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Int J Clin Exp Pathol 2011;4(5):468-475

Original Ariticle
The value of second-opinion pathology diagnoses on prostate biopsies from patients
referred for management of prostate cancer

Al B Barqawi, Ruslan Turcanu, Eduard J Gamito, M Scott Lucia, Colin I O’Donnell, E David Crawford, David D La Rosa, Francisco G La Rosa

Department of Surgery, Urologic Oncology, and Department of Pathology, University of Colorado Denver, Anschutz Campus, Aurora, CO 80045,

Received May 4, 2011; accepted May, 2011; Epub May, 2011, published May, 2011

Abstract: Gleason score (GS) (sum of primary plus secondary grades) is used to predict patients’ clinical outcome and to customize treatment
strategies for prostate cancer (PC). However, due in part to pathologist misreading, there is significant discrepancy of GS between needle-core
biopsies (NCB) and radical prostatectomy specimens.  We assessed the requirement for re-evaluating NCB diagnosed by outside
pathologists in patients referred to our institution for management of PC.  In 100 patients, we reviewed both their original “outside” and second-
opinion (“in-house”) diagnoses of the same NCB specimens, and compared them with the diagnoses of the whole-mount radical
prostatectomy (WMRP) specimens (gold standard for analysis). We found that both outside and in-house biopsy GS vary significantly from the
WMRP diagnoses, with GS undergrading substantially predominating above overgrading. Statistical analysis demonstrated that the main
diagnostic discrepancy was in the differentiation between primary and secondary Gleason grades (mainly 3 and 4) and that outside NCB GS
was significantly less accurate with respect to the WMRP specimens than the in-house NCB GS.  In addition, in a different cohort of 65 NCB
cases, we found that in 5 out of 11 patients, outside pathologists failed to report the presence of extraprostatic extension, an important feature
for diagnosis of a higher pathology stage (pT3a). Since histopathological evaluation is a critical factor for appropriate treatment selection, we
recommend that a re-evaluation by in-house urologic pathologists should be performed in all outside NCB specimens before patients are
admitted for treatment in any given institution. (IJCEP1105001)

Keywords: Prostate cancer, second-opinion, gleason score, gleason grade, needle-core biopsy, whole mount radical prostatectomy

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Address all correspondence to:
Francisco G. La Rosa, MD
Department of Pathology
University of Colorado Denver
Anschutz Campus
Aurora, CO 80045, USA.