Testicular cancer: The usage of central review for pathology diagnosis of orchiectomy specimens

Saul E. Harari, Daniel J. Sassoon, David S. Priemer, Joseph M. Jacob, John Eble, Anna Caliò, David Grignon, Muhammad Idrees, Costantine Albany, Timothy Masterson, Nasser Hanna, Richard Foster, Thomas Ulbright, Lawrence Einhorn, Liang Cheng

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Radical orchiectomy specimens present a unique set of challenges for pathology assessment owing to their rarity and complexity. This study compares second opinion pathology reports generated at a single, large academic institution to primary reports from outside hospitals. Methods: A database search was conducted for orchiectomy cases that were sent to our institution for management of testicular cancer from 2014 to 2015. Cases sent for consultation without a finalized diagnosis from the outside hospitals were excluded. A total of 221 consecutive cases were evaluated for comparison of final diagnoses between the outside institution and central pathology review. Results: This study revealed significant discrepancy involving multiple parameters between original and second opinion pathology reports. Of 221 cases of germ cell tumors assessed, 31% showed some discrepancy of histologic subtype. Overall, reporting of lymphovascular invasion changed in 22% of cases; of those, initially called positive 23% were changed to negative and of those initially called negative 12% were changed to positive. Although the overall discrepancy for spermatic cord invasion was 9%, an initial positive diagnosis was negated 35% of the time. The pathologic stage was altered in 23% of cases, mostly secondary to differences interpreting lymphovascular and spermatic cord invasion. Conclusion: Pathologists evaluating orchiectomy specimens should be aware of the major pitfalls in classification and staging, many of which may affect patient management.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Nov 11 2016

Fingerprint

Orchiectomy
Testicular Neoplasms
Pathology
Spermatic Cord
Referral and Consultation
Germ Cell and Embryonal Neoplasms
Databases

Keywords

  • Central pathology review
  • Differential diagnosis
  • Germ cell tumor
  • Orchiectomy
  • Pathologic staging
  • Testis
  • Vascular invasion

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

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title = "Testicular cancer: The usage of central review for pathology diagnosis of orchiectomy specimens",
abstract = "Background: Radical orchiectomy specimens present a unique set of challenges for pathology assessment owing to their rarity and complexity. This study compares second opinion pathology reports generated at a single, large academic institution to primary reports from outside hospitals. Methods: A database search was conducted for orchiectomy cases that were sent to our institution for management of testicular cancer from 2014 to 2015. Cases sent for consultation without a finalized diagnosis from the outside hospitals were excluded. A total of 221 consecutive cases were evaluated for comparison of final diagnoses between the outside institution and central pathology review. Results: This study revealed significant discrepancy involving multiple parameters between original and second opinion pathology reports. Of 221 cases of germ cell tumors assessed, 31{\%} showed some discrepancy of histologic subtype. Overall, reporting of lymphovascular invasion changed in 22{\%} of cases; of those, initially called positive 23{\%} were changed to negative and of those initially called negative 12{\%} were changed to positive. Although the overall discrepancy for spermatic cord invasion was 9{\%}, an initial positive diagnosis was negated 35{\%} of the time. The pathologic stage was altered in 23{\%} of cases, mostly secondary to differences interpreting lymphovascular and spermatic cord invasion. Conclusion: Pathologists evaluating orchiectomy specimens should be aware of the major pitfalls in classification and staging, many of which may affect patient management.",
keywords = "Central pathology review, Differential diagnosis, Germ cell tumor, Orchiectomy, Pathologic staging, Testis, Vascular invasion",
author = "Harari, {Saul E.} and Sassoon, {Daniel J.} and Priemer, {David S.} and Jacob, {Joseph M.} and John Eble and Anna Cali{\`o} and David Grignon and Muhammad Idrees and Costantine Albany and Timothy Masterson and Nasser Hanna and Richard Foster and Thomas Ulbright and Lawrence Einhorn and Liang Cheng",
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TY - JOUR

T1 - Testicular cancer

T2 - The usage of central review for pathology diagnosis of orchiectomy specimens

AU - Harari, Saul E.

AU - Sassoon, Daniel J.

AU - Priemer, David S.

AU - Jacob, Joseph M.

AU - Eble, John

AU - Caliò, Anna

AU - Grignon, David

AU - Idrees, Muhammad

AU - Albany, Costantine

AU - Masterson, Timothy

AU - Hanna, Nasser

AU - Foster, Richard

AU - Ulbright, Thomas

AU - Einhorn, Lawrence

AU - Cheng, Liang

PY - 2016/11/11

Y1 - 2016/11/11

N2 - Background: Radical orchiectomy specimens present a unique set of challenges for pathology assessment owing to their rarity and complexity. This study compares second opinion pathology reports generated at a single, large academic institution to primary reports from outside hospitals. Methods: A database search was conducted for orchiectomy cases that were sent to our institution for management of testicular cancer from 2014 to 2015. Cases sent for consultation without a finalized diagnosis from the outside hospitals were excluded. A total of 221 consecutive cases were evaluated for comparison of final diagnoses between the outside institution and central pathology review. Results: This study revealed significant discrepancy involving multiple parameters between original and second opinion pathology reports. Of 221 cases of germ cell tumors assessed, 31% showed some discrepancy of histologic subtype. Overall, reporting of lymphovascular invasion changed in 22% of cases; of those, initially called positive 23% were changed to negative and of those initially called negative 12% were changed to positive. Although the overall discrepancy for spermatic cord invasion was 9%, an initial positive diagnosis was negated 35% of the time. The pathologic stage was altered in 23% of cases, mostly secondary to differences interpreting lymphovascular and spermatic cord invasion. Conclusion: Pathologists evaluating orchiectomy specimens should be aware of the major pitfalls in classification and staging, many of which may affect patient management.

AB - Background: Radical orchiectomy specimens present a unique set of challenges for pathology assessment owing to their rarity and complexity. This study compares second opinion pathology reports generated at a single, large academic institution to primary reports from outside hospitals. Methods: A database search was conducted for orchiectomy cases that were sent to our institution for management of testicular cancer from 2014 to 2015. Cases sent for consultation without a finalized diagnosis from the outside hospitals were excluded. A total of 221 consecutive cases were evaluated for comparison of final diagnoses between the outside institution and central pathology review. Results: This study revealed significant discrepancy involving multiple parameters between original and second opinion pathology reports. Of 221 cases of germ cell tumors assessed, 31% showed some discrepancy of histologic subtype. Overall, reporting of lymphovascular invasion changed in 22% of cases; of those, initially called positive 23% were changed to negative and of those initially called negative 12% were changed to positive. Although the overall discrepancy for spermatic cord invasion was 9%, an initial positive diagnosis was negated 35% of the time. The pathologic stage was altered in 23% of cases, mostly secondary to differences interpreting lymphovascular and spermatic cord invasion. Conclusion: Pathologists evaluating orchiectomy specimens should be aware of the major pitfalls in classification and staging, many of which may affect patient management.

KW - Central pathology review

KW - Differential diagnosis

KW - Germ cell tumor

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KW - Pathologic staging

KW - Testis

KW - Vascular invasion

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