Renshaw Andrew A, Schultz Delray, Cote Kerri, Loffredo Marian, Ziemba David E, D'Amico Anthony V
Department of Pathology, Baptist Hospital of Miami, Miami, Fla 33176, USA.
Arch Pathol Lab Med. 2003 Aug;127(8):1007-8. doi: 10.5858/2003-127-1007-AGGOPA.
Gleason grading of prostatic adenocarcinoma in core needle biopsies is important for predicting prognosis and selecting appropriate therapy. Previous studies have shown that Gleason scores assigned by general pathologists have a low correlation with those assigned by urologic pathologists, and that general pathologists tend to undergrade prostate carcinoma.
To determine if the performance of general pathologists grading prostate needle biopsies has changed over time.
Four hundred sixteen prostate biopsies from men treated at a single community-based institution between 1987 and 2000 were reviewed by one urologic pathologist (A.A.R.). The correlation between the original Gleason score and the reviewer's score was determined over time.
Cases were divided into those performed and originally interpreted in the first half of the study (1987-1996) and those performed and originally interpreted in the second half (1996-2000). Overall concordance for exact Gleason score was 59% (244/416). The exact concordance of the Gleason score assigned by the original pathologist and the reviewer during the first half of the study was 51%, whereas in the second half of the study the concordance was significantly greater (66.3%, P =.002). However, when grouped into score categories of 6 or less, 7, and 8 or greater, there was no significant difference in the exact concordance between the first half of the study (78.3%) and the second half (78.4%). Fifty-five percent of the cases in which there was discordance were graded as 7 by the reference pathologist and 6 or less by the original pathologist. There was no correlation between concordance in Gleason score and the percentage of tissue involved by carcinoma.
The concordance between general pathologists' Gleason grading and that of a reference pathologist in this study is much higher than that in previously reported studies. Although exact concordance has significantly improved over time, concordance by clinically significant groups has remained high throughout the study, is dominated by the difference between Gleason score 7 and 6 or less, and is unrelated to the size of the tumor focus.
在粗针穿刺活检中，前列腺腺癌的Gleason分级对于预测预后和选择合适的治疗方法很重要。先前的研究表明，普通病理学家给出的Gleason评分与泌尿外科病理学家给出的评分相关性较低，并且普通病理学家往往对前列腺癌分级不足。
确定普通病理学家对前列腺穿刺活检进行分级的表现是否随时间发生了变化。
由一名泌尿外科病理学家（A.A.R.）回顾了1987年至2000年期间在一家社区机构接受治疗的男性的416例前列腺活检。确定了原始Gleason评分与审阅者评分之间随时间的相关性。
病例分为在研究的前半段（1987 - 1996年）进行并最初解读的病例，以及在研究的后半段（1996 - 2000年）进行并最初解读的病例。Gleason评分完全一致的总体符合率为59%（244/416）。在研究的前半段，原始病理学家和审阅者给出的Gleason评分的完全符合率为51%，而在研究的后半段，符合率显著更高（66.3%，P = 0.002）。然而，当分为6分及以下、7分和8分及以上的评分类别时，研究前半段（78.3%）和后半段（78.4%）的完全符合率没有显著差异。在存在分歧的病例中，55%被参考病理学家评为7分，而被原始病理学家评为6分及以下。Gleason评分的符合率与癌组织累及的百分比之间没有相关性。
在本研究中，普通病理学家的Gleason分级与参考病理学家的分级之间的符合率远高于先前报道的研究。尽管随着时间的推移完全符合率有显著提高，但在整个研究过程中，具有临床意义的组别的符合率一直很高，主要由Gleason评分7分与6分及以下之间的差异主导，并且与肿瘤灶的大小无关。
