Document Type : Review Article
Pediatric Pathology Research Center, Shahid Beheshti University of Medical Sciences Tehran, Iran
APCP, Pathobiology Laboratory Center, Tehran, Iran
APCP, Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Background: Presence of discordance between the Gleason score on needle biopsy and the score of radical prostatectomy specimen is common and universal. In this study, we determined the accuracy of Gleason grading of biopsies in predicting histological grading of radical prostatectomy specimens and the degree of overgrading and undergrading of prostatic adenocarcinoma in our center, which is one of the referral centers in Tehran.
Methods: In this retrospective study, we analyzed the results of prostate needle biopsies and subsequent prostatectomies diagnosed at the Pathobiology Laboratory Center, Tehran, Iran in 45 patients between 2002 and 2013. Preoperative clinical data and theinformation from biopsy and prostatectomy specimens were collected.The accuracy, sensitivity, specificity, and positive and negative predictive values of different grades and groups were assessed. Pearson and Spearman correlation coefficient were used to determine the relation of different variables.
Results: The biopsy Gleason score was identical to the scores in prostatectomy specimens in 68.2% cases, while 31.8% were discrepant by 1 or 2 Gleason score. We had 9.1% downgrading and 22.7% cases upgraded after prostatectomy. The sensitivity and positive predictive value was 86% and 79% for low grade, 67% and 75% for moderate grade, and 80% and 80% for high-grade tumors, respectively. Conclusion: Overall, the reliability of Gleason grading of needle biopsies in predicting final pathology was satisfavory. Moderate grade group was the most difficult to diagnose in needle biopsy.
- Ro JY, Kim K-R, Shen SS, Amin MB, Ayala AG. Tumors and tumor-like conditions of the male genital tract. In: Fletcher CDM, editor. Diagnostic Histopathology of Tumors. 4th ed. Philadelphia: Saunders; 2013.
- Gleason DF. Classification of prostatic carcinoma. Cancer Chemother Rep 1966; 50(3):125-8.
- Amin MB, Grignon DJ, Humphery PA, Srigley JR. Gleason grading of prostate cancer. Philadelphia: Lippincott Williams & Wilkins; 2004.
- King CR.Patterns of prostate cancer biopsy grading: Trends and clinical implications. IJC 2000; 90(6):305-11.
- Humphrey PA. Prostate pathology. Chicago: ASCP Press; 2003.
- Cohen MS, Hanley RS, Kurteva T, Ruthazer R, Silverman ML, Sorcini A, et al. Comparing the Gleason prostate biopsy and Gleason prostatectomy grading system: The Lahey Clinic Medical Center Experience and an International Meta-Analysis. Eur Urol 2008; 54(2):371-81.
- Fine SW, Epstein JI. A Contemporary Study Correlating Prostate Needle Biopsy and Radical Prostatectomy Gleason Score. J Urol 2008; 179(4):1335-9.
- Memis A, Ugurlu O, Ozden C, Oztekin CV, Aktas BK, Akdemir AO. The correlation among the percentage of positive biopsy cores from the dominant side of prostate, adverse pathology, and biochemical failure after radical prostatectomy. Kaohsiung J Med Sci 2011; 27(8):307-13.
- Müntener M, Epstein JI, Hernandez DJ, Gonzalgo ML, Mangold L, Humphreys E, et al. Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy. Eur Urol 2008; 53(4):767-76.
- Bostwik DG. Gleason grading of prostatic needle biopsies. Correlation with grade in 316 matched prostatectomies. Am J Surg Pathol 1994; 18(8):796-803.
- Steinberg DM, Sauvageot J, Piantadosi S, Epstein JI. Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. Am J Surg Pathol 1997; 21(5):566-76.
- Cookson MS, Fleshner NE, Soloway SM, Fair RF. Correlation between Gleason score of needle biopsy and radical prostatectomy specimens: Accuracy and clinical implications. J Urol 1997; 157(2):559-62.
- Rubin MA, Dunn R, Kambham N, Misick CP, O’Toole KM. Should a Gleason score be assigned to a minute focus of carcinoma on prostate biopsy? Am J Surg Pathol 2000; 24(12):1634-40.
- Lange PH, Narayan P. Understaging and undergrading of prostate cancer. Urology 1983; 21(2):113-8.
- Garnett JE, Oyasu R, Grayhack JT. The accuracy of diagnostic biopsy specimen in predicting tumor grades by Gleason's classification of radical prostatectomy specimens. J Urol 1984; 131(4):690-3.
- Mills SE, Fowler JE. Gleason histologic grading of prostatic carcinoma. Correlation between biopsy and prostatectomy specimens. Cancer 1986; 57(2):346-9.
- Epstein JI, Netto GJ. Biopsy interpretation of the prostate. Philadelphia: Lippincott Williams & Wilkins; 2008.
- Ruijter E, Van Leenders G, Miller G, Debruyne F, Van de Kaa C. Errors in histological grading by prostatic needle biopsy specimens: frequency and predisposing factors. J Pathol 2000; 192(2):229-33.
- Gleason DF. Histologic grading of prostate cancer: a perspective. Hum Pathol 1992; 23(3):273–79.
- Divrik RT, Eroğlu, A, Şahin A, ZorluF, Özen H. Increasing the number of biopsies increases the concordance of Gleason scores of needle biopsies and prostatectomy specimens. Eur Urol 2007; 25(5):376-82.
- Freeman A. Perineural and lymphovascular invasion on prostatic biopsy: Pathological assessment and significance. Surg Oncol 2009; 18(3):200-2.