Challenges in pathologic staging of renal cell carcinoma

A study of interobserver variability among urologic pathologists

Sean R. Williamson, Priya Rao, Ondrej Hes, Jonathan I. Epstein, Steven C. Smith, Maria M. Picken, Ming Zhou, Maria S. Tretiakova, Satish K. Tickoo, Ying Bei Chen, Victor E. Reuter, Stewart Fleming, Fiona M. Maclean, Nilesh S. Gupta, Naoto Kuroda, Brett Delahunt, Rohit Mehra, Christopher G. Przybycin, Liang Cheng, John N. Eble & 11 others David J. Grignon, Holger Moch, Jose I. Lopez, Lakshmi P. Kunju, Pheroze Tamboli, John R. Srigley, Mahul Amin, Guido Martignoni, Michelle S. Hirsch, Stephen M. Bonsib, Kiril Trpkov

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1253-1261
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume42
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Observer Variation
Renal Cell Carcinoma
Kidney
Blood Vessels
Neoplasms
Kidney Neoplasms
Specimen Handling
Renal Veins
Pathologists
Veins
Coloring Agents
Fats
Pathology

All Science Journal Classification (ASJC) codes

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Challenges in pathologic staging of renal cell carcinoma : A study of interobserver variability among urologic pathologists. / Williamson, Sean R.; Rao, Priya; Hes, Ondrej; Epstein, Jonathan I.; Smith, Steven C.; Picken, Maria M.; Zhou, Ming; Tretiakova, Maria S.; Tickoo, Satish K.; Chen, Ying Bei; Reuter, Victor E.; Fleming, Stewart; Maclean, Fiona M.; Gupta, Nilesh S.; Kuroda, Naoto; Delahunt, Brett; Mehra, Rohit; Przybycin, Christopher G.; Cheng, Liang; Eble, John N.; Grignon, David J.; Moch, Holger; Lopez, Jose I.; Kunju, Lakshmi P.; Tamboli, Pheroze; Srigley, John R.; Amin, Mahul; Martignoni, Guido; Hirsch, Michelle S.; Bonsib, Stephen M.; Trpkov, Kiril.

In: American Journal of Surgical Pathology, Vol. 42, No. 9, 01.09.2018, p. 1253-1261.

Research output: Contribution to journalArticle

Williamson, SR, Rao, P, Hes, O, Epstein, JI, Smith, SC, Picken, MM, Zhou, M, Tretiakova, MS, Tickoo, SK, Chen, YB, Reuter, VE, Fleming, S, Maclean, FM, Gupta, NS, Kuroda, N, Delahunt, B, Mehra, R, Przybycin, CG, Cheng, L, Eble, JN, Grignon, DJ, Moch, H, Lopez, JI, Kunju, LP, Tamboli, P, Srigley, JR, Amin, M, Martignoni, G, Hirsch, MS, Bonsib, SM & Trpkov, K 2018, 'Challenges in pathologic staging of renal cell carcinoma: A study of interobserver variability among urologic pathologists', American Journal of Surgical Pathology, vol. 42, no. 9, pp. 1253-1261. https://doi.org/10.1097/PAS.0000000000001087
Williamson, Sean R. ; Rao, Priya ; Hes, Ondrej ; Epstein, Jonathan I. ; Smith, Steven C. ; Picken, Maria M. ; Zhou, Ming ; Tretiakova, Maria S. ; Tickoo, Satish K. ; Chen, Ying Bei ; Reuter, Victor E. ; Fleming, Stewart ; Maclean, Fiona M. ; Gupta, Nilesh S. ; Kuroda, Naoto ; Delahunt, Brett ; Mehra, Rohit ; Przybycin, Christopher G. ; Cheng, Liang ; Eble, John N. ; Grignon, David J. ; Moch, Holger ; Lopez, Jose I. ; Kunju, Lakshmi P. ; Tamboli, Pheroze ; Srigley, John R. ; Amin, Mahul ; Martignoni, Guido ; Hirsch, Michelle S. ; Bonsib, Stephen M. ; Trpkov, Kiril. / Challenges in pathologic staging of renal cell carcinoma : A study of interobserver variability among urologic pathologists. In: American Journal of Surgical Pathology. 2018 ; Vol. 42, No. 9. pp. 1253-1261.
@article{9dbc7d1ee23a4555af78b10242755431,
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.",
author = "Williamson, {Sean R.} and Priya Rao and Ondrej Hes and Epstein, {Jonathan I.} and Smith, {Steven C.} and Picken, {Maria M.} and Ming Zhou and Tretiakova, {Maria S.} and Tickoo, {Satish K.} and Chen, {Ying Bei} and Reuter, {Victor E.} and Stewart Fleming and Maclean, {Fiona M.} and Gupta, {Nilesh S.} and Naoto Kuroda and Brett Delahunt and Rohit Mehra and Przybycin, {Christopher G.} and Liang Cheng and Eble, {John N.} and Grignon, {David J.} and Holger Moch and Lopez, {Jose I.} and Kunju, {Lakshmi P.} and Pheroze Tamboli and Srigley, {John R.} and Mahul Amin and Guido Martignoni and Hirsch, {Michelle S.} and Bonsib, {Stephen M.} and Kiril Trpkov",
year = "2018",
month = "9",
day = "1",
doi = "10.1097/PAS.0000000000001087",
language = "English (US)",
volume = "42",
pages = "1253--1261",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Challenges in pathologic staging of renal cell carcinoma

T2 - A study of interobserver variability among urologic pathologists

AU - Williamson, Sean R.

AU - Rao, Priya

AU - Hes, Ondrej

AU - Epstein, Jonathan I.

AU - Smith, Steven C.

AU - Picken, Maria M.

AU - Zhou, Ming

AU - Tretiakova, Maria S.

AU - Tickoo, Satish K.

AU - Chen, Ying Bei

AU - Reuter, Victor E.

AU - Fleming, Stewart

AU - Maclean, Fiona M.

AU - Gupta, Nilesh S.

AU - Kuroda, Naoto

AU - Delahunt, Brett

AU - Mehra, Rohit

AU - Przybycin, Christopher G.

AU - Cheng, Liang

AU - Eble, John N.

AU - Grignon, David J.

AU - Moch, Holger

AU - Lopez, Jose I.

AU - Kunju, Lakshmi P.

AU - Tamboli, Pheroze

AU - Srigley, John R.

AU - Amin, Mahul

AU - Martignoni, Guido

AU - Hirsch, Michelle S.

AU - Bonsib, Stephen M.

AU - Trpkov, Kiril

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85048274579&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048274579&partnerID=8YFLogxK

U2 - 10.1097/PAS.0000000000001087

DO - 10.1097/PAS.0000000000001087

M3 - Article

VL - 42

SP - 1253

EP - 1261

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 9

ER -