A Working Group Classification of Focal Prostate Atrophy Lesions : The American Journal of Surgical Pathology

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A Working Group Classification of Focal Prostate Atrophy Lesions

De Marzo, Angelo M. MD, PhD; Platz, Elizabeth A. ScD, MPH; Epstein, Jonathan I. MD; Ali, Tehmina MD; Billis, Anthanase MD; Chan, Teresa Y. MD; Cheng, Liang MD, PhD; Datta, Milton MD, PhD; Egevad, Lars MD, PhD; Ertoy-Baydar, Dilek MD; Farre, Xavier MD, PhD; Fine, Samson W. MD; Iczkowski, Kenneth A. MD; Ittmann, Michael MD, PhD; Knudsen, Beatrice S. MD, PhD; Loda, Massimo MD, PhD; Lopez-Beltran, Antonio MD; Magi-Galluzzi, Cristina MD, PhD; Mikuz, Gregor MD; Montironi, Roldolfo MD, PhD; Pikarsky, Eli MD, PhD; Pizov, Galina MD; Rubin, Mark A. MD; Samaratunga, Hema MD; Sebo, Thomas MD, PhD; Sesterhenn, Isabel A. MD; Shah, Rajal B. MD; Signoretti, Sabina MD, PhD; Simko, Jeffery MD, PhD; Thomas, George MD, PhD; Troncoso, Patricia MD; Tsuzuki, Toyonori T. MD, PhD; van Leenders, Geert J. MD, PhD; Yang, Ximing J. MD, PhD; Zhou, Ming MD, PhD; Figg, William D. MD; Hoque, Ashraful PhD; Lucia, M. S. MD

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The American Journal of Surgical Pathology 30(10):p 1281-1291, October 2006. | DOI: 10.1097/01.pas.0000213289.50660.be

Abstract

Focal atrophy is extremely common in prostate specimens. Although there are distinct histologic variants, the terminology is currently nonstandardized and no formal classification has been tested for interobserver reliability. This lack of standardization hampers the ability to study the biologic and clinical significance of these lesions. After informal and formal meetings by a number of the authors, focal atrophy lesions were categorized into 4 distinct subtypes as follows: (i) simple atrophy, (ii) simple atrophy with cyst formation, (iii) postatrophic hyperplasia, and (iv) partial atrophy. In phase 1 of the study, pathologists with varying levels of experience in prostate pathology were invited to view via the Internet a set of “training” images with associated descriptions of lesions considered typical of each subtype. In phase 2 of the study, each participant provided diagnoses on a series of 140 distinct “test” images that were viewed over the Internet. These test images consisted of the 4 subtypes of atrophy and images of normal epithelium, high grade prostatic intraepithelial neoplasia, and carcinoma. The diagnoses for each image from each pathologist were compared with a set of “standard” diagnoses and the κ statistic was computed. Thirty-four pathologists completed both phases of the study. The interobserver reliability (median κ) for classification of lesions as normal, cancer, prostatic intraepithelial neoplasia, or focal atrophy was 0.97. The median κ for the classification of atrophy lesions into the 4 subtypes was 0.80. The median percent agreement with the standard diagnosis for the atrophy subtypes were: simple 60.6%, simple with cyst formation 100%; postatrophic hyperplasia 87.5%; partial atrophy 93.9%. The lower percentage for simple atrophy reflected a propensity to diagnose some of these as simple atrophy with cyst formation. Seven pathologists completed the phase 2 analysis a second time, and their intraobserver reproducibility was excellent. Three of 4 pathologists with low agreement with the standard diagnosis for simple atrophy improved their scores after repeating the analysis after re-examination of the “training set” of images. In conclusion, these criteria for variants of focal prostate atrophy may facilitate studies to examine the relation between various patterns of prostate atrophy and prostate cancer.

Errata

De Marzo AM, Platz EA, Epstein JI, Ali T, Billis A, Chan TY, Cheng L, Datta M, Egevad L, Ertoy-Baydar D, Farre X, Fine SW, Iczkowski KA, Ittmann M, Knudsen BS, Loda M, Lopez-Beltran A, Magi-Galluzzi C, Mikuz G, Montironi R, Pikarsky E, Pizov G, Rubin MA, Samaratunga H, Sebo T, Sesterhenn IA, Shah RB, Signoretti S, Simko J, Thomas G, Troncoso P, Tsuzuki TT, van Leenders GJ, Yang XJ, Zhou M, Figg WD, Hoque A, Lucia MS. A working group classification of focal prostate atrophy lesions. Am J Surg Pathol. 2006;30:1281-91.

In the article on page 1281, two authors' names were supplied incorrectly.

They should have been: Rajal B. Shah and Ashraful Hoque.

The authors regret this error.

The American Journal of Surgical Pathology. 31(4):652, April 2007.

De Marzo AM, Platz EA, Epstein JI, Ali T, Billis A, Chan TY, Cheng L, Datta M, Egevad L, Ertoy-Baydar D, Farree X, Fine SW, Iczkowski KA, Ittmann M, Knudsen BS, Loda M, Lopez-Beltran A, Magi-Galluzzi C, Mikuz G, Montironi R, Pikarsky E, Pizov G, Rubin MA, Samaratunga H, Sebo T, Sesterhenn IA, Shah RB, Signoretti S, Simko J, Thomas G, Troncoso P, Tsuzuki TT, van Leenders GJ, Yang XJ, Zhou M, Figg WD, Hoque A, Lucia MS. A working group classification of focal prostate atrophy lesions. Am J Surg Pathol 2006;30:1281–1291.

In the article on pg. 1281, the eleventh author's name was misspelled. It should be Xavier Farre, MD, PhD. The Journal apologizes for this error.

The American Journal of Surgical Pathology. 30(11):1489, November 2006.

© 2006 Lippincott Williams & Wilkins, Inc.

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