Department of Urology, Rigshospitalet, University of Copenhagen, Denmark.
APMIS. 2011 Apr;119(4-5):239-46. doi: 10.1111/j.1600-0463.2011.02723.x. Epub 2011 Mar 22.
Histopathological grading of prostate cancer (PCa) is associated with significant interobserver variability. This, as well as clinical consequences of histopathological re-evaluation, was investigated. In 350 patients, histopathological re-evaluations of prostate biopsies were compared with primary pathology reports and with histopathology of the radical prostatectomy specimen. The consequences of re-evaluation for clinical workup and treatment of patients according to local algorithms were determined. For Gleason score (GS), complete agreement between primary report and re-evaluation was found in 76.9%. The cancers were assessed with higher GS at re-evaluation in 25.0% of patients in cases with primary GS ≤ 6, while scores were devaluated in 3.0% and 10.3% of the patients with primary GS = 7 and ≥ 8, respectively. Strategies for clinical evaluation and treatment were changed as a result of the biopsy re-evaluations in 19.7% and 13.1% of patients, respectively. Gleason scoring based on the radical prostatectomy specimen was higher than in both primary reports and re-evaluation of biopsies. Although a relatively high degree of concordance was found between biopsy assessments, the significant trend towards higher Gleason scoring at re-evaluation, leading to frequent changes in clinical assessments and surgical strategy, justifies re-evaluation of PCa biopsies in patients with primary GS ≤ 6.
前列腺癌（PCa）的组织病理学分级与显著的观察者间变异性相关。本研究调查了这种变异性以及组织病理学重新评估的临床后果。在 350 例患者中，对前列腺活检的组织病理学重新评估与原发性病理报告和根治性前列腺切除术标本的组织病理学进行了比较。根据当地的算法，确定了重新评估对患者临床检查和治疗的影响。对于 Gleason 评分（GS），在原发性报告和重新评估之间发现了 76.9%的完全一致性。在原发性 GS≤6 的患者中，25.0%的患者在重新评估时被评估为更高的 GS，而在原发性 GS=7 和≥8 的患者中，评分分别被低估了 3.0%和 10.3%。由于活检的重新评估，分别有 19.7%和 13.1%的患者的临床评估和治疗策略发生了变化。基于根治性前列腺切除术标本的 Gleason 评分高于原发性报告和活检的重新评估。尽管在活检评估之间发现了相对较高的一致性，但在重新评估时 GS 评分升高的明显趋势，导致临床评估和手术策略频繁变化，这证明了在原发性 GS≤6 的患者中重新评估 PCa 活检是合理的。
