Introduction: The Gleason scoring system is an essential tool in deciding a prostate cancer treatment strategy. However, the Gleason grade group (GGG) often differs between needle-core biopsy (NCB) and radical prostatectomy (RP) specimens. We investigated the diagnostic value of second opinion pathology review on NCB specimens.
Methods: From January 2012 to May 2018, 733 patients underwent robot-assisted radical prostatectomy. Patients whose original biopsy specimens from outside hospitals were reviewed by a urological pathology expert in our institution were included. Patients who had received neoadjuvant hormonal therapy were excluded. The weighted kappa (k) coefficients were used to evaluate the diagnostic accuracy of each review.
Results: A total of 403 patients were included. Agreement in GGG between initial and second-opinion diagnoses was present in 256 cases (63.5%) with substantial agreement (weighted k=0.783). Although single-opinion cases had moderate agreement on GGG of RP specimens (initial: 35.2%, weighted k=0.500, second opinion; 36.5%, weighted k=0.574), opinion-matched cases improved concordance (41.4%, 106/256 cases) with substantial agreement (weighted k=0.610).
Conclusions: The second opinion pathology review is useful for improving the accuracy of NCB specimens. However, more than half of opinion-matched cases were discordant from that assigned based on RP specimens. Source of