Review by urological pathologists improves the accuracy of Gleason grading by general pathologists

BACKGROUNDS Urologists use biopsy Gleason scores for patient counseling, prognosis prediction, and decision making. The accuracy of Gleason grading is very important. However, the variability of Gleason grading between general pathologists cannot be overlooked. Here we evaluate the discrepancy in the Gleason grading between 2 urologic pathologists and general pathologists as well as improvement in the accuracy of Gleason grading by general pathologists as a result of review by urologic pathologists. METHODS The subjects enrolled in the study were 755 patients who underwent prostate needle biopsy at affiliate hospitals of Nara Medical University over a period of 2 years. The biopsy samples were diagnosed by general pathologists. All biopsy samples were sent to Nara Medical University where they were diagnosed by 2 urologic pathologists. The results were then returned to the general pathologists. We compared the diagnostic accuracy of the general pathologists with that of the urologic pathologists for the parameters of no malignancy, atypical small acinar proliferation, high grade prostatic intraepithelial neoplasia and Gleason score (6, 3 + 4, 4 + 3 and 8-10). We then evaluated the concordance rate between the general and urologic pathologists for each of four consecutive 6-month periods. RESULTS The overall concordance rate of urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 71.8% (140/198), 79.8% (168/225), 89.7% (166/185) and 89.9% (133/148), respectively. The concordance rate of the Gleason score between urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 47.5% (38/80), 62.6% (57/91),76.9% (50/65) and 78.7% (48/61), respectively, and the kappa value was 0.55, 0.68, 0.81 and 0.84, respectively. The concordance rate improved significantly over the course of each period (P = 0.04). CONCLUSION The concordance rate of the Gleason grading between the general pathologists and the urologic pathologists was 47.5%. However, improvement of the concordance rate as a result of review by the urological pathologist could be seen.