title: Improving the Gleason grading accuracy of transrectal ultrasound-guided biopsy.
abstract: BACKGROUND
  Transrectal ultrasound (TRUS)-guided prostate biopsy is the technique of choice for the assessment of clinical suspicion of prostate cancer (PC) based on abnormal digital rectal examination (DRE) and/or elevated or rising levels of prostate-specific antigen (PSA).
  
  
  OBJECTIVE
  To identify factors involved in TRUS-guided prostate biopsy, which can be modified by radiologists in order to improve Gleason score (GS) accuracy, and to assess the influence of clinical variables.
  
  
  METHODS
  We carried out a retrospective review of the records of 185 patients with PC treated surgically at our hospital between 2005 and 2008. Biopsy schemes were classified according to the number of cores (≤7, 8-9, 10-11, 12-15) and the needle length (11, 16, 20 mm). Clinical characteristics - age, family history of PC, DRE, PSA levels, and sonographic data - and prostatectomy GS (pGS) were collected.
  
  
  RESULTS
  Non-random concordance between biopsy Gleason score (bGS) and pGS was obtained for 36% of patients (P < 0.001). Under- and over-staging were 30% and 4%, respectively. Concordance was correlated with the core number (45% for ≤7, 54% for 8-9, 85% for 10-11, and 80% for 12-15; P < 0.001), but not with the needle length. The concordance rate showed a seven-fold increase when 10-11 cores were obtained (95% CI, 2-18; P < 0.001) compared to those cases in which the core number obtained was ≤7. Among clinical variables, only PSA correlated with concordance, showing an inverse relationship.
  
  
  CONCLUSIONS
  The Gleason correlation values were not improved when 12 or more cores were collected. These values reached a plateau beyond that number of samples. Therefore, when determining treatment strategies, physicians must consider the biopsy scheme used since it has proven to be a predictor of the accuracy of the PC grading system.
authors.affiliation: Diagnostic Imaging Department, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Nieto-Morales
authors.forename: Julián
authors.initials: J
authors.lastname: Fernández-Ramos
authors.forename: Lina
authors.initials: L
authors.lastname: Pérez-Méndez
authors.forename: Elena
authors.initials: E
authors.lastname: Alventosa-Fernández
authors.forename: María Soledad
authors.initials: MS
authors.lastname: Pastor-Santoveña
authors.forename: Angeles
authors.initials: A
authors.lastname: Arias-Rodríguez
authors.forename: Armando
authors.initials: A
authors.lastname: Aguirre-Jaime
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
keywords: Gleason; Prostatic neoplasms; needle biopsy; prostatectomy; transrectal ultrasound-guided prostate biopsy; ultrasonography