poorly formed pattern 4 glands had to be considered. Conclusions: The reproducibility of grading classic Gleason patterns is high. However, variability in grading occurred when distinguishing between tangentially sectioned pattern 3 glands and the poorly formed gland subset of pattern 4. Developing universally accepted histological and/or molecular criteria to distinguish these patterns and subsequently characterizing their natural history would be useful when treating patients on active surveillance.

Original languageEnglish (US)
Pages (from-to)465-469
Number of pages5
JournalJournal of Urology
Volume186
Issue number2
DOIs
StatePublished - Aug 2011

Keywords

  • adenocarcinoma
  • biopsy
  • pathology
  • prostate
  • reproducibility of results

ASJC Scopus subject areas

  • Urology

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