Gleason score code N[N]

Identifying and definitional attributes

Metadata item type:Value Domain
METeOR identifier:436193
Registration status:Health, Standard 14/05/2015
Definition:A system of grading prostate cancer based on the sum of the primary and secondary tumour grades/patterns in sections of biopsied or resected tissue.

Representational attributes

Representation class:Code
Data type:Number
Format:N[N]
Maximum character length:2
Permissible values:
ValueMeaning
2Grade 2
3Grade 3
4Grade 4
5Grade 5
6Grade 6
7Grade 7
8Grade 8
9Grade 9
10Grade 10

Collection and usage attributes

Guide for use:

The Gleason score (sum) is formed by adding the primary and secondary Gleason grades/patterns together as outlined in Table 1 for radical prostatectomy specimens and Table 2 for needle core biopsy specimens. If only one grade is found in the tissue sample, then that grade (the primary Gleason grade) is multiplied by two to give the score.

Gleason grades range from 2 to 10 for radical prostatectomy specimens and 5-10 for needle core biopsy specimens (Grades 2-4 are not applicable to needle core biopsy specimens).

Table 1: Gleason scoring in radical prostatectomy specimens

Number of different grades present

Proportion of grades present

Comments
1 - Primary One of 2, 3, 4 or 5 only Double primary grade to get score

(eg 4+4=8)

Record for dominant nodule +/- nondominant (smaller) nodule if of higher grade (if present)

2 – Primary and secondary

Grades mixed

Report both grades, dominant pattern* first (2+3, 3+4, 4+3 ..)

Record for dominant nodule +/- nondominant (smaller) nodule if of higher grade (if present)

Secondary grade is lower and of limited amount (<5%)

Ignore lower grade – 4+3 becomes 4+4

Record for dominant nodule +/- non dominant (smaller) nodule if of higher grade (if present)

Secondary grade is higher and of limited amount (<5%)

Include higher grade – 3+3 becomes 3+4

Record for dominant nodule +/- non dominant (smaller) nodule if of higher grade (if present)

3 – Primary, secondary and tertiary Grades 2, 3, 4 or 5

Report dominant grade (largest area) first, then secondary grade (second largest area), then tertiary grade (only if 4 or 5)

eg 3+4=7 with tertiary grade 5*

eg 2+3=5 with tertiary grade 4*

Record for dominant nodule +/- non dominant (smaller) nodule if of higher grade (if present)

 

Table 2: Gleason scoring in needle core biopsy specimens

Number of different grades present

Proportion of grades present

Comments
1 - Primary

One of 3, 4 or 5 only

Double grade to get score

(eg 4+4=8)

2 – Primary and secondary

Grades mixed

Report both grades, dominant pattern first ( 3+4, 4+3 ..)

Secondary grade is lower and of limited amount (<5%)

Ignore lower grade –

4+3 becomes 4+4

Secondary grade is higher and of limited amount (<5%)

Include higher grade –

3+3 becomes 3+4

3 – Primary, secondary and tertiary Grades 3, 4 or 5

Score the primary grade and the highest grade:

eg 3+4+5 becomes 3+5=8

eg 4+5+3=5 becomes 4+5=9

* The tertiary grade is recorded separately under the item Person with cancer—histopathological grade, tertiary Gleason grade, code N

Note: Dominant (primary) grade is that which occupies the greatest area.

More extensive guidelines are available in the Prostate cancer (radical prostatectomy) structured reporting protocol (2nd Ed.) at the Royal College of Pathologists of Australasia website.

 

Source and reference attributes

Submitting organisation:Cancer Australia
Reference documents:

American College of Surgeons 2011. Facility Oncology Registry Data Standards: Revised for 2011. American College of Surgeons: Chicago.

Humphrey PA 2004. Gleason grading and prognostic factors in carcinoma of the prostate. Modern pathology, 17(3):p292-306.

Royal College of Pathologists of Australasia 2014. Prostate cancer (radical prostatectomy) structured reporting protocol (2nd Ed.). Royal College of Pathologists of Australasia: Sydney.

Relational attributes

Data elements implementing this value domain:

Person with cancer—histopathological grade, Gleason score code N[N] Health, Standard 14/05/2015