https://doi.org/10.4081/aiua.2026.15596
Digital pathology for repeat prostate biopsy reassessment during active surveillance: an institutional experience
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Published: 15 June 2026
Introduction: Repeat biopsy remains central to active surveillance (AS) because upgrading and tumor burden may change management.
Methods: This retrospective paired workflow study included 38 men and 47 repeat biopsy sessions (2023-2025), comprising 846 biopsy cores and 871 H&E slides. Whole-slide imaging (WSI) and conventional microscopy were compared after a washout interval. QuPath was used only for pathologist-guided tumorlength and greatest percentage of cancer (GPC) documentation.
Results: On the first eligible repeat biopsy, upgrading to ISUP Grade Group (GG) 2 occurred in 7/38 men (18.4%; 95% CI, 7.7- 34.3). No GG3, cribriform morphology, or intraductal carcinoma was identified. Protocol-linked reclassification occurred in 11/38 men (28.9%). Slide-level cancer-detection agreement was 856/871 (98.3%; kappa = 0.91), and raw patient-level agreement for upgrading was 36/38 (94.7%; kappa = 0.80). After adjudication, no upgraded patient remained missed. QuPathsupported measurement was interpretable in 79/101 positive core-level assessments (78.2%), with excellent agreement (ICC = 0.98) and shorter median measurement time (41 s vs 78 s).
Conclusions: WSI reproduced management-relevant conventional microscopy outputs in repeat AS biopsies. Its value was organizational and documentary, not autonomous cancer detection or grading.
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CRediT authorship contribution
Ludovica Pepe: Conceptualization; Methodology; Investigation; Data curation; Writing - original draft; Writing - review and editing. Vincenzo Fiorentino: Conceptualization; Methodology; Investigation; Validation; Data curation; Writing - original draft; Writing - review and editing. Mara Curduman: Investigation; Validation; Data curation; Writing - review and editing. Pietro Pepe: Conceptualization; Resources; Supervision; Project administration; Writing - review and editing. All authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
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Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request, subject to institutional regulations and applicable privacy restrictions.
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