Department of Pathology, Stanford University Medical Center, Stanford, CA 94305, USA.
J Urol. 2011 Aug;186(2):465-9. doi: 10.1016/j.juro.2011.03.115. Epub 2011 Jun 15.
We evaluated the reproducibility of Gleason grading as relevant to the clinical treatment of men on active surveillance.
Three sets of digital images of prostatic adenocarcinoma in biopsies were reviewed and assigned Gleason scores by a total of 11 pathologists from 7 institutions. Interobserver and intra-observer reproducibility were assessed for assignment of the highest Gleason pattern (3 vs 4 or higher). We also identified 97 consecutive patients on active surveillance. Prostate biopsy glass slides from 82 of the patients were available for re-review and the frequency of carcinoma requiring the distinction of tangentially sectioned Gleason pattern 3 from 4 was determined.
Interobserver reproducibility for classic Gleason patterns was substantial (Light's κ 0.76). Interobserver reproducibility for the histological distinction of tangentially sectioned Gleason pattern 3 from Gleason pattern 4 was only fair (Light's κ 0.27). Intra-observer reproducibility ranged from 65% to 100% (mean 81.5%). Of the 82 patients on active surveillance 61 had carcinoma and 15 (24.5%) had a set of biopsies with at least 1 focus in which the distinction between tangentially sectioned Gleason pattern 3 and poorly formed pattern 4 glands had to be considered.
The reproducibility of grading classic Gleason patterns is high. However, variability in grading occurred when distinguishing between tangentially sectioned pattern 3 glands and the poorly formed gland subset of pattern 4. Developing universally accepted histological and/or molecular criteria to distinguish these patterns and subsequently characterizing their natural history would be useful when treating patients on active surveillance.
我们评估了 Gleason 分级在主动监测男性患者的临床治疗中的可重复性。
对 7 家机构的 11 位病理学家进行了 3 组前列腺腺癌活检的数字图像回顾，并对 Gleason 评分进行了分配。评估了最高 Gleason 模式（3 级与 4 级或更高）的分配中观察者间和观察者内的可重复性。我们还确定了 97 例接受主动监测的连续患者。82 例患者的前列腺活检玻片可用于重新审查，并确定需要区分切线部分的 Gleason 模式 3 与 4 的癌的频率。
经典 Gleason 模式的观察者间可重复性较高（Light's κ 0.76）。切线部分的 Gleason 模式 3 与 Gleason 模式 4 之间的组织学区分的观察者间可重复性仅为中等（Light's κ 0.27）。观察者内的可重复性范围为 65%至 100%（平均 81.5%）。在接受主动监测的 82 例患者中，61 例患有癌，15 例（24.5%）至少有 1 个焦点的活检需要考虑区分切线部分的 Gleason 模式 3 和发育不良的模式 4 腺体。
分级经典 Gleason 模式的可重复性较高。然而，在区分切线部分的模式 3 腺体和模式 4 的发育不良腺体亚组时，分级存在差异。开发普遍接受的组织学和/或分子标准来区分这些模式，并随后描述其自然史，对于治疗接受主动监测的患者将是有用的。
