# Assessment of Reporting Completeness in Prostate Core Biopsies: A Four-Year Audit From a Tertiary Care Centre (2021-2024)

## TL;DR

This study evaluated how complete prostate cancer biopsy reports were at a hospital, finding mostly good adherence to international standards but some room for improvement.

## Contribution

The study provides a four-year audit of prostate biopsy reporting completeness using international guidelines at a tertiary care center.

## Key findings

- All malignant cases had complete Gleason grading, showing excellent compliance with ISUP guidelines.
- Tumour percentage per core was the most frequently omitted parameter, documented in 92% of cases.
- Gross description and tissue fragment count were fully documented in all cases.

## Abstract

Background: Accurate and standardised histopathology reporting of prostate core biopsies is essential for appropriate risk stratification, prognostication, and clinical decision-making in patients with prostatic adenocarcinoma. Adherence to internationally recognised reporting guidelines ensures consistency, completeness, and clinical relevance of pathology reports. Clinical audits serve as an effective quality assurance tool to evaluate reporting practices and identify areas requiring improvement.

Objective: This study aimed to assess the completeness of histopathological reporting of prostate core biopsies diagnosed as prostatic adenocarcinoma at a tertiary care academic hospital, using established international standards as audit benchmarks.

Methods: A retrospective clinical audit was conducted in the Histopathology Department of Sultan Qaboos University Hospital. Prostate core biopsy reports issued between January 2021 and December 2024 were retrieved from the laboratory information system. A total of 116 consecutive prostate biopsies were included, comprising both benign and malignant diagnoses. Reporting completeness was evaluated only in the 64 cases diagnosed as prostatic adenocarcinoma. Audit criteria were derived from the College of American Pathologists (CAP) Prostate Cancer Protocol (2023 update), the WHO Classification of Tumours of the Urinary System and Male Genital Organs (2022), and the International Society of Urological Pathology (ISUP) consensus guidelines on Gleason grading. Key parameters assessed included histological tumour type, primary and secondary Gleason patterns, total Gleason score, WHO/ISUP Grade Group, perineural invasion status, tumour percentage per core, and documentation of tissue fragment count. Data were analysed descriptively using counts and proportions.

Results: Of the 116 prostate biopsies reviewed, 52 cases (45%) were benign, and 64 cases (55%) were diagnosed as prostatic adenocarcinoma. All malignant cases (100%) had complete documentation of Gleason grading parameters, reflecting excellent compliance with ISUP recommendations. Histological tumour type was reported in 94% of cases, WHO/ISUP Grade Group in 95%, and perineural invasion status in 97%. Tumour percentage per core was documented in 92% of cases, representing the most frequently omitted parameter. Gross description, including tissue fragment count, was complete in all cases.

Conclusion: This audit demonstrates a high level of adherence to international prostate biopsy reporting standards, with minor deficiencies identified in the reporting of tumour extent. Regular audits and targeted interventions may further enhance reporting quality and standardisation.