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Variation between specialist uropatholgists in reporting extraprostatic extension after radical prostatectomy
  1. Richard J Bryant1,2,
  2. Anne J Schmitt3,
  3. Ian S D Roberts3,
  4. Pelvender S Gill3,
  5. Lisa Browning3,
  6. Simon F Brewster2,
  7. Freddie C Hamdy1,2,
  8. Clare Verrill3
  1. 1Nuffield Department of Surgical Sciences, University of Oxford, Old Road Campus Research Building (off Roosevelt Drive), Oxford, UK
  2. 2Department of Urology, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
  3. 3Department of Cellular Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Clare Verrill, Department of Cellular Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK; Clare.Verrill{at}ouh.nhs.uk

Abstract

Aims Extraprostatic extension of prostate cancer in radical prostatectomy specimens significantly affects patient management. We evaluated the degree of interobserver variation between uropathologists at a tertiary referral teaching hospital in assessing the extraprostatic extension of prostate cancer in radical prostatectomy specimens.

Methods Histopathological data from a consecutive series of 293 radical prostatectomy specimens (January 2007–December 2012) were reviewed. A subset of 50 consecutive radical prostatectomy cases originally staged as tumours confined to the prostate (pT2) or tumours extending into periprostatic tissue (pT3a) during this period were reviewed by four specialist uropathologists.

Results Five consultant histopathologists reported these specimens with significant differences in the reported stage (p=0.0164) between pathologists. Double-blind review by 4 uropathologists of 50 consecutive radical prostatectomy cases showed a lack of consensus in 16/50 (32%) cases (κ score 0.58, moderate agreement). A consensus meeting was held, but consensus could still not be reached in 9/16 cases.

Conclusions Our findings highlight variability in the reporting of pT stage in radical prostatectomy specimens even by specialist uropathologists. Assessment of extraprostatic extension has important implications for patient management and there is a need for more precise guidance.

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