PD19-08 DISCREPANCY IN PATHOLOGY REPORTS UPON SECOND REVIEW OF RADICAL ORCHIECTOMY SPECIMENS FOR TESTICULAR GERM CELL TUMORS

Abstract

INTRODUCTION AND OBJECTIVE: Accurate pathological reporting is important in testis cancer due to the implications for treatment after radical orchiectomy (RO). The aim of this study was to evaluate the discrepancies between primary pathology report and second pathology review of RO specimens in Ontario. METHODS: A retrospective review was performed of RO specimens performed from the Ontario Cancer Registry All cases required both a primary pathology report and a second pathology review from another institution. Histopathological variables assessed for comparison included histological subtype and components of mixed germ cell tumor (GCT), pathologic tumor (pT) stage, lymphovascular invasion (LVI), spermatic cord invasion, and surgical margin. RESULTS: Between 1994 and 2015, 5048 RO were performed with 2719 (53.9%) seminoma and 2029 (40.2%) nonseminoma. 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 down-staging 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 5 (9.6%) cases. CONCLUSIONS: Only 10% of orchiectomy specimens for testicular germ cell tumors in Ontario 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 radical orchiectomy specimens should be considered as it has significant implications for decision making. Source of Funding: None