Abstract
Objectives
Due to PSA screening and increased awareness, prostate cancer (PCa) is identified earlier resulting in smaller diagnostic samples on prostate needle biopsy. Because Gleason grading plays a critical role in treatment planning, we undertook a controlled study to evaluate interobserver variability among German pathologists to grade small PCas using a series of tissue microarray (TMA) images.
Methods
We have previously demonstrated excellent agreement in Gleason grading using TMAs among expert genitourinary pathologists. In the current study, we identified 331 TMA images (95% PCa and 5% benign) to be evaluated by an expert PCa pathologist and subsequently by practicing pathologists throughout Germany. The images were presented using the Bacus Webslide Browser on a CD-ROM. Evaluations were kept anonymous and participant’s scoring was compared to the expert’s results.
Results
A total of 29 German pathologists analysed an average of 278 images. Mean percentage of TMA images which had been assigned the same Gleason score (GS) as done by the expert was 45.7%. GSs differed by no more than one point (±1) in 83.5% of the TMA samples evaluated. The respondents were able to correctly assign a GS into clinically relevant categories (i.e. <7, 7, >7) in 68.3% of cases. A total of 75.9% respondents under-graded the TMA images. Gleason grading agreement with the expert reviewer correlated with the number of biopsies evaluated by the pathologist per week. Years of diagnostic experience, self-description as a urologic pathologist or affiliation with a university hospital did not correlate with the pathologist’s performance.
Conclusion
The vast majority of participants under-graded the small tumors. Clinically relevant GS categories were correctly assigned in 68% of cases. This raises a potentially significant problem for pathologists, who have not had as much experience evaluating small PCas.
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Acknowledgments
We would like to thank all participating pathologists, since this study could not have been possible without their extensive work. As we promised anonymity to the study participants their names and affiliations are not mentioned here.
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M. Burchardt and R. Engers contributed equally to this work.
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Burchardt, M., Engers, R., Müller, M. et al. Interobserver reproducibility of Gleason grading: evaluation using prostate cancer tissue microarrays. J Cancer Res Clin Oncol 134, 1071–1078 (2008). https://doi.org/10.1007/s00432-008-0388-0
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DOI: https://doi.org/10.1007/s00432-008-0388-0