@surftohealth88 I totally agree that saying all Gleason 4 slides have cribriform is false. What I just learned from you is that a grouping of Gleason 3 cells can legitimately be upgraded to Gleason 4 if there is some cribriform pattern mixed in. Additionally, Gleason 4 cells with cribriform pattern can be upgraded to Gleason 5.

What I had previously thought was that a grouping of Gleason 4 cancer cells stayed at Gleason 4 and either had cribriform pattern present or not. I had always thought of cribriform as an independent feature in the same way that intraductal stands alone. I did confirm with google AI that cribriform affects the Gleason score while intraductal stands alone and does not affect the Gleason score.