A working group classification of focal prostate atrophy lesions

De Marzo A.M., Platz E.A., Epstein J.I., Ali T., Billis A., Chan T.Y., Cheng L., Datta M., Egevad L., Ertoy-Baydar D., Farree X., Fine S.W., Iczkowski K.A., Ittmann M., Knudsen B.S., Loda M., Lopez-Beltran A., Magi-Galluzzi C., Mikuz G., Montironi R., Pikarsky E., Pizov G., Rubin M.A., Samaratunga H., Sebo T., Sesterhenn I.A., Shah R.B., Signoretti S., Simko J., Thomas G., Troncoso P., Tsuzuki T.T., Van Leenders G.J., Yang X.J., Zhou M., Figg W.D., Hoque A. and Lucia M.S. (2006) A working group classification of focal prostate atrophy lesions. American Journal of Surgical Pathology, 30 10: 1281-1291. doi:10.1097/01.pas.0000213289.50660.be

Author De Marzo A.M.
Platz E.A.
Epstein J.I.
Ali T.
Billis A.
Chan T.Y.
Cheng L.
Datta M.
Egevad L.
Ertoy-Baydar D.
Farree X.
Fine S.W.
Iczkowski K.A.
Ittmann M.
Knudsen B.S.
Loda M.
Lopez-Beltran A.
Magi-Galluzzi C.
Mikuz G.
Montironi R.
Pikarsky E.
Pizov G.
Rubin M.A.
Samaratunga H.
Sebo T.
Sesterhenn I.A.
Shah R.B.
Signoretti S.
Simko J.
Thomas G.
Troncoso P.
Tsuzuki T.T.
Van Leenders G.J.
Yang X.J.
Zhou M.
Figg W.D.
Hoque A.
Lucia M.S.
Title A working group classification of focal prostate atrophy lesions
Journal name American Journal of Surgical Pathology   Check publisher's open access policy
ISSN 0147-5185
Publication date 2006
Sub-type Article (original research)
DOI 10.1097/01.pas.0000213289.50660.be
Volume 30
Issue 10
Start page 1281
End page 1291
Total pages 304
Language eng
Subject 2702 Anatomy
2734 Pathology and Forensic Medicine
Abstract Focal atrophy is extremely common in prostate specimens. Although there are distinct histologic variants, the terminology is currently nonstandardized and no formal classification has been tested for interobserver reliability. This lack of standardization hampers the ability to study the biologic and clinical significance of these lesions. After informal and formal meetings by a number of the authors, focal atrophy lesions were categorized into 4 distinct subtypes as follows: (i) simple atrophy, (ii) simple atrophy with cyst formation, (iii) postatrophic hyperplasia, and (iv) partial atrophy. In phase 1 of the study, pathologists with varying levels of experience in prostate pathology were invited to view via the Internet a set of "training" images with associated descriptions of lesions considered typical of each subtype. In phase 2 of the study, each participant provided diagnoses on a series of 140 distinct "test" images that were viewed over the Internet. These test images consisted of the 4 subtypes of atrophy and images of normal epithelium, high grade prostatic intraepithelial neoplasia, and carcinoma. The diagnoses for each image from each pathologist were compared with a set of "standard" diagnoses and the κ statistic was computed. Thirty-four pathologists completed both phases of the study. The interobserver reliability (median κ) for classification of lesions as normal, cancer, prostatic intraepithelial neoplasia, or focal atrophy was 0.97. The median κ for the classification of atrophy lesions into the 4 subtypes was 0.80. The median percent agreement with the standard diagnosis for the atrophy subtypes were: simple 60.6%, simple with cyst formation 100%; postatrophic hyperplasia 87.5%; partial atrophy 93.9%. The lower percentage for simple atrophy reflected a propensity to diagnose some of these as simple atrophy with cyst formation. Seven pathologists completed the phase 2 analysis a second time, and their intraobserver reproducibility was excellent. Three of 4 pathologists with low agreement with the standard diagnosis for simple atrophy improved their scores after repeating the analysis after re-examination of the "training set" of images. In conclusion, these criteria for variants of focal prostate atrophy may facilitate studies to examine the relation between various patterns of prostate atrophy and prostate cancer. Copyright
Keyword Focal prostate atrophy
Interobserver reliability
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
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