36 
Clinical disagreement in histological diagnosis and pathological stage in a series of nephrectomy specimens: the impact of recent changes to the WHO and TNM systems

• Published in: BJU international Vol. 97; no. s1; pp. 10 - 11
• Main Authors: CAMPBELL, P.A., PERRY‐KEENE, J., WILSON, I., MACTAGGART, P., NICOL, D.L., CAMPBELL, C.M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2006
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2006.06085_36.x

Introduction:  The prognosis and treatment of carcinoma of the kidney is predicted by the histological subtype and the pathological stage of the tumour. These are determined by pathological examination of the surgical specimen and the application of accepted classification and staging systems. We aimed to document how frequently disagreement in diagnosis and staging occurred in a retrospective review of a series of nephrectomy specimens. Materials and methods:  All nephrectomies performed for tumour (all originally diagnosed as ‘renal cell carcinoma’) in the years 1990–1995 were identified. The original pathology report and the archived histological material were re‐examined. Cases were re‐classified using the 2004 WHO histological classification and clear cell renal cell carcinomas (RCC) were re‐staged using the 2002 TNM staging system. The revised and original classifications were compared for disagreement. Results:  One hundred and twenty four (124) nephrectomy specimens were reviewed and a discrepant diagnosis was recorded in 24 (19%). Re‐classification of 123 primary tumours identified 100 clear cell RCC, 1 multilocular cystic clear cell RCC, 9 papillary RCC, 4 chromophobe RCC and 9 oncocytomas. When the 2002 and 1997 TNM stages were compared there was agreement for all cases of pT1a, pT3b, pT3c and pT4 tumours. Four pT1b and 2 pT2 cases were originally staged as pT3a. In 19 cases of pT3a tumours, 2 were originally staged as pT1, 6 as pT2 and 2 as pT3b. This represents a disagreement in 16% of cases (16/97). In 24/60 (40%) cases of organ confined disease, renal sinus fat had not been sampled and a pT3a stage could not be excluded. Conclusion:  A retrospective review of nephrectomy specimens performed for tumour re‐assessed using the 2004 WHO classification and the 2002 TNM staging systems, demonstrated clinical disagreement in 19% and 16% of cases respectively. In 40% of cases of presumed organ confined disease the specimen had not been adequately sampled to exclude pT3a stage disease.