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Int J Clin Exp Pathol 2010;3(x):xxx-xxx
Original Article
The value of second opinion pathology diagnoses on prostate biopsies from patients
referred for management of prostatic cancer
Al B. Barqawi, Ruslan Turcanu, M. Scott Lucia, Colin I. O’Donnell, E. David Crawford, Francisco G. La Rosa
Department of Medicine, Division of Medical Oncology; Department of Pathology, and Department of Surgery, Division of Urology, University of
Colorado Denver, School of Medicine, Aurora, CO 80045, USA.
Received February 18, 2010, accepted May, 2010, available online: May, 2010
Abstract: Gleason scoring is used to predict patient's clinical outcome and to customize treatment strategies in patients with prostatic
adenocarcinoma. However, due in part to pathologist misgrading, there is significant discrepancy of Gleason scores between needle biopsy
and radical prostatectomy specimens, which could have significant clinical impact. We assessed the requirement for re-evaluating biopsy
specimens diagnosed by outside pathologists in patients referred to our institution for management of prostatic cancer. One hundred patients
undergoing radical prostatectomy for clinically localized prostatic adenocarcinoma were studied. We reviewed both the original “outside”
biopsy pathology evaluation and “in-house” second opinion evaluation of the same specimens, followed by final in-house diagnosis of the
whole mount prostatectomy specimens. Outside and in-house biopsy Gleason scores (sum of primary plus secondary grades) was compared
to scores from whole-mount prostatectomy specimens (gold standard for analysis). We found that both outside and in-house biopsy Gleason
scoring varies significantly from the whole-mount diagnoses, with Gleason under-grading substantially predominating above over-grading.
The main diagnostic discrepancy was in the differentiation between primary and secondary Gleason grades (3 plus 4 vs. 4 plus 3). Statistical
analysis demonstrated that outside biopsy Gleason scoring was significantly less accurate with respect to the whole-mount specimens than
the in-house scoring. Since accurate Gleason scoring is a critical factor for appropriate treatment selection, we recommend that a re-
evaluation by in-house urologic pathologists should be performed in all outside biopsy specimens before patients are admitted for treatment in
any given Institution. (IJCEP1002007).
Key words: Prostate cancer, second opinion, gleason score, gleason grade, needle biopsy, radical prostatectomy
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Original Article
The value of second opinion pathology diagnoses on prostate biopsies from patients
referred for management of prostatic cancer
Al B. Barqawi, Ruslan Turcanu, M. Scott Lucia, Colin I. O’Donnell, E. David Crawford, Francisco G. La Rosa
Department of Medicine, Division of Medical Oncology; Department of Pathology, and Department of Surgery, Division of Urology, University of
Colorado Denver, School of Medicine, Aurora, CO 80045, USA.
Received February 18, 2010, accepted May, 2010, available online: May, 2010
Abstract: Gleason scoring is used to predict patient's clinical outcome and to customize treatment strategies in patients with prostatic
adenocarcinoma. However, due in part to pathologist misgrading, there is significant discrepancy of Gleason scores between needle biopsy
and radical prostatectomy specimens, which could have significant clinical impact. We assessed the requirement for re-evaluating biopsy
specimens diagnosed by outside pathologists in patients referred to our institution for management of prostatic cancer. One hundred patients
undergoing radical prostatectomy for clinically localized prostatic adenocarcinoma were studied. We reviewed both the original “outside”
biopsy pathology evaluation and “in-house” second opinion evaluation of the same specimens, followed by final in-house diagnosis of the
whole mount prostatectomy specimens. Outside and in-house biopsy Gleason scores (sum of primary plus secondary grades) was compared
to scores from whole-mount prostatectomy specimens (gold standard for analysis). We found that both outside and in-house biopsy Gleason
scoring varies significantly from the whole-mount diagnoses, with Gleason under-grading substantially predominating above over-grading.
The main diagnostic discrepancy was in the differentiation between primary and secondary Gleason grades (3 plus 4 vs. 4 plus 3). Statistical
analysis demonstrated that outside biopsy Gleason scoring was significantly less accurate with respect to the whole-mount specimens than
the in-house scoring. Since accurate Gleason scoring is a critical factor for appropriate treatment selection, we recommend that a re-
evaluation by in-house urologic pathologists should be performed in all outside biopsy specimens before patients are admitted for treatment in
any given Institution. (IJCEP1002007).
Key words: Prostate cancer, second opinion, gleason score, gleason grade, needle biopsy, radical prostatectomy
Full text PDF
Address all correspondence to:
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