Interobserver Variability (IV) Of Uropathologists For Extraprostatic Extension (EPE) And Margins (M) In Radical Prostatectomy (RP) Specimens

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 08 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - In conversations, some young urologists who leave fellowship and enter private practice report much lower positive margin rates than seen by their mentors at academic centers. Are these young and relatively inexperienced surgeons really better prostatectomists than their much more experienced and revered mentors? Clearly not! GU pathologists from academic centers undoubtedly produce more reliable evaluation of prostatectomy specimens than non-specialized community pathologists. What about interobserver variability between specialized GU pathologists themselves? This excellent study clearly demonstrates that not all experts agree with other experts. The study is particularly timely, as positive margin rates at different institutions are scrutinized.

Pathologic interpretations of a group of 3 expert pathologists were used as the gold standard for the study. A total of 60 slides were selected by this 3-person panel. 10 slide represented definitive examples of positive extraprostatic extension (EPE), while 10 slides were clear examples of negative EPE. Another 10 slides were a definitive example of positive surgical margins with yet another set of 10 showing unambiguous examples of negative margin status. An additional 20 slides were chosen because they showed equivocal findings (10 represented equivocal EPE and 10 equivocal positive margin status). 12 uropathologists evaluated all 60 slides.

Good to excellent overall agreement was seen in evaluation of unequivocal cases with margin status enjoying higher agreement between pathologists than EPE. Equivocal examples were problematic, as a low percentage of the 12 uropathologists agreed with the 3-man expert panel (10 of 12 called equivocal example EPE as positive for EPE). Crush/cautery effects, artifactual tares (especially at apex), exact definition of the extraprostatic border, and ink close to the pathologic margin all contributed to these problematic interpretations.

No clear guidelines for such cases exist, and the authors plan to lead the effort in developing consensus guidelines for these difficult scenarios.

Presented by Andrew Evans, MD, Pauline C Henry, MD, Gina Lockwood, MD, Doug Tkachuk, MD, John R Srigley, MD, The GU Expert Group, Theo H Van der Kwast, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Alexander Kutikov, MD

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