title: Standardization of Gleason grading among 337 European pathologists.
abstract: OBJECTIVE
  The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7.
  
  
  RESULTS
  Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases (P = 0.009).
  
  
  CONCLUSIONS
  While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization.
authors.affiliation: Department of Oncology–Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden. lars.egevad@ki.se
authors.forename: Lars
authors.initials: L
authors.lastname: Egevad
authors.forename: Amar S
authors.initials: AS
authors.lastname: Ahmad
authors.forename: Ferran
authors.initials: F
authors.lastname: Algaba
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Berney
authors.forename: Liliane
authors.initials: L
authors.lastname: Boccon-Gibod
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Evans
authors.forename: David
authors.initials: D
authors.lastname: Griffiths
authors.forename: Rainer
authors.initials: R
authors.lastname: Grobholz
authors.forename: Glen
authors.initials: G
authors.lastname: Kristiansen
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Beltran
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.forename: Sue
authors.initials: S
authors.lastname: Moss
authors.forename: Pedro
authors.initials: P
authors.lastname: Oliveira
authors.forename: Ben
authors.initials: B
authors.lastname: Vainer
authors.forename: Murali
authors.initials: M
authors.lastname: Varma
authors.forename: Philippe
authors.initials: P
authors.lastname: Camparo
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology*; D001706:Biopsy; D032921:Consensus; D005060:Europe; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D015588:Observer Variation; D010340:Pathology, Surgical / Q000379:methods / Q000592:standards; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology*; D015203:Reproducibility of Results