Diagnosis of "poorly formed glands" Gleason pattern 4 prostatic adenocarcinoma on needle biopsy: An interobserver reproducibility study among urologic pathologists with recommendations

Ming Zhou, Jianbo Li, Liang Cheng, Lars Egevad, Fang Ming Deng, Lakshmi Priya Kunju, Cristina Magi-Galluzzi, Jonathan Melamed, Rohit Mehra, Savvas Mendrinos, Adeboye O. Osunkoya, Gladell Paner, Steve S. Shen, Toyonori Tsuzuki, Kiril Trpkov, Wei Tian, Ximing Yang, Rajal B. Shah

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Accurate recognition of Gleason pattern (GP) 4 prostate carcinoma (PCa) on needle biopsy is critical for patient management and prognostication. "Poorly formed glands" are the most common GP4 subpattern. We studied the diagnostic reproducibility and the quantitative threshold of grading GP4 "poorly formed glands" and the criteria to distinguish them from tangentially sectioned GP3 glands. Seventeen urologic pathologists were first queried for the definition of "poorly formed glands" using cases representing a spectrum of PCa glandular differentiation. Cancer glands with no or rare lumens, elongated compressed glands, and elongated nests were considered "poorly formed glands" by consensus. Participants then graded a second set of 23 PCa cases that potentially contained "poorly formed glands" with a fair interobserver agreement (k=0.34). The consensus diagnoses, defined as agreement by >70% participants, were then correlated with the quantitative (≤5, 6 to 10, >10) and topographic features of poorly formed glands (clustered, immediately adjacent to, and intermixed with other well-formed PCa glands) in each case. Poorly formed glands immediately adjacent to other well-formed glands regardless of their number and small foci of ≤5 poorly formed glands regardless of their location were not graded as GP4. In contrast, large foci of >10 poorly formed glands that were not immediately adjacent to well-formed glands were graded as GP4. Grading "poorly formed glands" is challenging. Some morphologic features are, however, reproducible for and against a GP4 diagnosis. This study represents an important step in standardization of grading of "poorly formed glands" based on quantitative and topographic morphologic features.

Original languageEnglish (US)
Pages (from-to)1331-1339
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume39
Issue number10
DOIs
StatePublished - Oct 1 2015

Keywords

  • Gleason grade
  • Gleason pattern 4
  • Interobserver reproducibility
  • Poorly formed glands
  • Prostate cancer
  • Prostate needle biopsy

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Fingerprint Dive into the research topics of 'Diagnosis of "poorly formed glands" Gleason pattern 4 prostatic adenocarcinoma on needle biopsy: An interobserver reproducibility study among urologic pathologists with recommendations'. Together they form a unique fingerprint.

Cite this