Challenges in pathologic staging of renal cell carcinoma: A study of interobserver variability among urologic pathologists Journal Article


Authors: Williamson, S. R.; Rao, P.; Hes, O.; Epstein, J. I.; Smith, S. C.; Picken, M. M.; Zhou, M.; Tretiakova, M. S.; Tickoo, S. K.; Chen, Y. B.; Reuter, V. E.; Fleming, S.; Maclean, F. M.; Gupta, N. S.; Kuroda, N.; Delahunt, B.; Mehra, R.; Przybycin, C. G.; Cheng, L.; Eble, J. N.; Grignon, D. J.; Moch, H.; Lopez, J. I.; Kunju, L. P.; Tamboli, P.; Srigley, J. R.; Amin, M. B.; Martignoni, G.; Hirsch, M. S.; Bonsib, S. M.; Trpkov, K.
Article Title: Challenges in pathologic staging of renal cell carcinoma: A study of interobserver variability among urologic pathologists
Abstract: Staging criteria for renal cell carcinoma differ from many other cancers, in that renal tumors are often spherical with subtle, finger-like extensions into veins, renal sinus, or perinephric tissue. We sought to study interobserver agreement in pathologic stage categories for challenging cases. An online survey was circulated to urologic pathologists interested in kidney tumors, yielding 89% response (31/35). Most questions included 1 to 4 images, focusing on: vascular and renal sinus invasion (n =24), perinephric invasion (n =9), and gross pathology/specimen handling (n =17). Responses were collapsed for analysis into positive and negative/equivocal for upstaging. Consensus was regarded as an agreement of 67% (2/3) of participants, which was reached in 20/33 (61%) evaluable scenarios regarding renal sinus, perinephric, or vein invasion, of which 13/33 (39%) had ≥ 80% consensus. Lack of agreement was especially encountered regarding small tumor protrusions into a possible vascular lumen, close to the tumor leading edge. For gross photographs, most were interpreted as suspicious but requiring histologic confirmation. Most participants (61%) rarely used special stains to evaluate vascular invasion, usually endothelial markers (81%). Most agreed that a spherical mass bulging well beyond the kidney parenchyma into the renal sinus (71%) or perinephric fat (90%) did not necessarily indicate invasion. Interobserver agreement in pathologic staging of renal cancer is relatively good among urologic pathologists interested in kidney tumors, even when selecting cases that test the earliest and borderline thresholds for extrarenal extension. Disagreements remain, however, particularly for tumors with small, finger-like protrusions, closely juxtaposed to the main mass. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: renal cell carcinoma; pathologic staging; perinephric invasion; renal sinus invasion; vein invasion
Journal Title: American Journal of Surgical Pathology
Volume: 42
Issue: 9
ISSN: 0147-5185
Publisher: Lippincott Williams & Wilkins  
Date Published: 2018-09-01
Start Page: 1253
End Page: 1261
Language: English
DOI: 10.1097/pas.0000000000001087
PROVIDER: scopus
PUBMED: 29878933
DOI/URL:
Notes: Article -- Export Date: 4 September 2018 -- Source: Scopus
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MSK Authors
  1. Satish K Tickoo
    369 Tickoo
  2. Yingbei Chen
    221 Chen
  3. Victor Reuter
    913 Reuter