CONSISTENCIES AND INCONSISTENCIES OF GLEASON SCORE AND GRADE GROUP SYSTEM IN PROSTATE BIOPSY AND RADICAL PROSTATECTOMY
Abstract
The diagnostic of prostatic adenocarcinoma (PADK) is based on two scoring systems, namely the Gleason grading system and the grade group system - both of them being included in the pathology report. There is a discrepancy in the Gleason score given on the initial biopsy and prostatectomy specimen, respectively, that affects both patients who can benefit from active surveillance and those who cannot benefit from curative surgical treatment, and for whom therapeutic alternatives must be established. In this context, our study aimed at analyzing the diagnostic concordance between biopsies and subsequent prostatectomies, in order to establish the accuracy of prostate biopsy in predicting final Gleason score of the prostatectomy specimens. Material and methods: We analyzed 79 cases of PADK, initially diagnosed by prostate biopsy and subsequently treated by radical prostatectomy. The accuracy degree of the tumoral grading system assigned to the prostate biopsy, compared with the radical prostatectomy, was assessed by calculation of the Cohen's kappa concordance coefficient and calculation of sensitivity, specificity, positive prognostic value and negative prognostic value. Results: 37 cases (46.83%) presented the same Gleason score given for prostate biopsies and radical prostatectomies. In prostate biopsies, 32 cases (40.50%) were underestimated, compared to the Gleason score established by evaluating radical prostatectomy specimens, and 10 cases (12.65%) were overestimated. The highest agreement rate between the Gleason score in prostate biopsy and radical prostatectomy was found for Gleason score 6 (3+3) and 7 (3+4)-17 cases (21.51%) for each score category. The lowest agreement rate was observed for Gleason score 5, where no case showed a similar score for biopsy and prostatectomy. Statistical analysis indicated a kappa coefficient of 0.23, corresponding to a statistically significant satisfactory agreement (p = 0.01). The agreement on ISUP prognostic grade groups between prostate biopsy and radical prostatectomy indicated a slight increase in kappa coefficient -0.41, while maintaining a statistically significant moderate agreement (p = 0.0001). Conclusions: Our results demonstrate an increase in the predictive accuracy of prostate biopsy, as a result of the application of prognostic grade group system, which ensure the decrease of overestimating tendency of the old scoring system, ultimately leading to a preliminary characterization of potential lesions in prostatectomy specimens and a more effective treatment stratification of patients.
References
2. Epstein JI, Zelefsky MJ, Sjoberg DD, et al. A contemporary prostate cancer grading system: A vali-dated alternative to the Gleason score. Eur Urol 2016; 69(3): 428-435.
3. Gleason DF. Classification of prostatic carcinomas. Cancer Chemother Rep 1966; 50(3):125-128.
4. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histo-logical grading and clinical staging. J Urol 1974; 111(1): 58-64.
5. Gleason DF. Histological grading and staging of prostatic carcinoma. In Tannenbaum M (editor) Urologic Pathology: The Prostate. Philadephia: Lea and Feibiger, 1977, 171-198.
6. Gleason DF. Histologic grading of prostate cancer: a perspective. Hum Pathol 1992; 23(3): 273-279.
7. Epstein JI, Allsbrook Jr WC, Amin MB, Egevad LL. The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005; 29(9): 1228-1242.
8. Stark JR, Perner S, Stampfer MJ, et al. Gleason score and lethal prostate cancer: does 3+4 = 4+3? J Clin Oncol 2009; 27(21): 3459-3464.
9. Wright JL, Salinas CA, Lin DW, et al. Prostate cancer specific mortality and Gleason 7 disease dif-ferences in prostate cancer outcomes between cases with Gleason 4+3 and Gleason 3+4 tumors in a population-based cohort. J Urol 2009; 182(6): 2702–2707.
10. Epstein JI. An update of the Gleason grading system. J Urol 2010; 183(2): 433‑440.
11. Helpap B, Egevad L. Modified Gleason grading. An updated review. Histol Histopathol 2009; 24(5): 661-666.
12. Montironi R, Cheng L, Lopez-Beltran A, et al. Original Gleason system versus 2005 ISUP modified Gleason system: the importance of indicating which system is used in the patient’s pathology and clinical reports. Eur Urol 2010; 58(3): 369-373.
13. Egevad L, Mazzucchelli R, Montironi R. Implications of the International Society of Urological Pathology modified Gleason grading system. Arch Pathol Lab Med 2012; 136(4): 426-434.
14. Ramakrishnan VM, Bossert K, Singer G, Lehmann K, Hefermehl LJ. The impact of the 2005 Interna-tional Society of Urological Pathology Gleason grading consensus on active surveillance for prostate cancer. Cent European J Urol 2017; 70(4): 344-348.
15. D'Elia C, Cerruto MA, Cioffi A, Novella G, Cavalleri S, Artibani W. Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy. Mol Clin Oncol 2014; 2(6): 1145-1149.
16. Chen RC, Rumble RB, Loblaw DA, et al. Active surveillance for the management of localized prostate cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice guideline endorsement. J Clin Oncol 2016; 34(18): 2182-2190.
17. Offermann A, Hohensteiner S, Kuempers C, et al. Prognostic value of the new prostate cancer Inter-national Society of Urological Pathology Grade Groups. Front Med (Lausanne) 2017; 4: 157.
