Kweldam Charlotte F, Nieboer Daan, Algaba Ferran, Amin Mahul B, Berney Dan M, Billis Athanase, Bostwick David G, Bubendorf Lukas, Cheng Liang, Compérat Eva, Delahunt Brett, Egevad Lars, Evans Andrew J, Hansel Donna E, Humphrey Peter A, Kristiansen Glen, van der Kwast Theodorus H, Magi-Galluzzi Cristina, Montironi Rodolfo, Netto George J, Samaratunga Hemamali, Srigley John R, Tan Puay H, Varma Murali, Zhou Ming, van Leenders Geert J L H
Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
Histopathology. 2016 Sep;69(3):441-9. doi: 10.1111/his.12976. Epub 2016 May 24.
To assess the interobserver reproducibility of individual Gleason grade 4 growth patterns.
Twenty-three genitourinary pathologists participated in the evaluation of 60 selected high-magnification photographs. The selection included 10 cases of Gleason grade 3, 40 of Gleason grade 4 (10 per growth pattern), and 10 of Gleason grade 5. Participants were asked to select a single predominant Gleason grade per case (3, 4, or 5), and to indicate the predominant Gleason grade 4 growth pattern, if present. 'Consensus' was defined as at least 80% agreement, and 'favoured' as 60-80% agreement. Consensus on Gleason grading was reached in 47 of 60 (78%) cases, 35 of which were assigned to grade 4. In the 13 non-consensus cases, ill-formed (6/13, 46%) and fused (7/13, 54%) patterns were involved in the disagreement. Among the 20 cases where at least one pathologist assigned the ill-formed growth pattern, none (0%, 0/20) reached consensus. Consensus for fused, cribriform and glomeruloid glands was reached in 2%, 23% and 38% of cases, respectively. In nine of 35 (26%) consensus Gleason grade 4 cases, participants disagreed on the growth pattern. Six of these were characterized by large epithelial proliferations with delicate intervening fibrovascular cores, which were alternatively given the designation fused or cribriform growth pattern ('complex fused').
Consensus on Gleason grade 4 growth pattern was predominantly reached on cribriform and glomeruloid patterns, but rarely on ill-formed and fused glands. The complex fused glands seem to constitute a borderline pattern of unknown prognostic significance on which a consensus could not be reached.
评估个体Gleason 4级生长模式的观察者间可重复性。
23名泌尿生殖病理学家参与了对60张选定高倍照片的评估。所选病例包括10例Gleason 3级、40例Gleason 4级（每种生长模式10例）和10例Gleason 5级。要求参与者为每个病例选择单一主要的Gleason分级（3级、4级或5级），并指出主要的Gleason 4级生长模式（如果存在）。“共识”定义为至少80%的一致性，“倾向”定义为60%-80%的一致性。60例病例中有47例（78%）达成了Gleason分级的共识，其中35例被归为4级。在13例未达成共识的病例中，形态不佳（6/13，46%）和融合（7/13，54%）模式参与了分歧。在至少有一名病理学家将形态不佳的生长模式归为某级的20例病例中，无一例（0%，0/20）达成共识。融合、筛状和肾小球样腺体模式的共识分别在2%、23%和38%的病例中达成。在35例（26%）达成Gleason 4级共识的病例中，有9例参与者对生长模式存在分歧。其中6例的特征是上皮细胞大量增生，其间有纤细的纤维血管核心，这些病例被交替指定为融合或筛状生长模式（“复杂融合”）。
Gleason 4级生长模式的共识主要在筛状和肾小球样模式上达成，但在形态不佳和融合腺体上很少达成。复杂融合腺体似乎构成了一种预后意义不明的临界模式，无法达成共识。
