title: Prostate needle biopsies: interobserver variation and clinical consequences of histopathological re-evaluation.
abstract: Histopathological grading of prostate cancer (PCa) is associated with significant interobserver variability. This, as well as clinical consequences of histopathological re-evaluation, was investigated. In 350 patients, histopathological re-evaluations of prostate biopsies were compared with primary pathology reports and with histopathology of the radical prostatectomy specimen. The consequences of re-evaluation for clinical workup and treatment of patients according to local algorithms were determined. For Gleason score (GS), complete agreement between primary report and re-evaluation was found in 76.9%. The cancers were assessed with higher GS at re-evaluation in 25.0% of patients in cases with primary GS ≤ 6, while scores were devaluated in 3.0% and 10.3% of the patients with primary GS = 7 and ≥ 8, respectively. Strategies for clinical evaluation and treatment were changed as a result of the biopsy re-evaluations in 19.7% and 13.1% of patients, respectively. Gleason scoring based on the radical prostatectomy specimen was higher than in both primary reports and re-evaluation of biopsies. Although a relatively high degree of concordance was found between biopsy assessments, the significant trend towards higher Gleason scoring at re-evaluation, leading to frequent changes in clinical assessments and surgical strategy, justifies re-evaluation of PCa biopsies in patients with primary GS ≤ 6.
authors.affiliation: Department of Urology, Rigshospitalet, University of Copenhagen, Denmark. kasperdrimerberg@gmail.com
authors.forename: Kasper Drimer
authors.initials: KD
authors.lastname: Berg
authors.forename: Birgitte Grønkaer
authors.initials: BG
authors.lastname: Toft
authors.forename: Martin Andreas
authors.initials: MA
authors.lastname: Røder
authors.forename: Klaus
authors.initials: K
authors.lastname: Brasso
authors.forename: Ben
authors.initials: B
authors.lastname: Vainer
authors.forename: Peter
authors.initials: P
authors.lastname: Iversen
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D001707:Biopsy, Needle; D015331:Cohort Studies; D003718:Denmark; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009367:Neoplasm Staging; D015588:Observer Variation; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D012017:Referral and Consultation