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Background: Variations in surgical technique of temporal artery biopsy (TAB) performed for diagnosis of giant cell arteritis (GCA) may contribute to high false-negative rates. This was a retrospective analysis of a large database that explored potential associations between specimen length and diagnostic sensitivity of TAB. Methods: Histopathological reports and medical records of patients who underwent TAB in six hospitals between 2004 and 2009 were reviewed. Results: A total of 966 biopsies were analysed. The median postfixation specimen length was 1 (range 0·1-8·5) cm and 207 biopsies (21·4 per cent) were positive for GCA. Significant variation in prebiopsy erythrocyte sedimentation rate (ESR), arterial specimen length and positive results was noted amongst hospitals. Multivariable analysis revealed that patient age, ESR value and specimen length were independent predictors of GCA. Positive biopsies had significantly longer median specimen length compared with negative biopsies: 1·2 (range 0·3-8·5) versus 1·0 (0·2-8·0) cm respectively ( P = 0·001). Receiver operating characteristic (ROC) analysis identified postfixation specimen length of at least 0·7 cm as the cut-off length with highest positive predictive value for a positive biopsy (area under ROC curve 0·574). Biopsies with specimen length of 0·7 cm or more had a significantly higher rate of positive results than smaller specimens (24·8 versus 12·9 per cent respectively; odds ratio 2·17, P = 0·001). Conclusion: Specimen length and ESR were independent prognostic factors of a positive TAB result. A uniform referral practice and standard specimen length of approximately 1 cm could help eliminate discrepancies in the results of TAB. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims: The frequency of prostatic core biopsies to detect cancer has been increasing with more widespread prostate specific antigen (PSA) testing. Gleason score has important implications for patient management but morphological reproducibility data for British practice are limited. Using literature-based criteria nine uropathologists took part in a reproducibility study. Methods: Each of the nine participants submitted slides from consecutive cases of biopsy-diagnosed cancer assigned to the Gleason score groups 2–4, 5–6, 7 and 8–10 in the original report. A random selection of slides was taken within each group and examined by all pathologists, who were blind to the original score. Over six circulations, new slides were mixed with previously read slides, resulting in a total of 47 of 81 slides being read more than once. Results: For the first readings of the 81 slides, the agreement with the consensus score was 78% and overall interobserver agreement was κ 0.54 for Gleason score groups 2–4, 5–6, 7, 8–10. Kappa values for each category were 0.33, 0.56, 0.44 and 0.68, respectively. For the 47 slides read more than once, intra-observer agreement was 77%, κ 0.66. The study identified problems in core biopsy interpretation of Gleason score at levels 2–4 and 7. Patterns illustrated by Gleason as 2 tended to be categorized as 3 because of the variable acinar size and unassessable lesional margin. In slides with consensus Gleason score 7, 13% of readings were scored 6 and in slides with consensus 6, 18% of readings were scored 7. Conclusions: Recommendations include the need to increase objectivity of the Gleason criteria but limits of descriptive morphology may have to be accepted. [ABSTRACT FROM AUTHOR]

Aims: To test the effectiveness of a teaching resource (a decision tree with diagnostic criteria based on published literature) in improving the proficiency of Gleason grading of prostatic cancer by general pathologists. Methods: A decision tree with diagnostic criteria was developed by a panel of urological pathologists during a reproducibility study. Twenty-four general histopathologists tested this teaching resource. Twenty slides were selected to include a range of Gleason score groups 2–4, 5–6, 7 and 8–10. Interobserver agreement was studied before and after a presentation of the decision tree and criteria. The results were compared with those of the panel of urological pathologists. Results: Before the teaching session, 83% of readings agreed within ± 1 of the panel's consensus scores. Interobserver agreement was low (κ = 0.33) compared with that for the panel (κ = 0.62). After the presentation, 90% of readings agreed within ± 1 of the panel's consensus scores and interobserver agreement amongst the pathologists increased to κ = 0.41. Most improvement in agreement was seen for the Gleason score group 5–6. Conclusions: The lower level of agreement among general pathologists highlights the need to improve observer reproducibility. Improvement associated with a single training session is likely to be limited. Additional strategies include external quality assurance and second opinion within cancer networks. [ABSTRACT FROM AUTHOR]