Pathologist experience critical for accurate Gleason score

Researchers from Hungary have found that concordance between the preoperative and postoperative staging of prostate cancer in patients undergoing radical prostatectomy increases with pathologist experience.

Writing in International Urology and Nephrology, the team says that the findings emphasize the need to “improve the experience of pathologists and assure their regular training in order to perform proper [Gleason score] and grading evaluation.”

They examined results from 322 patients whose samples were assessed at an academic pathology department processing a large volume of prostate samples (Group 1), compared with those of 108 patients assessed at a non-academic low-volume department with limited experience of radical prostatectomy grading (Group 2).

The team found that, on the whole, preoperative Gleason scores from biopsies differed significantly from those obtained from radical prostatectomy, at a mean of 6.2 and 6.9, respectively.

This gave an overall concordance rate between pre- and postoperative grading of 50.7%, with a significantly higher concordance seen for Group 1 than Group 2, at 58.4% versus 27.7%

The overall rates of preoperative undergrading, upgrading, and understaging were 36.0%, 13.3%, and 35.1%, respectively. However, undergrading was significantly more common in Group 2, at 56.5% compared with 29.1% in Group 1. Rates of upgrading and understaging were comparable between the two groups, with the exception of upgrading by two Gleason grades (well-differentiated to poorly differentiated) being significantly more common in Group 2 (6.5 vs 1.9% in Group 1).

Authors Attila Majoros (Semmelweis University, Budapest, Hungary) and colleagues, say that their findings indicate that patients who were preoperatively graded at non-academic departments may have missed out on curative treatments due to surveillance being chosen over surgery.

“In contrast, the less frequently described upgrading can lead to overtreatment, namely to unnecessary surgery,” they add.

They conclude: “The experience of the pathologist has a significant influence on the concordance of [Gleason score] and grade, and on the rate of undergrading of [prostate biopsy] in contrast to the post-operative specimen.”

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