Discrepancy in pathology reports upon second review of radical orchiectomy specimens for testicular germ cell tumors

Authors

  • Gregory J. Nason Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
  • Joan Sweet
  • Lauren Landoni
  • Ricardo Leao
  • Lynn Anson-Cartwright
  • Spencer Mok
  • Vanessa Guzylak
  • Andrea D’Angelo
  • Zhi Yi Fang
  • Ilana Geist
  • Padraig Warde
  • Michael A.S. Jewett
  • Robert J. Hamilton

DOI:

https://doi.org/10.5489/cuaj.6481

Keywords:

germ cell tumor; testis cancer; pathology; orchiectomy

Abstract

Introduction: We sought to evaluate the discrepancies between primary pathology report and second pathology review of radical orchiectomy (RO) specimens.

Methods: A retrospective review was performed of RO specimens from the Ontario Cancer Registry. All cases required both a primary pathology report and a second pathology review from another institution. Histopathological variables assessed included histological subtype and components of mixed germ cell tumor (GCT), pathological tumor (pT) stage, lymphovascular invasion (LVI), spermatic cord invasion, and surgical margin.

Results: Between 1994 and 2015, 5048 ROs were performed with 2719 (53.9%) seminoma and 2029 (40.2%) non-seminoma. Of these, 519 (10.3%) received a second pathology review. There was concordance between primary pathology report and second pathology review in 326 (62.8%) cases. The most common discrepancies involved a change in pT stage (n=148, 28.5%), with upstaging in 83 (16%) and downstaging in 65 (12.5%) cases relative to the original pT stage. The second most common discrepancy regarded the reporting of LVI (n=121, 23.3%), with 62 (11.9%) reporting presence of LVI when the primary pathology report did not. Other discrepancies included a change in the histological subtype in 28 (5.4%) cases and spermatic cord margin status in five (9.6%) cases.

Conclusions: Only 10% of orchiectomy specimens underwent a second pathology review, with nearly 40% of reviews leading to a meaningful change in parameters. Such variation could lead to incorrect tumor staging, estimate of relapse risk, and inappropriate treatment decisions. Expert pathology review of RO specimens should be considered, as it has significant implications for decision-making.

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Published

2020-06-16

How to Cite

Nason, G. J., Sweet, J. ., Landoni, L. ., Leao, R. ., Anson-Cartwright, L. ., Mok, S. ., Guzylak, V. ., D’Angelo, A., Fang, Z. Y. ., Geist, I. ., Warde, P. ., Jewett , M. A. ., & Hamilton, R. J. . (2020). Discrepancy in pathology reports upon second review of radical orchiectomy specimens for testicular germ cell tumors. Canadian Urological Association Journal, 14(12), 411–5. https://doi.org/10.5489/cuaj.6481

Issue

Vol. 14 No. 12 (2020): CUAJ December

Section

Original Research

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