Gleason grade group (GG) is the most powerful prognostic variable in localized prostate cancer; however, interobserver variability remains a challenge. Artificial intelligence algorithms applied to histopathologic images standardize grading, but most have been tested only for agreement with pathologist GG, without assessment of performance with respect to oncologic outcomes. We compared deep learning-based and pathologist-based GGs for an association with metastatic outcome in three surgical cohorts comprising 777 unique patients. A digitized whole slide image of the representative hematoxylin and eosin-stained slide of the dominant tumor nodule was assigned a GG by an artificial intelligence-based grading algorithm and was compared with the GG assigned by a contemporary pathologist or the original pathologist-assigned GG for the entire prostatectomy. Harrell's C-indices based on Cox models for time to metastasis were compared. In a combined analysis of all cohorts, the C-index for the artificial intelligence-assigned GG was 0.77 (95% confidence interval [CI]: 0.73-0.81), compared with 0.77 (95% CI: 0.73-0.81) for the pathologist-assigned GG. By comparison, the original pathologist-assigned GG for the entire case had a C-index of 0.78 (95% CI: 0.73-0.82). PATIENT SUMMARY: Artificial intelligence-enabled prostate cancer grading on a single slide was comparable with pathologist grading for predicting metastatic outcome in men treated by radical prostatectomy, enabling equal access to expert grading in lower resource settings.
European urology oncology. 2024 Sep 03 [Epub ahead of print]
Lia D Oliveira, Jiayun Lu, Eric Erak, Adrianna A Mendes, Oluwademilade Dairo, Onur Ertunc, Ibrahim Kulac, Javier A Baena-Del Valle, Tracy Jones, Jessica L Hicks, Stephanie Glavaris, Gunes Guner, Igor D Vidal, Bruce J Trock, Uttara Joshi, Chaith Kondragunta, Saikiran Bonthu, Corinne Joshu, Nitin Singhal, Angelo M De Marzo, Tamara L Lotan
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Suleyman Demirel University School of Medicine, Isparta, Turkey., Koç University School of Medicine, Istanbul, Turkey., Fundacion Santa Fe de Bogota University Hospital, Bogota, Colombia., Faculty of Medicine, Hacettepe University, Ankara, Turkey., Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., AIRA Matrix Private Limited, Mumbai, India., Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: .