Singh R V, Agashe S R, Gosavi A V, Sulhyan K R
Department of Pathology, Tarini Cancer Hospital, Alwar, Rajasthan, India.
Indian J Cancer. 2011 Oct-Dec;48(4):488-95. doi: 10.4103/0019-509X.92277.
Gleason grade is the most widely used grading system for prostatic carcinoma and is recommended by World Health Organization. It is essential that there should be good interobserver reproducibility of this grading system as it has important implications in patient management.
To assess interobserver reproducibility of Gleason grading of prostatic adenocarcinoma.
A total of 20 cases of prostatic adenocarcinoma were scored using Gleason grade by 21 general pathologists. The scores were then compared using κ-coefficient and consensus score.
For Gleason score groups (2-4, 5-6, 7 and 8-10) overall agreement with consensus score was 68%. Exact agreement for Gleason scores with consensus score was 43.3% and 92.3% within ±1 of the consensus score. κ coefficient for primary grade ranged from -0.32 to 0.92 with 60% of the readings in fair to moderate agreement range; and for secondary grade κ ranged from -0.30 to 0.62 with 78% of the readings in slight to fair agreement range. Kappa for Gleason scores ranged from -0.13 to 0.55 with 80% of the readings in slight to fair agreement range; and for Gleason score groups κ ranged from -0.11 to 0.82 with 68.5% of the readings in fair to moderate agreement range.
In our study interobserver reproducibility of Gleason scores among general pathologists was at lower level and it highlights the need to improve the observer reproducibility by continuous educational sessions and taking second opinion in cases where grade could significantly influence management.
Gleason分级是前列腺癌最广泛使用的分级系统，且被世界卫生组织推荐。该分级系统在患者管理中具有重要意义，因此观察者间具有良好的可重复性至关重要。
评估前列腺腺癌Gleason分级的观察者间可重复性。
21名普通病理学家使用Gleason分级对20例前列腺腺癌病例进行评分。然后使用κ系数和一致性评分对评分进行比较。
对于Gleason评分组（2 - 4分、5 - 6分、7分和8 - 10分），与一致性评分的总体一致性为68%。Gleason评分与一致性评分的完全一致性在一致性评分的±1范围内分别为43.3%和92.3%。主要分级的κ系数范围为 - 0.32至0.92，60%的读数处于中等程度的一致性范围；次要分级的κ系数范围为 - 0.30至0.62，78%的读数处于轻微至中等程度的一致性范围。Gleason评分的kappa范围为 - 0.13至0.55，80%的读数处于轻微至中等程度的一致性范围；对于Gleason评分组，κ系数范围为 - 0.11至0.82，68.5%的读数处于中等程度的一致性范围。
在我们的研究中，普通病理学家之间Gleason评分的观察者间可重复性处于较低水平，这突出表明需要通过持续的教育课程以及在分级可能对管理产生重大影响的病例中寻求第二种意见来提高观察者的可重复性。