18. Epstein JI. Prostate cancer grading: a decade after the 2005 modified system. Mod Pathol 2018; 31(S1): S47-S63.
19. Grignon DJ. Prostate cancer reporting and staging: needle biopsy and radical prostatectomy specimens. Mod Pathol 2018; 31(S1): S96-S109.
20. Poulos CK, Daggy JK, Cheng L. Preoperative prediction of Gleason grade in radical prostatectomy specimens: the influence of different Gleason grades from multiple positive biopsy sites. Mod Pathol 2005; 18(2): 228-234.
21. Park HK, Choe G, Byun SS, Lee HW, Lee SE, Lee E. Evaluation of concordance of Gleason score between prostatectomy and biopsies that show more than two different Gleason scores in positive cores. Urology 2006; 67(1): 110-114.
22. Kunju LP, Daignault S, Wei JT, Shah RB. Multiple prostate cancer cores with different Gleason grades submitted in the same specimen container without specific site designation: should each core be assigned an individual Gleason score? Hum Pathol 2009; 40(4): 558-564.
23. Karram S, Trock BJ, Netto GJ, Epstein JI. Should intervening benign tissue be included in the meas-urement of discontinuous foci of cancer on prostate needle biopsy? Correlation with radical prostatec-tomy findings. Am J Surg Pathol 2011; 35(9): 1351-1355.
24. Bsirini C, Danakas AM, Miyamoto H. Continuous versus discontinuous tumor involvement: A di-lemma in prostate biopsy quantitation. Prostate 2018; 78(15): 1166-1171.
25. Cole AI, Morgan TM, Spratt DE, et al. Prognostic value of percent Gleason grade 4 at prostate biopsy in predicting prostatectomy pathology and recurrence. J Urol 2016; 196(2): 405-411.
26. Carmona Echeverria LM, Haider A, Freeman A, et al. A critical evaluation of visual proportion of Gleason 4 and maximum cancer core length quantified by histopathologists. Sci Rep 2020; 10(1): 17177 / doi.org/10.1038/s41598-020-73524-z
27. van der Slot MA, Hollemans E, den Bakker MA, et al. Inter-observer variability of cribriform archi-tecture and percent Gleason pattern 4 in prostate cancer: relation to clinical outcome. Virchows Arch 2021; 478(2): 249-256.
28. Haffner MC, Salles DC, Gao G, Epstein JI. Gleason pattern 4 with cribriform morphology on biopsy is associated with adverse clinicopathological findings in a prospective radical prostatectomy cohort. Hum Pathol 2020; 98(4): 74-80.
29. Acosta AM, Taplin ME, Mata DA, D'Amico AV, Hirsch MS. Volume of Gleason pattern 4 stratifies risk of metastasis and death in patients with Gleason score 3+5=8 / 5+3=8 positive prostate core biop-sies. Hum Pathol 2020; 99(5): 62-74.
30. King CR. Patterns of prostate cancer biopsy grading: trends and clinical implications. Int J Cancer 2000; 90(6): 305-311.
31. Ericson KJ, Wu SS, Lundy SD, Thomas LJ, Klein EA, McKenney JK. Diagnostic accuracy of prostate biopsy for detecting cribriform Gleason pattern 4 carcinoma and intraductal carcinoma in paired radical prostatectomy specimens: implications for active surveillance. J Urol 2020; 203(2): 311-319.
32. Humphrey PA. Prostate Pathology. Chicago: ASCP Press, 2003.
33. Kvåle R, Møller B, Wahlqvist R, et al. Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens: A population-based study. BJU Int 2008; 103(12): 1647-1654.
34. Nepple KG, Wahls TL, Hillis SL, Joudi FN. Gleason score and laterality concordance between prostate biopsy and prostatectomy specimens. Int Braz J Urol 2009; 35(5): 559-564.
35. Cohen MS, Hanley RS, Kurteva T, et al. Comparing the Gleason prostate biopsy and Gleason prosta-tectomy grading system: the Lahey Clinic Medical Center experience and an international meta-analysis. Eur Urol 2008; 54(2): 371-381.
36. Epstein JI, Netto GJ. Biopsy Interpretation of the Prostate. Philadelphia: Lippincott Williams & Wilkins, 2008.
37. Evans SM, Bandarage VP, Kronborg C, Earnest A, Millar J, Clouston D. Gleason group concordance between biopsy and radical prostatectomy specimens: A cohort study from Prostate Cancer Outcome Registry -Victoria. Prostate Int 2016; 4(4): 145-151.
38. Wong AT, Agarwal M, Navo EB, Schwartz D, Schreiber D. Concordance of Gleason score on biopsy and after prostatectomy: A SEER database analysis. J Clin Oncol 2017; 33(S7): 50.
39. Athanazio D, Gotto G, Shea-Budgell M, Yilmaz A, Trpkov K. Global Gleason grade groups in prostate cancer: concordance of biopsy and radical prostatectomy grades and predictors of upgrade and downgrade. Histopathology 2017; 70(7): 1098-1106.
40. Soenens C, Dekuyper P, De Coster G, et al. Concordance Between Biopsy and Radical Prostatectomy Gleason Scores: Evaluation of Determinants in a Large-Scale Study of Patients Undergoing RARP in Belgium. Pathol Oncol Res 2020; 26(4): 2605-2612.
41. Diamand R, Oderda M, Al Hajj Obeid W, et al. A multicentric study on accurate grading of prostate cancer with systematic and MRI/US fusion targeted biopsies: comparison with final histopathology after radical prostatectomy. World J Urol 2019; 37(10): 2109-2117.
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