Al-Maghrabi Jaudah Ahmed, Bakshi Nasir A, Farsi Hasan M A
Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Ann Saudi Med. 2013 Jan-Feb;33(1):40-4. doi: 10.5144/0256-4947.2013.40.
The Gleason grading of prostate carcinoma (PCa) in needle core biopsies is a major determinant used in management planning. The objective of this study was to evaluate the concordance between general pathologists Gleason grading and that of a urologic pathologist in our community.
Retrospective review conducted at three tertiary care hospitals in Jeddah and Riyadh for all prostatic biopsies with carcinoma from January 2002 to January 2011.
Gleason scores assigned by the original pathologist were compared with that of the reviewing urologic pathologists. Biopsies were originally obtained and diagnosed at different referring hospitals and independent laboratories. The kappa test was used to evaluate agreement between the original and review scores.
For 212 biopsies the exact concordance of the Gleason score assigned by the original pathologist and the reviewer was 38.7% (82/212). However, when grouped into the main four-score categories of 2-4, 5-6, 7, and 8 or greater, disagreement was noted in 88 (41.5%) biopsies; 87 were upgraded and 1 was downgraded on review. When grouped into two-score categories of low grade (≤6) and high grade (≥7), disagreement was noted in 32 (15%) of the biopsies.
Gleason grade score shows that there was only slight to fair agreement between outside and review scoring (kappa=0.43). When using only low versus high grade categorization, there was good agreement (kappa=0.69). Almost all of the cases with score disagreement were upgraded on review.
针芯活检中前列腺癌（PCa）的Gleason分级是管理规划中的一个主要决定因素。本研究的目的是评估我们社区普通病理学家的Gleason分级与泌尿外科病理学家的分级之间的一致性。
对吉达和利雅得的三家三级医疗医院2002年1月至2011年1月间所有前列腺癌活检病例进行回顾性研究。
将原病理学家给出的Gleason评分与复审的泌尿外科病理学家给出的评分进行比较。活检样本最初是在不同的转诊医院和独立实验室获取并诊断的。采用kappa检验评估原评分与复审评分之间的一致性。
对于212例活检病例，原病理学家和复审者给出的Gleason评分完全一致的比例为38.7%（82/212）。然而，当分为2 - 4、5 - 6、7以及8分及以上这四个主要评分类别时，88例（41.5%）活检病例存在分歧；复审时有87例升级，1例降级。当分为低级别（≤6）和高级别（≥7）两个评分类别时，32例（15%）活检病例存在分歧。
Gleason分级评分显示外部评分与复审评分之间只有轻微到中等程度的一致性（kappa = 0.43）。仅使用低级别与高级别分类时，一致性良好（kappa = 0.69）。几乎所有评分存在分歧的病例在复审时都被升级了。
