title: The influence of expertise of the surgical pathologist to undergrading, upgrading, and understaging of prostate cancer in patients undergoing subsequent radical prostatectomy.
abstract: OBJECTIVE
  The main objective of this retrospective study was to evaluate the influence of pathological experience in histological examination of prostate cancer (PCa) on preoperative understaging (UNS), undergrading (UNG), and upgrading (UPG).
  
  
  METHODS
  Histopathological data of prostate biopsy (PB) and radical prostatectomy (RP) specimens of patients undergoing subsequent radical prostatectomy (n = 430) in our center were compared. Histological diagnoses of PB were provided either by corresponding academic pathology institute (Group 1: 322 patients) or by external (nonacademic) departments which had a lower number (≤ 100/year) of PCa histopathological evaluations (Group 2 108 patients). The rate of UNG, UPG, and UNS in both groups and also the effects of institutional learning curve were analyzed in terms of grading and staging.
  
  
  RESULTS
  Significant difference was detected between Group 1 and Group 2 in average preoperative Gleason score (GS) values and in the rate of well, moderately, and poorly differentiated cancers as well. There was also a significant difference in the rate of UNG (29.1 vs. 56.5 %, p < 0.0001). The mean preoperative and postoperative GS in Group 1 was significantly lower in the first 50 than in the last 50 patients, but the rates of UNG, UPG, and UNS did not differ significantly between the groups.
  
  
  CONCLUSIONS
  The experience of pathologists has direct influence on grading concordance and on UNG and UPG, between PB and RP specimen; however, it has no significant effect on complete preoperative understaging. The bigger pathological experience improves the sensitivity of the histological diagnostic process.
authors.affiliation: Department of Urology and Centre of Urooncology, Semmelweis University, Üllői út 78/b, 1082, Budapest, Hungary, majorosat@web.de.
authors.forename: Attila
authors.initials: A
authors.lastname: Majoros
authors.forename: Attila Marcell
authors.initials: AM
authors.lastname: Szász
authors.forename: Péter
authors.initials: P
authors.lastname: Nyirády
authors.forename: Eszter
authors.initials: E
authors.lastname: Székely
authors.forename: Péter
authors.initials: P
authors.lastname: Riesz
authors.forename: Attila
authors.initials: A
authors.lastname: Szendrői
authors.forename: Attila
authors.initials: A
authors.lastname: Keszthelyi
authors.forename: Janina
authors.initials: J
authors.lastname: Kulka
authors.forename: Imre
authors.initials: I
authors.lastname: Romics
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D001706:Biopsy; D002983:Clinical Competence; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010340:Pathology, Surgical / Q000592:standards*; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies