Poster session 6: Prostate cancer| Volume 8, ISSUE 8, P689, September 2009

C95 Reevaluation of Gleason score, extraprostatic extension and surgical margins status on radical prostatectomy specimens: learning curve in uropathology

      Introduction and Objectives

      It is well known that there is a substantial inter and intraobserver variability in evaluation of critical pathohistological parameters on RP specimens. Particularly, these variabilities are present in work of pathologists from community hospitals e.i. pathologists that routinely perform whole area of surgical pathology and are not dedicated to uropathology field alone. Recently, we have started to evaluate our 10-year material from clinico-pathological point of wiev. In time period 2000–2009 we managed 2735 needle core biopsies and 936 radical prostatectomy specimens.By reevaluating pathohistological parameters on RP specimens and assuming that our pathologist has made progress in uropathology field from year 2004 we try to define if there is learning curve and which factors influence it.

      Material and Methods

      One of us (BP) reevaluated Gleason score (GS), extraprostatic extension (EPE) and surgical margins status (SM) on 53 radical prostatectomy specimens originally diagnosed in 2004.


      Overall concordance in SM assessment was reached in 39 cases (73%), EPE in 35 cases (66%) and GS in 34 cases (64%), respectively. All 7 GS 4 and 5 cases in year 2004 turned to GS 6 in present rewiev, 6 cases GS 6 turned to GS 7 and 3 cases of GS 7 turned to GS 6, respectively. One case GS 7 turned to GS 8. In all but one of the discordant GS cases the difference showed ±1 GS digit. Forteen cases that were negatively assessed for EPE in 2004 turned to be EPE positive (14/53, 26%). Four cases assessed as SM negative turned to be positive (4/53, 7.5%), six SM positive cases turned to be negative (6/53, 11%) and four undetermined cases in 2004 turned to be negative (4/53, 7.5%).


      Assuming that current pathological assessment is correct (considering possible intraobserver variability error) we showed good concordance between original 2004 Gleason score assessment and current 2009 one (mostly within ±1 GS digit). However, we could’t be satisfied with original extraprostatic extension assessment which, on reevaluation showed shift from negative to positive in 26%. Regarding surgical margins assessment we observed shift from positive/undetermined in 2004 to negative in 10 cases (19%). Considering year 2004 as a starting year for this study we conclude that learning curve for our pathologist mostly affected surgical margins and extraprostatic extension assessment. To achieve lesser variability and more accurate diagnosis pathologist needs to dedicate himself to uropathology field. Urologist may contribute to this effort by improving operative technique (less surface artifacts and incisions which make correct pathological analysis difficult).