Inter-observer variability of cribriform architecture and percent Gleason pattern 4 in prostate cancer: relation to clin
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ORIGINAL ARTICLE
Inter-observer variability of cribriform architecture and percent Gleason pattern 4 in prostate cancer: relation to clinical outcome Margaretha A. van der Slot 1,2 & Eva Hollemans 3 & Michael A. den Bakker 1,2 & Robert Hoedemaeker 4 & Mike Kliffen 1,2 & Leo M. Budel 1,2 & Natascha N. T. Goemaere 1,2 & Geert J. L. H. van Leenders 3 Received: 11 June 2020 / Revised: 15 July 2020 / Accepted: 6 August 2020 # The Author(s) 2020
Abstract The Grade group is an important parameter for clinical decision-making in prostate cancer. Recently, percent Gleason pattern 4 and presence of invasive cribriform and/or intraductal carcinoma (CR/IDC) have been recognized for their independent predictive value for prostate cancer outcome. There is sparse data on the inter-observer agreement for these pathologic features in practice. Our objectives were to investigate inter-observer variability of percent Gleason pattern and CR/IDC and to relate individual tumour scores to clinical outcome. Our cohort included 80 consecutive radical prostatectomies with a median follow-up 87.1 months (interquartile range 43.3–119.2), of which the slide with largest tumour volume was scored by six pathologists for Grade group (four tiers: 1, 2, 3 and 4/5), percent Gleason pattern 4 (four tiers: 0–25%, 26–50%, 51–75% and 76–100%) and presence of CR/IDC (two tiers: absent, present). The individual assignments were related to post-operative biochemical recurrence (20/80). Inter-observer agreement was substantial (Krippendorff’s α 0.626) for assessment of Grade group and moderate for CR/IDC (α 0.507) and percent Gleason pattern 4 (α 0.551). For each individual pathologist, biochemical recurrence rates incremented by Grade group and presence of CR/IDC, although such relation was less clear for percent Gleason pattern 4. In conclusion, inter-observer agreement for CR/IDC and percent Gleason pattern 4 is lower than for Grade groups, indicating awareness of these features needs further improvement. Grade group and CR/IDC, but not percent Gleason pattern 4 was related to biochemical recurrence for each pathologist, indicating overall validity of individual grade assignments despite inter-observer variability. Keywords Prostate cancer . Grade group . Cribriform . Intraductal . Inter-observer variability
Introduction Radical prostatectomy (RP) is one of the main treatment modalities for prostate cancer. Despite its oncological efficacy, This article is part of the Topical Collection on Quality in Pathology * Margaretha A. van der Slot [email protected] 1
Anser Prostate Clinic, Maasstadweg 21, 3079, DZ Rotterdam, The Netherlands
2
Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands
3
Department of Pathology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
4
Department of Pathology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
RP is complicated by urinary incontinence and erectile dysfunction in a significant number of men [1, 2]. Since postoperative complications and oncological o
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