Abstract
Objective: The standard 12-core transrectal prostate needle biopsies don’t reflect the tumor entirely. Approximately 35-36% of needle biopsy diagnoses of Gleason grade group (GG) 1 are upgraded upon radical prostatectomy (RP). Pathologists are not in perfect concordance in Gleason scoring. Two uropathologists in a university hospital aimed to determine how concordant needle biopsy GGs were with RP GGs. Moreover, they also assessed how frequently they up-/down-graded the needle biopsy GGs each other gave when they graded RPs.
Material and Methods: In-house prostate needle biopsies and RPs from 31/01/2020 to 10/09/2022 were retrieved from the hospital database. Patients who had both a needle biopsy and an RP were included. Whether each case was down-/up-graded upon RP, GGs and the pathologist that reported the cases were tabulated.
Results: One hundred and thirty cases were assessed. Needle biopsy and RP GGs were identical in 63,1% (n=82). Pathologist1 (P1) assessed both the needle biopsy and RPs of 41 patients, 8 of which they downgraded and 8 upgraded (19,5%). Pathologist2 (P2) assessed both the needle biopsy and RP samples of 23 patients; downgrading 13% (n=3) and upgrading 17,4% (n=4) of cases. Where the needle biopsy was reported by P2 and RP was reported by P1 (n=48), 10 (20,8%) were downgraded and 8 (16,7%) were upgraded. The reverse scenario was noted in 18 patients; 2 (11,1%) of which were downgraded, 5 (27,8%) were upgraded. While P2 showed a tendency to upgrade more frequently, this was not statistically significant (p=0,2774, Pearson chi-square).
Discussion: The two uropathologists’ up- and down-grading rates seemed concordant. Routine practice doesn’t allow time for one pathologist to re-score the other’s cases, nor is every case consulted. Looking back at pathologist-specific tendencies to up/downgrade one’s own or a colleague’s scores may help direct ourselves and others to curb tendencies to over/undergrade.
Keywords: prostatic adenocarcinoma, gleason grade group, concordance, upgrading, downgrading, needle biopsy, radical prostatectomy
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Copyright (c) 2024 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
