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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Urology 1/2015

Review by urological pathologists improves the accuracy of Gleason grading by general pathologists

Zeitschrift:
BMC Urology > Ausgabe 1/2015
Autoren:
Yasushi Nakai, Nobumichi Tanaka, Keiji Shimada, Noboru Konishi, Makito Miyake, Satoshi Anai, Kiyohide Fujimoto
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

YN analysed and interpreted the data, and drafted the manuscript. NT conceived of the study and revised this manuscript. KS participated in this study as a urological pathologist and helped to carry out this study. NK participated in this study as a urological pathologist and provided valuable help on the study. MM and SA provided valuable help on the experiments. KF participated in its design and gave final approval of the version to be published. All authors read and approved the final manuscript.

Abstract

Backgrounds

Urologists use biopsy Gleason scores for patient counseling, prognosis prediction, and decision making. The accuracy of Gleason grading is very important. However, the variability of Gleason grading between general pathologists cannot be overlooked. Here we evaluate the discrepancy in the Gleason grading between 2 urologic pathologists and general pathologists as well as improvement in the accuracy of Gleason grading by general pathologists as a result of review by urologic pathologists.

Methods

The subjects enrolled in the study were 755 patients who underwent prostate needle biopsy at affiliate hospitals of Nara Medical University over a period of 2 years. The biopsy samples were diagnosed by general pathologists. All biopsy samples were sent to Nara Medical University where they were diagnosed by 2 urologic pathologists. The results were then returned to the general pathologists. We compared the diagnostic accuracy of the general pathologists with that of the urologic pathologists for the parameters of no malignancy, atypical small acinar proliferation, high grade prostatic intraepithelial neoplasia and Gleason score (6, 3 + 4, 4 + 3 and 8–10). We then evaluated the concordance rate between the general and urologic pathologists for each of four consecutive 6-month periods.

Results

The overall concordance rate of urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 71.8 % (140/198), 79.8 % (168/225), 89.7 % (166/185) and 89.9 % (133/148), respectively. The concordance rate of the Gleason score between urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 47.5 %(38/80), 62.6 %(57/91),76.9 %(50/65) and 78.7 %(48/61), respectively, and the kappa value was 0.55, 0.68, 0.81 and 0.84, respectively. The concordance rate improved significantly over the course of each period (P = 0.04).

Conclusion

The concordance rate of the Gleason grading between the general pathologists and the urologic pathologists was 47.5 %. However, improvement of the concordance rate as a result of review by the urological pathologist could be seen.
Literatur
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