The influence of expertise of the surgical pathologist to undergrading, upgrading, and understaging of prostate cancer in patients undergoing subsequent radical prostatectomy

Attila Majoros, Attila Marcell Szász, Péter Nyirády, Eszter Székely, Péter Riesz, Attila Szendroi, Attila Keszthelyi, Janina Kulka, Imre Romics

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5 Citations (Scopus)

Abstract

Purpose: The main objective of this retrospective study was to evaluate the influence of pathological experience in histological examination of prostate cancer (PCa) on preoperative understaging (UNS), undergrading (UNG), and upgrading (UPG). Methods: Histopathological data of prostate biopsy (PB) and radical prostatectomy (RP) specimens of patients undergoing subsequent radical prostatectomy (n = 430) in our center were compared. Histological diagnoses of PB were provided either by corresponding academic pathology institute (Group 1: 322 patients) or by external (nonacademic) departments which had a lower number (≤100/year) of PCa histopathological evaluations (Group 2 108 patients). The rate of UNG, UPG, and UNS in both groups and also the effects of institutional learning curve were analyzed in terms of grading and staging. Results: Significant difference was detected between Group 1 and Group 2 in average preoperative Gleason score (GS) values and in the rate of well, moderately, and poorly differentiated cancers as well. There was also a significant difference in the rate of UNG (29.1 vs. 56.5 %, p < 0.0001). The mean preoperative and postoperative GS in Group 1 was significantly lower in the first 50 than in the last 50 patients, but the rates of UNG, UPG, and UNS did not differ significantly between the groups. Conclusions: The experience of pathologists has direct influence on grading concordance and on UNG and UPG, between PB and RP specimen; however, it has no significant effect on complete preoperative understaging. The bigger pathological experience improves the sensitivity of the histological diagnostic process.

Original languageEnglish
Pages (from-to)371-377
Number of pages7
JournalInternational urology and nephrology
Volume46
Issue number2
DOIs
Publication statusPublished - Feb 1 2014

Keywords

  • Pathological experience
  • Prostate biopsy
  • Prostate cancer
  • Radical prostatectomy
  • Undergrading
  • Understaging

ASJC Scopus subject areas

  • Nephrology
  • Urology

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