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Accuracy of Grading Gleason Score 7 Prostatic Adenocarcinoma on Needle Biopsy: Influence of Percent Pattern 4 and Other Histological Factors
Author(s) -
Meliti Abdelrazak,
Sadimin Evita,
Diolombi Mario,
Khani Francesca,
Epstein Jonathan I.
Publication year - 2017
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.23314
Subject(s) - medicine , grading (engineering) , prostate cancer , cribriform , biopsy , prostate , prostatic adenocarcinoma , adenocarcinoma , prostatectomy , cancer , radiology , carcinoma , urology , pathology , civil engineering , engineering
BACKGROUND Recognition of Gleason pattern 4 in prostatic needle biopsies is crucial for both prognosis and therapy. Recently, it has been recommended to record percent pattern 4 when Gleason score 7 cancer is the highest grade in a case. METHODS Four hundred and five prostate needle core biopsies received for a second opinion at our institution from February–June, 2015 were prospectively diagnosed with prostatic adenocarcinoma Gleason score 7 as the highest score on review by a consultant urological pathologist. Percentage of core involvement by cancer, percentage of Gleason pattern 4 per core, distribution of Gleason pattern 4 (clustered, scattered), morphology of pattern 4 (cribriform, non‐cribriform), and whether the cancer was continuous or discontinuous were recorded. RESULTS Better agreement was noted between the consultant and referring pathologists when pattern 4 was clustered as opposed to dispersed in biopsies ( P = 0.009). The percentage of core involvement by cancer, morphology of pattern 4, and continuity of cancer did not affect the agreement between the consultant and referring pathologists. There was a trend ( P = 0.06) for better agreement based on the percent of pattern 4. CONCLUSIONS When pattern 4 is scattered amongst pattern 3 as opposed to being discrete foci, there is less interobserver reproducibility in grading Gleason score 7 cancer, and in this setting pathologists should consider obtaining second opinions either internally within their group or externally. Prostate 77: 681–685, 2017 . © 2017 Wiley Periodicals, Inc.