title: Review by urological pathologists improves the accuracy of Gleason grading by general pathologists.
abstract: BACKGROUND
  Urologists use biopsy Gleason scores for patient counseling, prognosis prediction, and decision making. The accuracy of Gleason grading is very important. However, the variability of Gleason grading between general pathologists cannot be overlooked. Here we evaluate the discrepancy in the Gleason grading between 2 urologic pathologists and general pathologists as well as improvement in the accuracy of Gleason grading by general pathologists as a result of review by urologic pathologists.
  
  
  METHODS
  The subjects enrolled in the study were 755 patients who underwent prostate needle biopsy at affiliate hospitals of Nara Medical University over a period of 2 years. The biopsy samples were diagnosed by general pathologists. All biopsy samples were sent to Nara Medical University where they were diagnosed by 2 urologic pathologists. The results were then returned to the general pathologists. We compared the diagnostic accuracy of the general pathologists with that of the urologic pathologists for the parameters of no malignancy, atypical small acinar proliferation, high grade prostatic intraepithelial neoplasia and Gleason score (6, 3 + 4, 4 + 3 and 8-10). We then evaluated the concordance rate between the general and urologic pathologists for each of four consecutive 6-month periods.
  
  
  RESULTS
  The overall concordance rate of urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 71.8% (140/198), 79.8% (168/225), 89.7% (166/185) and 89.9% (133/148), respectively. The concordance rate of the Gleason score between urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 47.5% (38/80), 62.6% (57/91),76.9% (50/65) and 78.7% (48/61), respectively, and the kappa value was 0.55, 0.68, 0.81 and 0.84, respectively. The concordance rate improved significantly over the course of each period (P = 0.04).
  
  
  CONCLUSIONS
  The concordance rate of the Gleason grading between the general pathologists and the urologic pathologists was 47.5%. However, improvement of the concordance rate as a result of review by the urological pathologist could be seen.
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. nakaiyasusiuro@live.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. sendo@naramed-u.ac.jp.
authors.forename: Nobumichi
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. keijishi@naramed-u.ac.jp.
authors.forename: Keiji
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. nkonishi@naramed-u.ac.jp.
authors.forename: Noboru
authors.initials: N
authors.lastname: Konishi
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. makitomiyake@yahoo.co.jp.
authors.forename: Makito
authors.initials: M
authors.lastname: Miyake
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. sanai@naramed-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Anai
authors.affiliation: Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. kiyokun@naramed-u.ac.jp.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010336:Pathology / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014572:Urology / Q000706:statistics & numerical data*