Cookson M S, Fleshner N E, Soloway S M, Fair W R
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 1997 Feb;157(2):559-62.
Despite the reliability of Gleason grading with respect to the same specimen, the correlation between the biopsy and prostatectomy specimen is less well defined. We compared the accuracy of Gleason grading of biopsies in predicting histological grading of radical retropublic prostatectomy specimens.
Gleason scores of 18 gauge needle biopsies were compared to those of radical retropublic prostatectomy specimens in 226 consecutive patients. In addition to comparing numeric discrepancies, differences between biopsy and specimen Gleason scores of 2 or more and a change in group from Gleason scores 2 to 4, 5 to 7 or 8 to 10 were evaluated by kappa testing, as well as any change in group from Gleason scores 2 to 4, 5 and 6, 7 and 8 to 10.
The biopsy score was identical to the specimen score in 31% of cases, while 26% were discrepant by 2 or more Gleason scores. Overall, 54% of biopsies were under graded, while 15% were over graded. If only cases in which discrepancies of 2 or more Gleason scores and a change in group were considered, there was good overall agreement (kappa 0.468, accuracy 80%). Among the cases with any change in group, the accuracy was only 46% with poor agreement (kappa 0.153).
Overall, the reliability of Gleason grading of needle biopsies in predicting final pathology was good. However, the limitations of Gleason grading based on biopsy should be considered when discussing treatment options and comparing results based on biopsy data.
尽管 Gleason 分级在同一标本上具有可靠性，但活检标本与前列腺切除标本之间的相关性仍不太明确。我们比较了活检 Gleason 分级在预测根治性耻骨后前列腺切除标本组织学分级方面的准确性。
对 226 例连续患者的 18 号针吸活检 Gleason 评分与根治性耻骨后前列腺切除标本的 Gleason 评分进行比较。除了比较数值差异外，还通过kappa 检验评估活检与标本 Gleason 评分相差 2 分或更多以及 Gleason 评分从 2 到 4、5 到 7 或 8 到 10 的组间变化，以及 Gleason 评分从 2 到 4、5 和 6、7 和 8 到 10 的任何组间变化。
31% 的病例活检评分与标本评分相同，而 26% 的病例 Gleason 评分相差 2 分或更多。总体而言，54% 的活检分级过低，而 15% 的活检分级过高。如果仅考虑 Gleason 评分相差 2 分或更多以及组间变化的病例，总体一致性良好（kappa 0.468，准确性 80%）。在有任何组间变化的病例中，准确性仅为 46%，一致性较差（kappa 0.153）。
总体而言，针吸活检 Gleason 分级在预测最终病理结果方面的可靠性良好。然而，在讨论治疗方案并基于活检数据比较结果时，应考虑基于活检的 Gleason 分级的局限性。
