title: A working group classification of focal prostate atrophy lesions.
abstract: Focal atrophy is extremely common in prostate specimens. Although there are distinct histologic variants, the terminology is currently nonstandardized and no formal classification has been tested for interobserver reliability. This lack of standardization hampers the ability to study the biologic and clinical significance of these lesions. After informal and formal meetings by a number of the authors, focal atrophy lesions were categorized into 4 distinct subtypes as follows: (i) simple atrophy, (ii) simple atrophy with cyst formation, (iii) postatrophic hyperplasia, and (iv) partial atrophy. In phase 1 of the study, pathologists with varying levels of experience in prostate pathology were invited to view via the Internet a set of "training" images with associated descriptions of lesions considered typical of each subtype. In phase 2 of the study, each participant provided diagnoses on a series of 140 distinct "test" images that were viewed over the Internet. These test images consisted of the 4 subtypes of atrophy and images of normal epithelium, high grade prostatic intraepithelial neoplasia, and carcinoma. The diagnoses for each image from each pathologist were compared with a set of "standard" diagnoses and the kappa statistic was computed. Thirty-four pathologists completed both phases of the study. The interobserver reliability (median kappa) for classification of lesions as normal, cancer, prostatic intraepithelial neoplasia, or focal atrophy was 0.97. The median kappa for the classification of atrophy lesions into the 4 subtypes was 0.80. The median percent agreement with the standard diagnosis for the atrophy subtypes were: simple 60.6%, simple with cyst formation 100%; postatrophic hyperplasia 87.5%; partial atrophy 93.9%. The lower percentage for simple atrophy reflected a propensity to diagnose some of these as simple atrophy with cyst formation. Seven pathologists completed the phase 2 analysis a second time, and their intraobserver reproducibility was excellent. Three of 4 pathologists with low agreement with the standard diagnosis for simple atrophy improved their scores after repeating the analysis after re-examination of the "training set" of images. In conclusion, these criteria for variants of focal prostate atrophy may facilitate studies to examine the relation between various patterns of prostate atrophy and prostate cancer.
authors.affiliation: Johns Hopkins University School of Medicine, USA. ademarz@jhmi.edu
authors.forename: Angelo M
authors.initials: AM
authors.lastname: De Marzo
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Platz
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Tehmina
authors.initials: T
authors.lastname: Ali
authors.forename: Anthanase
authors.initials: A
authors.lastname: Billis
authors.forename: Teresa Y
authors.initials: TY
authors.lastname: Chan
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: Milton
authors.initials: M
authors.lastname: Datta
authors.forename: Lars
authors.initials: L
authors.lastname: Egevad
authors.forename: Dilek
authors.initials: D
authors.lastname: Ertoy-Baydar
authors.forename: Xavier
authors.initials: X
authors.lastname: Farre
authors.forename: Xavier
authors.initials: X
authors.lastname: Farree
authors.forename: Samson W
authors.initials: SW
authors.lastname: Fine
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Iczkowski
authors.forename: Michael
authors.initials: M
authors.lastname: Ittmann
authors.forename: Beatrice S
authors.initials: BS
authors.lastname: Knudsen
authors.forename: Massimo
authors.initials: M
authors.lastname: Loda
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Beltran
authors.forename: Cristina
authors.initials: C
authors.lastname: Magi-Galluzzi
authors.forename: Gregor
authors.initials: G
authors.lastname: Mikuz
authors.forename: Roldolfo
authors.initials: R
authors.lastname: Montironi
authors.forename: Eli
authors.initials: E
authors.lastname: Pikarsky
authors.forename: Galina
authors.initials: G
authors.lastname: Pizov
authors.forename: Mark A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Hema
authors.initials: H
authors.lastname: Samaratunga
authors.forename: Thomas
authors.initials: T
authors.lastname: Sebo
authors.forename: Isabel A
authors.initials: IA
authors.lastname: Sesterhenn
authors.forename: Rajal B
authors.initials: RB
authors.lastname: Shah
authors.forename: Rajiv B
authors.initials: RB
authors.lastname: Shah
authors.forename: Sabina
authors.initials: S
authors.lastname: Signoretti
authors.forename: Jeffery
authors.initials: J
authors.lastname: Simko
authors.forename: George
authors.initials: G
authors.lastname: Thomas
authors.forename: Patricia
authors.initials: P
authors.lastname: Troncoso
authors.forename: Toyonori T
authors.initials: TT
authors.lastname: Tsuzuki
authors.forename: Geert J
authors.initials: GJ
authors.lastname: van Leenders
authors.forename: Ximing J
authors.initials: XJ
authors.lastname: Yang
authors.forename: Ming
authors.initials: M
authors.lastname: Zhou
authors.forename: William D
authors.initials: WD
authors.lastname: Figg
authors.forename: Ashraful
authors.initials: A
authors.lastname: Hoque
authors.forename: Ashrafal
authors.initials: A
authors.lastname: Hoque
authors.forename: M S
authors.initials: MS
authors.lastname: Lucia
mesh_terms: D001284:Atrophy; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology*; D011469:Prostatic Diseases / Q000145:classification* / Q000473:pathology*; D015203:Reproducibility of Results