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Should Centralized Histopathological Review in Prostate Cancer be the Gold Standard?

Hoda H M Al-Itejawi, Jakko A Nieuwenhuijzen, Lawrence Rozendaal, Theodorus M van der Kwast, Reindert Jeroen van Moorselaar and André N Vis

Background: To assess the potential impact of centralized histopathological review on prostate cancer management.

Methods: 1) Biopsy slides of 277 men with newly diagnosed prostate cancer between January 2010 and March 2014 from 22 centers were referred to our tertiary referral center for centralized histopathological review. 2) The biopsy Gleason score and D’Amico prognostic risk group were compared between those of the referring pathologists and those after assessment by a centralized histopathological review committee consisting of two specialized uro-pathologists. 3) Alterations in biopsy Gleason score and D’Amico prognostic risk group between referring pathologists and centralized histopathological committee were subdivided into treatment changes (i.e., lymph-node dissection, nerve sparing surgery, or active surveillance) and diagnostic changes (bone scintigraphy).

Results: 1) Consensus was reached in all cases between the two uro-pathologists of the centralized histological committee. 2) Overall concordance between referring pathologists and the centralized histopathological committee for Gleason score was 69.0%, with upgrading in 24.5% and downgrading in 6.5% of cases (κ 0.55). 3) Overall concordance for D’Amico risk group was 81.6% with a shift to a higher risk group in 15.5%. A shift to a lower risk group occurred in 2.9% of cases. 4) Treatment changes due to histopathological review would have occurred in 22.7% of patients. Diagnostic procedures would have changed in 8.0% of patients.

Conclusion: After centralized review, a substantial proportion of histology reports was revised, for biopsy Gleason score and D’Amico prognostic risk group. In almost one third of patients, a centralized histopathological review would have led to altered diagnostic work-up and/or treatment decisions.