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Review of initial and final pathology reports finds differences that could change therapy

-- Jeff Muise

Monday, July 5, 2010 (Last Updated: 07/06/2010)

MONDAY, July 5 (HealthDay News) -- A mandatory second opinion to interpret prostate needle biopsy prior to radical prostatectomy in a few cases results in differences that may affect therapy, according to research published in the July issue of the The Journal of Urology.

Fadi Brimo, M.D., of the Johns Hopkins Hospital in Baltimore, and colleagues compared original and reviewed pathology reports for patients referred for radical prostatectomy over the course of a year. Comparisons included diagnosis of tumor (benign, atypical, or malignant), final Gleason score, positive core number, core highest cancer percent, and perineural invasion or extraprostatic extension.

Of the 855 cases reviewed, the researchers found that prostate cancer was confirmed in 98.8 percent by needle biopsy and prostatectomy. Of those, upon review, 1 percent was found to be atypical, and 0.2 percent was found to be benign. The researchers identified major discrepancies in Gleason score in 14.7 percent of cases. Of the 777 cases with positive core numbers in each report, discrepancies were found in 9.1 percent. There was a significant difference in the highest cancer percent in a core in 9 percent of evaluable cases in which cancer was underestimated originally. Perineural invasion was not initially reported in 26.8 percent of cases in which it occurred. Extraprostatic extension was missed initially in four cases.

"Compared to a smaller study more than 10 years ago at our institution, the rate of unconfirmed cancer was identical (1.2 percent). To our knowledge, this is the first study to analyze concordance upon review of the number of positive cores and maximum percent positive in a core (each discrepancy 9 percent). In a few cases mandatory second opinion on prostate needle biopsy results in significant differences that may affect therapy," the authors write.

Abstract
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Specialties Urology
Hematology & Oncology
Pathology
Surgery

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