Standardization of Gleason grading among 337 European pathologists

Lars Egevad; Amar S Ahmad; Ferran Algaba; Daniel M Berney; Liliane Boccon-Gibod; Eva Compérat; Andrew J Evans; David Griffiths; Rainer Grobholz; Glen Kristiansen; Cord Langner; Antonio Lopez-Beltran; Rodolfo Montironi; Sue Moss; Pedro Oliveira; Ben Vainer; Murali Varma; Philippe Camparo

doi:10.1111/his.12008

Standardization of Gleason grading among 337 European pathologists

Lars Egevad, Amar S Ahmad, Ferran Algaba, Daniel M Berney, Liliane Boccon-Gibod, Eva Compérat, Andrew J Evans, David Griffiths, Rainer Grobholz, Glen Kristiansen, Cord Langner, Antonio Lopez-Beltran, Rodolfo Montironi, Sue Moss, Pedro Oliveira, Ben Vainer, Murali Varma, Philippe Camparo

Nutritional Immunology

91 Citationer (Scopus)

Abstract

AIMS: The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7.

METHODS AND RESULTS: Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases (P = 0.009).

CONCLUSIONS: While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization.

Originalsprog	Engelsk
Tidsskrift	Histopathology
Vol/bind	62
Udgave nummer	2
Sider (fra-til)	247-56
Antal sider	10
ISSN	0309-0167
DOI	https://doi.org/10.1111/his.12008
Status	Udgivet - jan. 2013

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Egevad, L., Ahmad, A. S., Algaba, F., Berney, D. M., Boccon-Gibod, L., Compérat, E., Evans, A. J., Griffiths, D., Grobholz, R., Kristiansen, G., Langner, C., Lopez-Beltran, A., Montironi, R., Moss, S., Oliveira, P., Vainer, B., Varma, M., & Camparo, P. (2013). Standardization of Gleason grading among 337 European pathologists. Histopathology, 62(2), 247-56. https://doi.org/10.1111/his.12008

Egevad, L, Ahmad, AS, Algaba, F, Berney, DM, Boccon-Gibod, L, Compérat, E, Evans, AJ, Griffiths, D, Grobholz, R, Kristiansen, G, Langner, C, Lopez-Beltran, A, Montironi, R, Moss, S, Oliveira, P, Vainer, B, Varma, M & Camparo, P 2013, 'Standardization of Gleason grading among 337 European pathologists', Histopathology, bind 62, nr. 2, s. 247-56. https://doi.org/10.1111/his.12008

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title = "Standardization of Gleason grading among 337 European pathologists",

abstract = "AIMS: The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7.METHODS AND RESULTS: Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases (P = 0.009).CONCLUSIONS: While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization.",

keywords = "Adenocarcinoma, Biopsy, Consensus, Europe, Humans, Male, Neoplasm Grading, Observer Variation, Pathology, Surgical, Prostatic Neoplasms, Reproducibility of Results",

author = "Lars Egevad and Ahmad, {Amar S} and Ferran Algaba and Berney, {Daniel M} and Liliane Boccon-Gibod and Eva Comp{\'e}rat and Evans, {Andrew J} and David Griffiths and Rainer Grobholz and Glen Kristiansen and Cord Langner and Antonio Lopez-Beltran and Rodolfo Montironi and Sue Moss and Pedro Oliveira and Ben Vainer and Murali Varma and Philippe Camparo",

note = "{\textcopyright} 2012 Blackwell Publishing Limited.",

year = "2013",

month = jan,

doi = "10.1111/his.12008",

language = "English",

volume = "62",

pages = "247--56",

journal = "Histopathology",

issn = "0309-0167",

publisher = "Wiley-Blackwell",

number = "2",

}

TY - JOUR

T1 - Standardization of Gleason grading among 337 European pathologists

AU - Egevad, Lars

AU - Ahmad, Amar S

AU - Algaba, Ferran

AU - Berney, Daniel M

AU - Boccon-Gibod, Liliane

AU - Compérat, Eva

AU - Evans, Andrew J

AU - Griffiths, David

AU - Grobholz, Rainer

AU - Kristiansen, Glen

AU - Langner, Cord

AU - Lopez-Beltran, Antonio

AU - Montironi, Rodolfo

AU - Moss, Sue

AU - Oliveira, Pedro

AU - Vainer, Ben

AU - Varma, Murali

AU - Camparo, Philippe

PY - 2013/1

Y1 - 2013/1

N2 - AIMS: The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7.METHODS AND RESULTS: Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases (P = 0.009).CONCLUSIONS: While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization.

AB - AIMS: The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7.METHODS AND RESULTS: Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases (P = 0.009).CONCLUSIONS: While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization.

KW - Adenocarcinoma

KW - Biopsy

KW - Consensus

KW - Europe

KW - Humans

KW - Male

KW - Neoplasm Grading

KW - Observer Variation

KW - Pathology, Surgical

KW - Prostatic Neoplasms

KW - Reproducibility of Results

U2 - 10.1111/his.12008

DO - 10.1111/his.12008

M3 - Journal article

C2 - 23240715

SN - 0309-0167

VL - 62

SP - 247

EP - 256

JO - Histopathology

JF - Histopathology

IS - 2

ER -

Standardization of Gleason grading among 337 European pathologists

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