917 Interobserver Reproducibility of Hilar Soft Tissue Invasion in Testicular Germ Cell Tumors Among Genitourinary Pathologists

Document Type

Conference Proceeding

Publication Date

3-24-2025

Publication Title

Lab Invest

Keywords

adipose tissue, clinical article, conference abstract, diagnosis, epididymis, female, follow up, histology, human, lymph vessel metastasis, pathologist, practice guideline, prostatectomy, reproducibility, soft tissue, testicular germ cell tumor, tissue section

Abstract

Disclosures: Douglas Wu: None; Mahmut Akgul: None; Sean Williamson: None; Andres Acosta: None; Khaleel Al-Obaidy: None; Mahul Amin: None; Daniel Berney: None; Fadi Brimo: None; Liang Cheng: None; Maurizio Colecchia: None; Eva Compérat: None; Kristine Cornejo: None; Jasreman Dhillon: None; Michelle Downes: None; Jonathan Epstein: None; Michelle Hirsch: None; Rafael Jimenez: None; Anandi Lobo: None; Seema Kaushal: None; Antonio Lopez-Beltran: None; Sambit Mohanty: None; Rohit Mehra: None; Gladell Paner: None; Priya Rao: None; Victor Reuter: None; Rajal Shah: None; Steven Shen: None; Steven Smith: None; Maria Tretiakova: None; Kiril Trpkov: None; Sara Wobker: None; Pheroze Tamboli: None; Debra Zynger: None; Ankur Sangoi: None Background: Compared to lymphovascular invasion (LVI), hilar soft tissue invasion (HSTI) is a relatively novel pT2 staging parameter in testicular germ cell tumors (GCT). There is however diagnostic variability in how pathologists interpret HSTI, and we sought to explore interobserver reproducibility among genitourinary (GU) pathologists. Design: Twenty digitally-scanned GCT slides were pre-classified as HSTI (n=10) or not HSTI (n=10) by internal consensus of the survey authors; slides with concomitant LVI were excluded. A survey (surveymonkey.com) was distributed to invited GU pathologists. All 20 slides consisted of tumors grossly approaching the hilum. Participants were asked follow-up questions pertaining to HSTI diagnosis. Results: Thirty of 50 GU pathologists completed the survey. A majority agreement (≥67% participants) was achieved in 17/20 (85%) slides, with strong consensus (≥80% participants) achieved in 16/20 (80%). In the 2 slides not reaching consensus, 63% and 60% of participants agreed with the design team’s HSTI designation, whereas 1 slide was nearly divided (53%/47%). In their respective daily practices, 57% of participants “occasionally encountered” HSTI without LVI, and 77% perceived that there are no clear-cut guidelines regarding HSTI staging on pathologic assessment. If the gross impression was HSTI but histologic sections were not supportive, 27% would still render HSTI (pT2) diagnosis. Histologic criteria used for HSTI designation included invasion beyond rete (62%), invasion to a level parallel to hilar adipose tissue (55%), and invasion beyond level parallel to hilar adipose tissue and directly abutting fat (66%). A minority (13%) considered epididymis invasion synonymous with HSTI. A majority (72%) evaluated HSTI independently of other parameters, but for some participants (28%), if stage pT2 was established via LVI or epididymis invasion, their threshold to also diagnose HSTI lowers. GCT subtype did not alter the diagnostic threshold for HSTI for great majority (93%). Akin to “EPE” (extraprostatic extension) for prostatectomy staging, the term “ETE” (extratesticular extension) as a proposed replacement to HSTI was met with mixed opinion (56% opposed the descriptor). [Formula presented] Conclusions: Although a good consensus exists among genitourinary pathologists on HSTI assessment, clarifying the diagnostic guidelines with specific set of criteria included in pathologic staging systems should improve its diagnosis.

Volume

105

Issue

3

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