title: Comparison of Classic and International Society of Urological Pathology 2005 Modified Gleason grading using needle biopsies from the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial.
abstract: BACKGROUND
  Use of the International Society of Urological Pathology (ISUP) 2005 modified Gleason score may result in higher scores compared with the classic Gleason scoring system.
  
  
  OBJECTIVE
  To compare scores derived using the 2 scoring systems.
  
  
  METHODS
  On-study and for-cause biopsies were centrally reviewed and assigned a classic Gleason score in the Reduction by Dutasteride of prostate Cancer Events trial. Positive biopsies were reviewed by an independent pathologist in a secondary review using the ISUP 2005 modified Gleason score. The independent pathologist also recorded a classic Gleason score.
  
  
  RESULTS
  In total, 1482/1507 (98%) positive biopsy results were independently reviewed. Scores assigned by the 2 pathologists (classic versus modified) agreed in 83% (1230 of 1481) of cases; 99% (1471 of 1481) of cancers were within ±1 of their previous score. Of discordant cases, similar numbers of biopsies were upgraded and downgraded in the secondary review, with minor differences in the score distributions. Interobserver agreement was good, with κ values ranging from 0.62 (95% confidence interval [CI], 0.56-0.67) to 0.70 (95% CI, 0.65-0.76). The overall number of high-grade tumors (Gleason score 8-10; n = 48) remained constant between reviews, with 3 fewer cases in the placebo group (n = 16) and 3 more in the dutasteride group (n = 32) in the secondary review. When comparing the independent pathologist's modified scores versus the classic, 17 of 1481 cancers (1.1%) were upgraded (including 9 of 17 upgrades [53%] to high-grade tumors).
  
  
  CONCLUSIONS
  This analysis showed similar score distributions between the classic and modified Gleason scoring systems. The differences seen between the 2 pathologists' scores likely reflect differences in interpretation rather than the scoring system chosen.
authors.affiliation: From the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Lucia); Bostwick Laboratories, Richmond, Virginia (Dr Bostwick); and GlaxoSmithKline, Research Triangle Park, North Carolina (Mr Somerville, Ms Fowler, and Dr Rittmaster). Ms Fowler is with Pharmaceutical Product Development, 929 North Front St, Wilmington, North Carolina. Dr Rittmaster is now at 42 William Glen Dr, Camden, Maine.
authors.forename: M Scott
authors.initials: MS
authors.lastname: Lucia
authors.forename: David G
authors.initials: DG
authors.lastname: Bostwick
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Somerville
authors.forename: Ivy L
authors.initials: IL
authors.lastname: Fowler
authors.forename: Roger S
authors.initials: RS
authors.lastname: Rittmaster
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D015588:Observer Variation; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D011897:Random Allocation