title: Agreement of Gleason score on prostate biopsy and radical prostatectomy specimen: is there improvement with increased number of biopsy cylinders and the 2005 revised Gleason scoring?
abstract: BACKGROUND
  The objectives of this study were to assess the agreement of GS on biopsy compared with RP specimens and to assess whether an increased number of biopsy cylinders and the 2005 International Society of Urological Pathology (ISUP) GS modification improved this agreement.
  
  
  METHODS
  Pathological data of biopsy and RP specimens were analyzed in 328 consecutive patients, before (group 1; n = 135) and after (group 2; n = 193) implementation of the 2005 ISUP modification. Additionally, patients had more biopsy cylinders taken in group 2 (mean 10 vs. 6.9). The agreement of GS between biopsy and RP specimens was evaluated using the kappa coefficient. GS was pooled into 3 grades: low- (GS ≤ 6), intermediate- (GS = 7), and high-grade (GS ≥ 8) prostate cancer.
  
  
  RESULTS
  Kappa coefficient for GS in group 1 and 2 was 0.261 and 0.341, respectively. For tumor grade, this was 0.308 and 0.359 for group 1 and 2, respectively. For RP specimens, there was more agreement between biopsy and RP GS in group 2 compared with group 1 (53.9% vs. 37.8%). Upgrading was almost exclusively (89.5%) seen in patients with biopsy GS ≤ 6 and was lower in group 2 (25.4% vs. 48.1%) because of classification of more intermediate- and high-grade tumors using the 2005 ISUP modification. Taking > 6 biopsy cylinders was associated with better GS and tumor grade agreement.
  
  
  CONCLUSIONS
  Extended biopsy template and the 2005 ISUP modification resulted in an improved agreement between biopsy GS and RP GS and a shift toward more aggressive tumors.
authors.affiliation: Department of Urology, Ghent University Hospital, Ghent, Belgium. Electronic address: charles.vanpraet@uzgent.be.
authors.forename: Charles
authors.initials: C
authors.lastname: Van Praet
authors.affiliation: Department of Pathology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Louis
authors.initials: L
authors.lastname: Libbrecht
authors.affiliation: Department of Urology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Frederiek
authors.initials: F
authors.lastname: D'Hondt
authors.affiliation: Department of Urology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Karel
authors.initials: K
authors.lastname: Decaestecker
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Fonteyne
authors.affiliation: Department of Pathology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Verschuere
authors.affiliation: Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rottey
authors.affiliation: Department of Pathology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Praet
authors.affiliation: Department of Radiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: De Visschere
authors.affiliation: Department of Urology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Lumen
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009929:Organ Size; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014463:Ultrasonography
keywords: Biopsy; Gleason score; Pathology; Prostatectomy; Prostatic neoplasms