Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Scand J Urol. 2020 Dec;54(6):463-469. doi: 10.1080/21681805.2020.1806354. Epub 2020 Aug 26.
Grading prostate biopsies has an important role in determining treatment strategy. Histopathological evaluations suffer from interobserver variability and therefore biopsies may be re-evaluated.
To provide insight into the extent of, characteristics associated with and clinical implications of prostate biopsy re-evaluations in daily clinical practice.
Patients diagnosed with prostate cancer (PCa) by biopsy between October 2015 and April 2016 identified through the Netherlands Cancer Registry were included. The proportion of re-evaluations was assessed and characteristics were compared between patients with and without biopsy re-evaluation. Interobserver concordance of ISUP grade and EAU prognostic risk classification was determined by calculating Cohen's kappa.
Biopsy re-evaluation was performed in 172 (3.3%) of 5214 patients. Primary reason for re-evaluation in patients treated with curative intent was referral to another hospital. Most referred patients treated with curative intent ( = 1856) had no re-evaluation (93.0%, = 1727). Patients with biopsy re-evaluation were younger and underwent more often prostatectomy compared to patients without re-evaluation. The disagreement rate for ISUP grade was 26.1% and interobserver concordance was substantial (-weighted = 0.74). Re-evaluation resulted in 21.1% ( = 14) of patients with localised PCa in a different prognostic risk group. More tumours were downgraded (57.1%) than upgraded (42.9%). Interobserver concordance was very good ( = 0.85).
Pathology review of prostate biopsies is infrequently requested by clinicians in the Netherlands but in a non-negligible minority of patients with localised PCa the pathology review led to a change in prognostic risk group which might impact their treatment.
前列腺活检分级在确定治疗策略方面具有重要作用。组织病理学评估存在观察者间变异性，因此可能需要重新评估活检结果。
了解在日常临床实践中对前列腺活检进行重新评估的程度、特征及临床意义。
通过荷兰癌症登记处，纳入 2015 年 10 月至 2016 年 4 月期间经活检诊断为前列腺癌（PCa）的患者。评估重新评估的比例，并比较有和无活检重新评估患者的特征。通过计算 Cohen 的 kappa 来确定 ISUP 分级和 EAU 预后风险分类的观察者间一致性。
对 5214 例患者中的 172 例（3.3%）进行了活检重新评估。对有治愈意向的患者进行重新评估的主要原因是转诊至其他医院。大多数接受治愈意向治疗的转诊患者（ = 1856）未进行重新评估（93.0%， = 1727）。与未进行重新评估的患者相比，进行活检重新评估的患者年龄更小，且更常接受前列腺切除术。ISUP 分级的不一致率为 26.1%，观察者间一致性为中等（加权 = 0.74）。重新评估导致 21.1%（ = 14）的局限性 PCa 患者处于不同的预后风险组。降级的肿瘤（57.1%）多于升级的肿瘤（42.9%）。观察者间一致性非常好（ = 0.85）。
荷兰临床医生很少要求对前列腺活检进行病理复查，但在少数局部性 PCa 患者中，病理复查导致预后风险组发生变化，可能影响其治疗。
