Concordance of Gleason grading with three-dimensional ultrasound systematic biopsy and biopsy core pre-embedding

Anouk A.M.A. van der Aa, Christophe K. Mannaerts, Hans van der Linden, Maudy Gayet, Bart Ph Schrier, Massimo Mischi, Harrie P. Beerlage, Hessel Wijkstra

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Purpose: To determine the value of a three-dimensional (3D) greyscale transrectal ultrasound (TRUS)-guided prostate biopsy system and biopsy core pre-embedding method on concordance between Gleason scores of needle biopsies and radical prostatectomy (RP) specimens. Methods: Retrospective analysis of prostate biopsies and subsequent RP for PCa in the Jeroen Bosch Hospital, the Netherlands, from 2007 to 2016. Two cohorts were analysed: conventional 2D TRUS-guided biopsies and RP (2007–2013, n = 266) versus 3D TRUS-guided biopsies with pre-embedding (2013–2016, n = 129). The impact of 3D TRUS-guidance with pre-embedding on Gleason score (GS) concordance between biopsy and RP was evaluated using the κ-coefficient. Predictors of biopsy GS 6 upgrading were assessed using logistic regression models. Results: Gleason concordance was comparable between the two cohorts with a κ = 0.44 for the 3D cohort, compared to κ = 0.42 for the 2D cohort. 3D TRUS-guidance with pre-embedding, did not significantly affect the risk of biopsy GS 6 upgrading in univariate and multivariate analysis. Conclusions: 3D TRUS-guidance with biopsy core pre-embedding did not improve Gleason concordance. Improved detection techniques are needed for recognition of low-grade disease upgrading.

Original languageEnglish
Pages (from-to)863-869
Number of pages7
JournalWorld Journal of Urology
Issue number6
Publication statusPublished - 1 Jun 2018


  • Biopsy
  • Neoplasm grading
  • Prostatectomy
  • Prostatic neoplasms
  • Three-dimensional imaging
  • Tissue embedding
  • Humans
  • Male
  • Netherlands
  • Neoplasm Grading
  • Prostate/pathology
  • Prostatic Neoplasms/pathology
  • Retrospective Studies
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration


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