Cribriform prostate cancer: Morphologic criteria enabling a diagnosis, based on survey of experts

Kenneth A. Iczkowski, Geert J.L.H. van Leenders, Sergey Tarima, Ruizhe Wu, Theodorus Van der Kwast, Daniel M. Berney, Andrew J. Evans, Thomas M. Wheeler, Jae Y. Ro, Hemamali Samaratunga, Brett Delahunt, John Srigley, Murali Varma, Toyonori Tsuzuki, Lars Egevad

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Among four sub-patterns of Gleason grade 4 prostate cancer, voluminous evidence supports that the cribriform pattern holds an unfavorable prognostic impact, as compared with poorly-formed, fused, or glomeruloid. The International Society of Urological Pathology (ISUP) recommends specifying whether invasive grade 4 cancer is cribriform. Recently, ISUP experts published a consensus definition of cribriform pattern highlighting criteria that distinguish it from mimickers. The current study aimed to analyze morphologic features separately to identify those that define the essence of the cribriform pattern. Thirty-two selected photomicrographs were classified by 12 urologic pathologists as: definitely cribriform cancer, probably cribriform, unsure, probably not cribriform, or definitely not cribriform. Consensus was defined as 9/12 agree or disagree, with ≤1 strongly supporting the opposite choice. Final consensus was achieved in 21 of 32 cases. Generalized estimating equation (GEE) model with logit link was fitted to estimate effect of multiple morphologic predictors. Fisher exact test was used for categorical findings. Presence of intervening stroma precluded calling cribriform cancer (p = 0.006). Mucin presence detracted (p = 0.003) from willingness to call cribriform cancer (only 3 cases had mucin). Lumen number was associated with cribriform consensus (p = 0.0006), and all consensus cases had ≥9 lumens. Predominant papillary pattern or an irregular outer boundary detracted (p = NS). Invasive cribriform carcinoma should have absence of intervening stroma, and usually neither papillary pattern, irregular outer boundary, nor very few lumens. Setting the criteria for cribriform will help prevent over- or undercalling this important finding.

Original languageEnglish (US)
Article number151733
Pages (from-to)151733
JournalAnnals of Diagnostic Pathology
StatePublished - Jun 2021


  • Consensus
  • Cribriform
  • Grade Group
  • Grading
  • Prostate Cancer
  • Societies, Medical/organization & administration
  • Prognosis
  • Surveys and Questionnaires/statistics & numerical data
  • Humans
  • Neoplasm Grading/methods
  • Prostatic Neoplasms/classification
  • Male
  • Urologists/organization & administration
  • Photomicrography/methods
  • Adenocarcinoma/diagnosis
  • Neoplasm Invasiveness/pathology
  • Mucins/metabolism
  • Pathologists/organization & administration

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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