Diagnostic criteria for ductal adenocarcinoma of the prostate: Interobserver variability among 20 expert uropathologists

Amanda H. Seipel, Brett Delahunt, Hemamali Samaratunga, Mahul Amin, Joel Barton, Daniel M. Berney, Athanase Billis, Liang Cheng, Eva Comperat, Andrew Evans, Samson W. Fine, David Grignon, Peter A. Humphrey, Cristina Magi-Galluzzi, Rodolfo Montironi, Isabell Sesterhenn, John R. Srigley, Kiril Trpkov, Theo van der Kwast, Murali VarmaMing Zhou, Amar Ahmad, Sue Moss, Lars Egevad

Research output: Contribution to journalArticle

23 Scopus citations


Aims: Ductal adenocarcinoma of the prostate (DAC) is clinically important, because its behaviour may differ from that of acinar adenocarcinoma. Our aims were to investigate the interobserver variability of this diagnosis among experts in uropathology and to define diagnostic criteria. Methods and results: Photomicrographs of 21 carcinomas with ductal features were distributed among 20 genitourinary pathologists from eight countries. DAC was diagnosed by 18 observers (mean 13.2 cases, range 6-19). In 11 (52%) cases, a 2/3 consensus was reached for a diagnosis of DAC, and in five (24%) there was consensus against. In DAC, the respondents reported papillary architecture (86%), stratification of nuclei (82%), high-grade nuclear features (54%), tall columnar epithelium (53%), elongated nuclei (52%), cribriform architecture (40%), and necrosis (7%). The most important diagnostic feature reported for DAC was papillary architecture (59%), whereas nuclear and cellular features were considered to be most important in only 2-11% of cases. The most common differential diagnoses were intraductal prostate cancer (52%), high-grade PIN (37%), and acinar adenocarcinoma (17%). The most common reason for not diagnosing DAC was lack of typical architecture (33%). Conclusions: Papillary architecture was the most useful diagnostic feature of DAC, and nuclear and cellular features were considered to be less important.

Original languageEnglish (US)
Pages (from-to)216-227
Number of pages12
Issue number2
StatePublished - Aug 2014



  • Ductal cancer
  • Pathology
  • Prostate cancer
  • Prostatectomy

ASJC Scopus subject areas

  • Histology
  • Pathology and Forensic Medicine
  • Medicine(all)

Cite this

Seipel, A. H., Delahunt, B., Samaratunga, H., Amin, M., Barton, J., Berney, D. M., Billis, A., Cheng, L., Comperat, E., Evans, A., Fine, S. W., Grignon, D., Humphrey, P. A., Magi-Galluzzi, C., Montironi, R., Sesterhenn, I., Srigley, J. R., Trpkov, K., van der Kwast, T., ... Egevad, L. (2014). Diagnostic criteria for ductal adenocarcinoma of the prostate: Interobserver variability among 20 expert uropathologists. Histopathology, 65(2), 216-227. https://doi.org/10.1111/his.12382