Accuracy of biopsy Gleason scores from a large uropathology laboratory: Use of a diagnostic protocol to minimize observer variability
Accuracy of biopsy Gleason scores from a large uropathology laboratory: Use of a diagnostic protocol to minimize observer variability
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DOI：
10.1016/s0090-4295(98)00002-8
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发表时间：
1998-04-01
期刊：
影响因子：
2.1
通讯作者：
Epstein, JI
中科院分区：
文献类型：
--
作者：
Carlson, GD;Calvanese, CB;Epstein, JI
目标.检查活检Gleason评分与来自实验室的根治性乳腺癌切除术标本的相关性，该实验室使用旨在最大限度减少观察者变异性的方案。该方案要求对所有非良性病例进行共识病例审查。1993年8月24日至1997年6月26日，在马里兰州巴尔的摩约翰霍普金斯医院接受根治性前列腺切除术的106名患者在一个实验室（DIANON系统）诊断并分级了前列腺癌。我们分析了活检和根治性切除术患者的Gleason评分。72例（68%）活检和根治性乳腺癌切除术Gleason评分之间存在确切相关性; 103例（97%）在1级内相关，所有病例均在2级内相关; 26例（25%）活检分级过低，8例（8%）分级过高。活检Gleason评分5、6和7的阳性预测值分别为66%、67%和71%。分组Gleason评分（高分化[2 - 4]、中分化[5，6]、中分化至低分化[7]和低分化[8 - 10]）与74例（70%）病例完全相关，所有病例均在1组内。患者年龄、直肠指检结果、阳性穿刺总数和活检肿瘤的最大百分比不影响相关性，但前列腺特异性抗原（PSA）水平确实影响相关性（当PSA水平低于5 ng/mL时，精确相关性为96%;当PSA水平为11 ng/mL或更高时，精确相关性为50%，P
Objectives. To examine the correlation of biopsy Gleason scores with radical prostatectomy specimens from a laboratory that uses protocols designed to minimize observer variability. This protocol mandates consensus case review of all nonbenign cases.Methods. Between August 24, 1993 and June 26, 1997, 106 patients who underwent radical prostatectomy at Johns Hopkins Hospital, Baltimore, Maryland had their prostate cancer diagnosed and graded at one laboratory (DIANON Systems). We analyzed the Gleason scores from the biopsy and radical prostatectomy specimens.Results. Exact correlation existed between biopsy and radical prostatectomy Gleason scores for 72 (68%) cases; 103 (97%) correlated within 1 grade, all cases correlated within 2 grades; 26 (25%) biopsies were undergraded and 8 (8%) were overgraded. Positive predictive values for biopsy Gleason scores 5, 6, and 7 were 66%, 67%, and 71%, respectively. Grouped Gleason scores (well differentiated [2 to 4], moderately differentiated [5, 6], moderately to poorly differentiated [7], and poorly differentiated [8 to 10]) correlated exactly for 74 (70%) cases and within 1 group for all cases. Patient age, digital rectal examination results, total number of positive cores, and maximum percentage of tumor on biopsy did not affect correlation, but prostate-specific antigen (PSA) levels did affect correlation (exact correlation 96% when the PSA level was less than 5 ng/mL; 50% when the PSA level was 11 ng/mL or greater, P