Gleason and Fuhrman no longer make the grade.
Grading is an important prognostic parameter for prostate adenocarcinoma and renal cell carcinoma (RCC); however, the most frequently used classifications fail to account for advances in our understanding of the diagnostic features, classification and/or behaviour of these tumours. In 2005 and 2014, the International Society of Urological Pathology (ISUP) proposed changes to Gleason scoring with the adoption of the ISUP grading for prostate cancer in 2014 (grade 1, score 3 + 3; grade 2, score 3 + 4; grade 3, score 4 + 3; grade 4, score 8; grade 5, score 9-10). Internationally the Fuhrman grading system is widely employed despite criticisms related to its application, validity, and reproducibility. In 2012, the ISUP established a grading system for RCC (grade 1, the nucleolus is not seen or is inconspicuous and basophilic at ×400 magnification; grade 2, nucleoli are eosinophilic and clearly visible at ×400 magnification; grade 3, nucleoli are clearly visible at ×100 magnification; grade 4, tumours show extreme pleomorphism or rhabdoid and/or sarcomatoid morphology). This grading has been validated for clear cell RCC and papillary RCC. It was further recommended that chromophobe RCC not be graded. For other morphotypes of RCC, ISUP grading has not been validated as a prognostic parameter, but can be used for descriptive purposes.
Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
Brett
B
Delahunt
Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Lars
L
Egevad
Aquesta Uropathology, Brisbane, Queensland, Australia.
Hemamali
H
Samaratunga
Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
Guido
G
Martignoni
Department of Surgery, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
John N
JN
Nacey
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
John R
JR
Srigley
D000230:Adenocarcinoma / Q000473:pathology*; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D060787:Neoplasm Grading / Q000379:methods* / Q000592:standards; D011471:Prostatic Neoplasms / Q000473:pathology*
Fuhrman; Gleason; International Society of Urological Pathology; prostatic adenocarcinoma; renal cell carcinoma