AIMS - To assess the inter-observer reproducibility of individual Gleason grade 4 growth patterns.
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METHODS - Twenty-three genitourinary pathologists participated in the evaluation of 60 selected high-magnification photographs.
The selection included 10 cases of Gleason grade 3, 40 Gleason grade 4 (10 per growth pattern) and 10 Gleason grade 5. Participants were asked to select a single predominant Gleason grade per case (3, 4, 5) and to indicate the predominant Gleason grade 4 growth pattern if present. "Consensus" was defined as at least 80% agreement and "favoured" as 60-80% agreement.
RESULTS - Consensus on Gleason grading was reached in 47/60 (78%) cases, 35 of which were assigned a grade 4. In the 13 non-consensus cases, ill-formed (6/13, 46%) and fused (7/13, 54%) patterns were involved in disagreement. Among the 20 cases where at least 1 pathologist assigned the ill-formed growth pattern none (0%, 0/20) reached consensus. Consensus for fused, cribriform and glomeruloid glands was reached in 2%, 23%, and 38%, respectively. In 9/35 (26%) consensus Gleason grade 4 cases, participants disagreed on growth pattern. Six of these were characterized by large epithelial proliferations with delicate intervening fibro-vascular cores, which were alternately given fused or cribriform growth pattern ("complex fused").
CONCLUSIONS - Consensus on Gleason grade 4 growth pattern was predominantly reached on cribriform and glomeruloid patterns, but rarely on ill-formed and fused glands. The complex fused glands seem to be a borderline pattern of unknown prognostic significance on which a consensus could not be reached. This article is protected by copyright. All rights reserved.
Histopathology. 2016 Mar 30 [Epub ahead of print]
Charlotte F Kweldam, Daan Nieboer, Ferran Algaba, Mahul B Amin, Dan M Berney, Athanase Billis, David G Bostwick, Lukas Bubendorf, Liang Cheng, Eva Compérat, Brett Delahunt, Lars Egevad, Andrew J Evans, Donna E Hansel, Peter A Humphrey, Glen Kristiansen, Theodorus H van der Kwast, Cristina Magi-Galluzzi, Rodolfo Montironi, George J Netto, Hemamali Samaratunga, John R Srigley, Puay H Tan, Murali Varma, Ming Zhou, Geert J L H van Leenders
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