Gleason grade 4 prostate adenocarcinoma patterns: an interobserver agreement study among genitourinary pathologists

Kweldam, Charlotte F., Nieboer, Daan, Algaba, Ferran, Amin, Mahul B., Berney, Dan M., Billis, Athanase, Bostwick, David G., Bubendorf, Lukas, Cheng, Liang, Comperat, Eva, Delahunt, Brett, Egevad, Lars, Evans, Andrew J., Hansel, Donna E., Humphrey, Peter A., Kristiansen, Glen, van der Kwast, Theodorus H., Magi-Galluzzi, Cristina, Montironi, Rodolfo, Netto, George J., Samaratunga, Hemamali, Srigley, John R., Tan, Puay H., Varma, Murali, Zhou, Ming and van Leenders, Geert J. L. H. (2016) Gleason grade 4 prostate adenocarcinoma patterns: an interobserver agreement study among genitourinary pathologists. Histopathology, 69 3: 441-449. doi:10.1111/his.12976

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Author Kweldam, Charlotte F.
Nieboer, Daan
Algaba, Ferran
Amin, Mahul B.
Berney, Dan M.
Billis, Athanase
Bostwick, David G.
Bubendorf, Lukas
Cheng, Liang
Comperat, Eva
Delahunt, Brett
Egevad, Lars
Evans, Andrew J.
Hansel, Donna E.
Humphrey, Peter A.
Kristiansen, Glen
van der Kwast, Theodorus H.
Magi-Galluzzi, Cristina
Montironi, Rodolfo
Netto, George J.
Samaratunga, Hemamali
Srigley, John R.
Tan, Puay H.
Varma, Murali
Zhou, Ming
van Leenders, Geert J. L. H.
Title Gleason grade 4 prostate adenocarcinoma patterns: an interobserver agreement study among genitourinary pathologists
Journal name Histopathology   Check publisher's open access policy
ISSN 1365-2559
Publication date 2016-09-01
Sub-type Article (original research)
DOI 10.1111/his.12976
Open Access Status File (Author Post-print)
Volume 69
Issue 3
Start page 441
End page 449
Total pages 9
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2017
Language eng
Formatted abstract
Aims: To assess the interobserver reproducibility of individual Gleason grade 4 growth patterns.

Methods and results: Twenty-three genitourinary pathologists participated in the evaluation of 60 selected high-magnification photographs. The selection included 10 cases of Gleason grade 3, 40 of Gleason grade 4 (10 per growth pattern), and 10 of Gleason grade 5. Participants were asked to select a single predominant Gleason grade per case (3, 4, or 5), and to indicate the predominant Gleason grade 4 growth pattern, if present. ‘Consensus’ was defined as at least 80% agreement, and ‘favoured’ as 60–80% agreement. Consensus on Gleason grading was reached in 47 of 60 (78%) cases, 35 of which were assigned to grade 4. In the 13 non-consensus cases, ill-formed (6/13, 46%) and fused (7/13, 54%) patterns were involved in the disagreement. Among the 20 cases where at least one pathologist assigned the ill-formed growth pattern, none (0%, 0/20) reached consensus. Consensus for fused, cribriform and glomeruloid glands was reached in 2%, 23% and 38% of cases, respectively. In nine of 35 (26%) consensus Gleason grade 4 cases, participants disagreed on the growth pattern. Six of these were characterized by large epithelial proliferations with delicate intervening fibrovascular cores, which were alternatively given the designation fused or cribriform growth pattern (‘complex fused’).

Conclusions: Consensus on Gleason grade 4 growth pattern was predominantly reached on cribriform and glomeruloid patterns, but rarely on ill-formed and fused glands. The complex fused glands seem to constitute a borderline pattern of unknown prognostic significance on which a consensus could not be reached.
Keyword Gleason grading
Interobserver variability
Prostate cancer
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

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