Handling and staging of renal cell carcinoma: The International Society of Urological Pathology Consensus (ISUP) conference recommendations

Kiril Trpkov, David J. Grignon, Stephen M. Bonsib, Mahul B. Amin, Athanase Billis, Antonio Lopez-Beltran, Hemamali Samaratunga, Pheroze Tamboli, Brett Delahunt, Lars Egevad, Rodolfo Montironi, John R. Srigley, Anila Abraham, Adebowale Adeniran, Khalid Ahmed, Hikmat Al Ahmadie, Ferran Algaba, Robert Allan, Pedram Argani, Ulrika AxcronaMarc Barry, Dilek Baydar, Louis Bégin, Dan Berney, Peter Bethwaite, Ruth Birbe, David Bostwick, Fadi Brimo, Helen Cathro, Ying Bei Chen, Liang Cheng, John Cheville, Yong Mee Cho, Ai Ying Chuang, Cynthia Cohen, Henry Crist, Warick Delprado, Fang Ming Deng, Jonathan Epstein, Andrew Evans, Oluwole Fadare, Daniel Fajardo, Sara Falzarano, Samson Fine, Stewart Fleming, Eddie Fridman, Bungo Furusato, Masoud Ganji, Masoumeh Ghayouri, Giovanna Giannico, Neriman Gokden, David Griffiths, Nilesh Gupta, Omar Hameed, Ondrej Hes, Michelle Hirsch, Jiaoti Huang, Wei Huang, Christina Hulsbergen Van De Kaa, Peter Humphrey, Sundus Hussein, Kenneth Iczkowski, Rafael Jimenez, Edward Jones, Laura Irene Jufe, James Kench, Masatoshi Kida, Glen Kristiansen, Lakshmi Priya Kunju, Zhaoli Lane, Mathieu Latour, Claudio Lewin, Kathrine Lie, Josep Lloreta, Barbara Loftus, Fiona Maclean, Cristina Magi-Galluzzi, Guido Martignoni, Teresa McHale, Jesse McKenney, Maria Merino, Rose Miller, Hiroshi Miyamoto, Holger Moch, Hedwig Murphy, John Nacey, Tipu Nazeer, Gabriella Nesi, George Netto, Peter Nichols, Marie O'Donnell, Semra Olgac, Roberto Orozco, Adeboye Osunkoya, Aysim Ozagari, Chin Chen Pan, Anil Parwani, Joanna Perry-Keene, Constantina Petraki, Maria Picken, Maria Pyda-Karwicka, Victor Reuter, Katayoon Rezaei, Nathalie Rioux-Leclercq, Brian Robinson, Stephen Rohan, Ruben Ronchetti, Laurie Russell, Marina Scarpelli, Ahmed Shabaik, Rajal Shah, Jonathan Shanks, Steven Shen, Maria Shevchuk, Mathilde Sibony, Bhuvana Srinivasan, Martin Susani, Sueli Suzigan, Joan Sweet, Hiroyuki Takahashi, Puay Hoon Tan, Satish Tickoo, Isabel Trias, Larry True, Toyonori Tsuzuki, Funda Vakar-Lopez, Theo Van Der Kwast, Cheng Wang, Anne Warren, Jorge Yao, Asli Yilmaz, Jin Zhao, Ming Zhou, Debra Zynger

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Abstract

The International Society of Urologic Pathology 2012 Consensus Conference on renal cancer, through working group 3, focused on the issues of staging and specimen handling of renal tumors. The conference was preceded by an online survey of the International Society of Urologic Pathology members, and the results of this were used to inform the focus of conference discussion. On formal voting a Z65% majority was considered a consensus agreement. For specimen handling it was agreed that with radical nephrectomy specimens the initial cut should be made along the long axis and that both radical and partial nephrectomy specimens should be inked. It was recommended that sampling of renal tumors should follow a general guideline of sampling 1 block/cm with a minimum of 3 blocks (subject to modification as needed in individual cases). When measuring a renal tumor, the length of a renal vein/caval thrombus should not be part of the measurement of the main tumor mass. In cases with multiple tumors, sampling should include at a minimum the 5 largest tumors. There was a consensus that perinephric fat invasion should be determined by examining multiple perpendicular sections of the tumor/perinephric fat interface and by sampling areas suspicious for invasion. Perinephric fat invasion was defined as either the tumor touching the fat or extending as irregular tongues into the perinephric tissue, with or without desmoplasia. It was agreed upon that renal sinus invasion is present when the tumor is in direct contact with the sinus fat or the loose connective tissue of the sinus, clearly beyond the renal parenchyma, or if there is involvement of any endothelium-lined spaces within the renal sinus, regardless of the size. When invasion of the renal sinus is uncertain, it was recommended that at least 3 blocks of the tumor-renal sinus interface should be submitted. If invasion is grossly evident, or obviously not present (small peripheral tumor), it was agreed that only 1 block was needed to confirm the gross impression. Other recommendations were that the renal vein margin be considered positive only when there is adherent tumor visible microscopically at the actual margin. When a specimen is submitted separately as "caval thrombus, "the recommended sampling strategy is to take 2 or more sections to look for the adherent caval wall tissue. It was also recommended that uninvolved renal parenchyma be sampled by including normal parenchyma with tumor and normal parenchyma distant from the tumor. There was consensus that radical nephrectomy specimens should be examined for the purpose of identifying lymph nodes by dissection/palpation of the fat in the hilar area only; however, it was acknowledged that lymph nodes are found in <10% of radical nephrectomy specimens.

Original languageEnglish (US)
Pages (from-to)1505-1517
Number of pages13
JournalAmerican Journal of Surgical Pathology
Volume37
Issue number10
DOIs
StatePublished - Oct 2013

Keywords

  • Fat invasion
  • International Society of Urological Pathology
  • ISUP
  • Kidney
  • Pathology
  • Renal cell carcinoma
  • Renal sinus
  • Renal vein invasion
  • Specimen handling
  • Stage

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

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    Trpkov, K., Grignon, D. J., Bonsib, S. M., Amin, M. B., Billis, A., Lopez-Beltran, A., Samaratunga, H., Tamboli, P., Delahunt, B., Egevad, L., Montironi, R., Srigley, J. R., Abraham, A., Adeniran, A., Ahmed, K., Al Ahmadie, H., Algaba, F., Allan, R., Argani, P., ... Zynger, D. (2013). Handling and staging of renal cell carcinoma: The International Society of Urological Pathology Consensus (ISUP) conference recommendations. American Journal of Surgical Pathology, 37(10), 1505-1517. https://doi.org/10.1097/PAS.0b013e31829a85d0