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Revised biopsy report--strange?

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Posted 12/23/2009 6:31 PM (GMT 0)
I had a biopsy at Umich. I got the report (Gleason 4+3; 5%-30%, 5/12 cores positive).

The slides were then sent to Ford Hospital (Dr. Menon's team). Their reading was much better.

(Gleason 3+4, 5%-20%, 5/12 cores positive).

Isn't that a bit unusual to have such a difference, or is that typical? I might add that the Umich 4+3 was split 60%-40%, so I guess it was somewhat close. Obviously there is an art to all of this. One would think that a computer could analyze the slides and come up with a definitive report.

(But, I'm not complaining!).

But, is it unusual? Have any of you folks had two different readings? I realize the post-op pathology report can be different since they then have the whole gland to analyze, but here we have two experts looking at the same biopsied tissues and getting different results!

Mel

Posted 12/23/2009 6:42 PM (GMT 0)
Mel...don't know if you have had the chance to look at what a grade 3 cell or what a grade 4 cell looks like, but I will tell you this...even to the untrained eye there is a difference. My guess is that you could have a dozen pathologists look at the slides and quite possible have a split to what they agree upon. Basically, I have heard this is quite common when slides are reread. They sometimes go up and sometimes down. I think it has to do with the individual pathologist reading the sample. Most pathologists would rather error on the high side than to take a chance with a gray area.

Just adds more complexity to this disease doesn't it.
Posted 12/23/2009 6:44 PM (GMT 0)
There is good reason to have those pathologies checked twice and I recommend it to all the newly diagnosed. I have seen discrepancy between pathologists. That stated, I have only seen on rare occasion that a 2nd opinion on a pathology would actually change whether a prostate cancer be treated any differently. Whether pathology 1 or pathology 2 here is most correct, you are still outside the guidelines for active surveillance and surgery or radiation is still the top recommendation you will find in dealing with your cancer. And your case is more likely in a high risk group that away from it.

Tony
Posted 12/23/2009 6:45 PM (GMT 0)
When Gleason designed the score it was based on a visual system of grading that 90% of pathologists would agree on when seeing the same thing. So by defination you will have 10% disagreement if everything went well.
JT
Posted 12/23/2009 6:47 PM (GMT 0)
mel,

when you ask for a second opinion,you get a second opinion, lol. the reading of the slides will always have a real heavy subjectiveness to it, depending on who is reading and their experience level. right now, to swap from a 4+3 to a 3+4 is better, but the only report that is really going to count is after your surgery, when they have all removed materials to examine. it may stay the same as now, go back the other way, or get upgraded. your two reads are still pretty close together, sounds like you are an honest gleason 7 case.

david in sc
Posted 12/23/2009 8:04 PM (GMT 0)

"Mel...don't know if you have had the chance to look at what a grade 3 cell or what a grade 4 cell looks like, but I will tell you this...even to the untrained eye there is a difference."

"When Gleason designed the score it was based on a visual system of grading that 90% of pathologists would agree on when seeing the same thing. So by defination [sic] you will have 10% disagreement if everything went well."

Both true to a point.  An exemplar Grade 3 is distinctly different than an exemplar Grade 4.  The problem is that in real life malignant prostate cells do not present as exemplars but rather fall on a continuum from Grade 1 to Grade 5.  Where on that continuum does a cell cease being a Grade 3 and start being a Grade 4?  That's very subjective.

Zen9    

Posted 12/23/2009 8:30 PM (GMT 0)
Second opinions can really suck when they don't match the first...Makes aperson really want to go out and get a third and then go with the Average Number.
Posted 12/23/2009 8:35 PM (GMT 0)
True. But in my case, it's more psychological than anything else.

The bottom line is that the treatment choice is the same and the big test/information will be the surgery pathology results.

Mel

Posted 12/23/2009 9:03 PM (GMT 0)
That's the nice thing about having a Gleason 9. Not much argument about that ! All three pathologists agreed.
Posted 12/23/2009 9:36 PM (GMT 0)
goodlife, that's the unfortunate truth, with your Gleason 9, there is nothing to dispute with the numbers. But you are still doing so well.

David in SC
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