Do European Pathologists Follow ISUP 2005 Gleason Grading Guidelines? A Web Based Survey
DM Berney, F Algaba, P Camparo, E Comperat, D Griffiths, G Kristiansen, A Lopez-Beltran, R Montironi, M Varma, L Egevad. St Bartholomew's Hospital, London, United Kingdom; Fundacio Puigvert-University Autonomous, Barcelona, Spain; Centre de Pathologie Amiens Picardie, Paris, France; Hopital La Pitié-Salpetrière, Paris, France; University Hospital of Wales, Cardiff, United Kingdom; University of Bonn, Bonn, Germany; Cordoba University Medical School, Cordoba, Spain; Polytechnic University of the Marche Region, Ancona, Italy; Karolinska Institutet, Stockholm, Sweden
Background: The Gleason grading system underwent a major revision at the International Society of Urological Pathology consensus conference in 2005 (ISUP 2005). It is not known how European uropathologists have adopted or interpreted its recommendations.
Design: A web-based survey was distributed among 661 members of the European Network of Uropathology (ENUP).
Results: Complete replies were received from 266 pathologists in 22 countries. All respondents used Gleason grading and 89% claimed to follow ISUP 2005 recommendations for pattern interpretation and reporting. Most often a Gleason pattern (GP) 3 would be assigned to regular and smoothly rounded cribriform glands (51%), a GP 4 to irregular cribriform glands (98%), poorly formed glands (84%) and glomeruloid glands (86%) and a GP 5 to cribriform glands with comedonecrosis (86%). A Gleason score (GS) 2-3, 4 and 5 would never be given by 98%, 94% and 70%. Clusters of single cells or solid strands of cancer seen already at 20x magnification were required by 72% to diagnose GP 5. Necrosis would be diagnosed as GP 5 by 62% while 38% thought necrosis by itself would be insufficient. Any amount of a secondary pattern of higher grade would be included in the GS by 58%, while others required this pattern to be identified already at medium to low power or to comprise 5% or more of the tumor. Similary, a tertiary GP of higher grade on needle biopsies was included in the GS by only 58%. Among those who embedded biopsy cores separately, only 56% would give a GS for each core/slide examined. Among those who sometimes blocked multiple biopsy cores, 46% would only give an overall GS for the case. A majority (68%) would give a concluding GS for the case and among them the most common method was to give a global GS (77%).
Conclusions: European pathologists generally claim to follow ISUP 2005 recommendations for Gleason grading, but misinterpretation is widespread, with a low threshold for diagnosing secondary GP 4 and not including tertiary GP of higher grade in the GS. Only slightly more than half would give a GS for each core/slide examined when embedded separately. Clarity in teaching ISUP 2005 recommendations is necessary to avoid misinterpretations.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 125, Wednesday Morning