Uropathologists' Perspectives on Utilization of Key Morphologic and Molecular Parameters in Urothelial, Renal, and Prostatic Cancers Based on Clinical Practice Guidelines
Recommended Citation
Mohanty S, Paner G, Lobo A, Parwani A, Sangoi A, Delahunt B, Manini C, Luthringer D, Sirohi D, Midha D, Maclean F, Giannico G, Martignoni G, AlAhmadie H, Moch H, Gandhi J, Srigley J, Epstein J, Lopez J, Trpkov K, Cheng L, Browning L, Akgul M, Aron M, Picken M, Tretiakova MA, Hirsch M, Varma M, Kuroda N, Gupta N, Tamboli P, Rao P, Mehra R, Desai S, Menon S, Williamson SR, Kaushal S, Jha S, Kandukuri S, Rao B, Amin M. Uropathologists' Perspectives on Utilization of Key Morphologic and Molecular Parameters in Urothelial, Renal, and Prostatic Cancers Based on Clinical Practice Guidelines. Mod Pathol 2022; 35(SUPPL 2):639-640.
Document Type
Conference Proceeding
Publication Date
3-19-2022
Publication Title
Mod Pathol
Abstract
Background: There are clinical guidelines (EAU, AUA, NCCN, CAP, GUPS and ISUP) incorporating histopathologic and molecular parameters in urothelial (UC), prostate (PC) and renal (RCC) cancers; however, their awareness, reporting trend and resource utilization practice patterns among pathologists is not known. This prompted us for a multi-institutional international survey to assess utilization and reporting trends and practices among uropathologists. Design: A survey instrument was shared among 65 uropathologists using SurveyMonkey software and the de-identified and anonymized respondent data were analysed. Results: 41 participants completed the survey. Only 26% would do genomic testing by Decipher GS assay in RP for PC. 75% agreed that presence of a primary pattern 4/5 in PC is an independent predictor of poor outcome. There is a dichotomy in risk stratifying PC based on GP, GG, cores involved and Tcategory. Majority (88%) were aware of criteria for positive surgical margin associated with unfavorable outcome. 71% would consider HRR assay in an IDCP and 67% have a fairly good idea on the mutual exclusiveness of DNA repair mutation and small cell histology. 88% of pathologists acknowledged the variables involved in defining renal sinus involvement and would quantify percent of sarcomatoid change. 88% would re-examine specimen in >7 cm RCC. 67% considered nodal involvement as the most significant pathologic parameters in a cystectomy specimen and 56% would consider prostatic urethral invasion as the highest risk for cystectomy in T1 bladder cancer. They are equally divided in their opinion on considering dysplasia in the surveillance protocol and in their opinion on cystectomy when concomitant non-invasive high gradepapillary UC and CIS are present. 77% considered plasmacytoid UC requires aggressive management even at T1 stage.58% emphasized that UC with glandular differentiation should be differentiated from a pure adenocarcinoma. Majority (83%) agreed on the indications for MSI assay in the upper tract UC for Lynch syndrome. Conclusions: In spite of well promulgated international guidelines, there are still differing views on implementation in clinical practice and in risk stratification of PC, renal sinus involvement and urothelial dysplasia. Molecular testing is still at an evolving stage and is primarily driven by clinicians despite of dedicated uropathology services, and requires more genotype-phenotype correlation studies.
PubMed ID
Not assigned.
Volume
35
Issue
SUPPL 2
First Page
639
Last Page
640
