Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands

Purpose: Our aim was to analyze grading variation between pathology laboratories and between pathologists within individual laboratories using nationwide real-life data. Methods: We retrieved synoptic (<i>n</i> = 13,397) and narrative (<i>n</i> = 29,377) needle biopsy reports...

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Autores principales:	Rachel N. Flach, Peter-Paul M. Willemse, Britt B. M. Suelmann, Ivette A. G. Deckers, Trudy N. Jonges, Carmen van Dooijeweert, Paul J. van Diest, Richard P. Meijer
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	Gleason grading pathology prostate cancer interlaboratory variation Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/4f5962fa64f146819ce9e963a048ca10
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spelling	oai:doaj.org-article:4f5962fa64f146819ce9e963a048ca102021-11-11T15:29:38ZSignificant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands10.3390/cancers132153782072-6694https://doaj.org/article/4f5962fa64f146819ce9e963a048ca102021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/21/5378https://doaj.org/toc/2072-6694Purpose: Our aim was to analyze grading variation between pathology laboratories and between pathologists within individual laboratories using nationwide real-life data. Methods: We retrieved synoptic (<i>n</i> = 13,397) and narrative (<i>n</i> = 29,377) needle biopsy reports from the Dutch Pathology Registry and prostate-specific antigen values from The Netherlands Cancer Registration for prostate cancer patients diagnosed between January 2017 and December 2019. We determined laboratory-specific proportions per histologic grade and unadjusted odds ratios (ORs) for International Society of Urological Pathologists Grades 1 vs. 2–5 for 40 laboratories due to treatment implications for higher grades. Pathologist-specific proportions were determined for 21 laboratories that consented to this part of analysis. The synoptic reports of 21 laboratories were used for analysis of case-mix correction for PSA, age, year of diagnosis, number of biopsies and positive cores. Results: A total of 38,321 reports of 35,258 patients were included. Grade 1 ranged between 19.7% and 44.3% per laboratory (national mean = 34.1%). Out of 40 laboratories, 22 (55%) reported a significantly deviant OR, ranging from 0.48 (95% confidence interval (CI) 0.39–0.59) to 1.54 (CI 1.22–1.93). Case-mix correction was performed for 10,294 reports, altering the status of 3/21 (14%) laboratories, but increasing the observed variation (20.8% vs. 17.7%). Within 15/21 (71%) of laboratories, significant inter-pathologist variation existed. Conclusion: Substantial variation in prostate cancer grading was observed between and within Dutch pathology laboratories. Case-mix correction did not explain the variation. Better standardization of prostate cancer grading is warranted to optimize and harmonize treatment.Rachel N. FlachPeter-Paul M. WillemseBritt B. M. SuelmannIvette A. G. DeckersTrudy N. JongesCarmen van DooijeweertPaul J. van DiestRichard P. MeijerMDPI AGarticleGleason gradingpathologyprostate cancerinterlaboratory variationNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5378, p 5378 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Gleason grading pathology prostate cancer interlaboratory variation Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Gleason grading pathology prostate cancer interlaboratory variation Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Rachel N. Flach Peter-Paul M. Willemse Britt B. M. Suelmann Ivette A. G. Deckers Trudy N. Jonges Carmen van Dooijeweert Paul J. van Diest Richard P. Meijer Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands
description	Purpose: Our aim was to analyze grading variation between pathology laboratories and between pathologists within individual laboratories using nationwide real-life data. Methods: We retrieved synoptic (<i>n</i> = 13,397) and narrative (<i>n</i> = 29,377) needle biopsy reports from the Dutch Pathology Registry and prostate-specific antigen values from The Netherlands Cancer Registration for prostate cancer patients diagnosed between January 2017 and December 2019. We determined laboratory-specific proportions per histologic grade and unadjusted odds ratios (ORs) for International Society of Urological Pathologists Grades 1 vs. 2–5 for 40 laboratories due to treatment implications for higher grades. Pathologist-specific proportions were determined for 21 laboratories that consented to this part of analysis. The synoptic reports of 21 laboratories were used for analysis of case-mix correction for PSA, age, year of diagnosis, number of biopsies and positive cores. Results: A total of 38,321 reports of 35,258 patients were included. Grade 1 ranged between 19.7% and 44.3% per laboratory (national mean = 34.1%). Out of 40 laboratories, 22 (55%) reported a significantly deviant OR, ranging from 0.48 (95% confidence interval (CI) 0.39–0.59) to 1.54 (CI 1.22–1.93). Case-mix correction was performed for 10,294 reports, altering the status of 3/21 (14%) laboratories, but increasing the observed variation (20.8% vs. 17.7%). Within 15/21 (71%) of laboratories, significant inter-pathologist variation existed. Conclusion: Substantial variation in prostate cancer grading was observed between and within Dutch pathology laboratories. Case-mix correction did not explain the variation. Better standardization of prostate cancer grading is warranted to optimize and harmonize treatment.
format	article
author	Rachel N. Flach Peter-Paul M. Willemse Britt B. M. Suelmann Ivette A. G. Deckers Trudy N. Jonges Carmen van Dooijeweert Paul J. van Diest Richard P. Meijer
author_facet	Rachel N. Flach Peter-Paul M. Willemse Britt B. M. Suelmann Ivette A. G. Deckers Trudy N. Jonges Carmen van Dooijeweert Paul J. van Diest Richard P. Meijer
author_sort	Rachel N. Flach
title	Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands
title_short	Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands
title_full	Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands
title_fullStr	Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands
title_full_unstemmed	Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands
title_sort	significant inter- and intralaboratory variation in gleason grading of prostate cancer: a nationwide study of 35,258 patients in the netherlands
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/4f5962fa64f146819ce9e963a048ca10
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Significant Inter- and Intralaboratory Variation in Gleason Grading of Prostate Cancer: A Nationwide Study of 35,258 Patients in The Netherlands

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