TY - JOUR
T1 - Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies
AU - Van Der Kwast, Theodorus H.
AU - Evans, Andrew
AU - Lockwood, Gina
AU - Tkachuk, Doug
AU - Bostwick, David G.
AU - Epstein, Jonathan I.
AU - Humphrey, Peter A.
AU - Montironi, Rodolfo
AU - Van Leenders, Geert J.L.H.
AU - Pihl, Carl Gustaf
AU - Neetens, Ingrid
AU - Kujala, Paula M.
AU - Laurila, Marita
AU - Mazerolles, Catharine
AU - Bubendorf, Lukas
AU - Finelli, Antonio
AU - Watson, Kemp
AU - Srigley, John
PY - 2010/2
Y1 - 2010/2
N2 - Pathologists are increasingly exposed to prostate biopsies with small atypical foci, requiring differentiation between adenocarcinoma, atypical small acinar proliferation suspicious for malignancy, and a benign diagnosis. We studied the level of agreement for such atypical foci among experts in urologic pathology and all-round reference pathologists of the European Randomized Screening study of Prostate Cancer (ERSPC). For this purpose, we retrieved 20 prostate biopsies with small (most <1 mm) atypical foci. Hematoxylin and eosin-stained slides, including 10 immunostained slides were digitalized for virtual microscopy. The lesional area was not marked. Five experts and 7 ERSPC pathologists examined the cases. Multirater κ statistics was applied to determine agreement and significant differences between experts and ERSPC pathologists. The κ value of experts (0.39; confidence interval, 0.29-0.49) was significantly higher than that of ERSPC pathologists (0.21; confidence interval, 0.14-0.27). Full (100%) agreement was reached by the 5 experts for 7 of 20 biopsies. Experts and ERSPC pathologists rendered diagnoses ranging from benign to adenocarcinoma on the same biopsy in 5 and 9 biopsies, respectively. Most of these lesions comprised between 2 and 5 atypical glands. The experts diagnosed adenocarcinoma (49%) more often than the ERSPC pathologists (32%) (P<0.001). As agreement was particularly poor for foci comprising <6 glands, we would encourage pathologists to obtain intercollegial consultation of a specialized pathologist for these lesions before a carcinoma diagnosis, whereas clinicians may consider to perform staging biopsies before engaging on deferred or definite therapy.
AB - Pathologists are increasingly exposed to prostate biopsies with small atypical foci, requiring differentiation between adenocarcinoma, atypical small acinar proliferation suspicious for malignancy, and a benign diagnosis. We studied the level of agreement for such atypical foci among experts in urologic pathology and all-round reference pathologists of the European Randomized Screening study of Prostate Cancer (ERSPC). For this purpose, we retrieved 20 prostate biopsies with small (most <1 mm) atypical foci. Hematoxylin and eosin-stained slides, including 10 immunostained slides were digitalized for virtual microscopy. The lesional area was not marked. Five experts and 7 ERSPC pathologists examined the cases. Multirater κ statistics was applied to determine agreement and significant differences between experts and ERSPC pathologists. The κ value of experts (0.39; confidence interval, 0.29-0.49) was significantly higher than that of ERSPC pathologists (0.21; confidence interval, 0.14-0.27). Full (100%) agreement was reached by the 5 experts for 7 of 20 biopsies. Experts and ERSPC pathologists rendered diagnoses ranging from benign to adenocarcinoma on the same biopsy in 5 and 9 biopsies, respectively. Most of these lesions comprised between 2 and 5 atypical glands. The experts diagnosed adenocarcinoma (49%) more often than the ERSPC pathologists (32%) (P<0.001). As agreement was particularly poor for foci comprising <6 glands, we would encourage pathologists to obtain intercollegial consultation of a specialized pathologist for these lesions before a carcinoma diagnosis, whereas clinicians may consider to perform staging biopsies before engaging on deferred or definite therapy.
KW - Diagnostics
KW - Interobserver variation
KW - Pathology
KW - Prostate biopsy
KW - Prostate cancer
KW - Virtual microscopy
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U2 - 10.1097/PAS.0b013e3181c7997b
DO - 10.1097/PAS.0b013e3181c7997b
M3 - Article
C2 - 20061936
AN - SCOPUS:75649145358
VL - 34
SP - 169
EP - 177
JO - American Journal of Surgical Pathology
JF - American Journal of Surgical Pathology
SN - 0147-5185
IS - 2
ER -