Abstract：
OBJECTIVE: To evaluate the frequencies and types of disagreements in a contemporary urological second-opinion consult service in order to improve pathologist awareness.
METHODS: For 7 years ending 30 October 2021, records were kept of our department\'s total urologic outside consultation and disagreed-upon cases. Disagreements were categorized according to specimen type and nature of conflict. All grading and staging assignments used International Society of Urological Pathology (ISUP) criteria. Statistical analyses for each specimen type included the percent disagreement. Cohen\'s kappa analysis was done to measure interrater reliability on the prostate biopsies, prostatectomies, and the bladder biopsies/resections. In addition, for the prostate biopsies, the potential for change in treatment candidacy calculation (CTC), was assessed as sum of changes from cancer to non-malignant tissue or the reverse, plus changes from Gleason Grade group (GG)1 to GG ≥ 2 (3 +4 =7) or the reverse.
RESULTS: Overall mean disagreement rate for all specimens was 15.2%. The highest rate was among 1545 prostate biopsy cases, where 410 contained disagreements (26.5%). 118 (7.6%) met criteria for CTC: 10 cases were altered from cancer to non-cancer, 38 cases downgraded from GG≥ 2 to GG1, and 70 upgraded from GG1 to GG≥ 2. Second opinion downgraded the overall highest GG more often than it upgraded it, with downgrade:upgrade ratios of 64:37 for the GG1/GG2 threshold, 79:67 for the GG2/GG3, and 14:0 for the GG3/GG4. 146 specimen parts had disagreements as to cancer vs. suspicious vs. benign, with 85 undercalled and 61 overcalled. Other rates of disagreement included: prostatectomy 34/198 (17.2%); bladder resection or biopsy 68/591 (11.5%); kidney 27/175 (15.4%); and orchiectomy 9/82 (11.0%). In bladder specimens, overgrading was 6X more frequent than undergrading; and overstaging muscularis propria invasion was 6X more frequent than understaging.
CONCLUSIONS: The review of uropathologic materials before definitive therapy can lead to changes that impact clinical decisions significantly. As an example, for prostate biopsies, candidacy for active surveillance versus definitive treatment hinges on GG1 versus 2 and this distinction constituted most CTC cases. The above findings highlight aspects of urological pathology to be emphasized to residents in training, and pathologists in practice.
METHODS: For 7 years ending 30 October 2021, records were kept of our department\'s total urologic outside consultation and disagreed-upon cases. Disagreements were categorized according to specimen type and nature of conflict. All grading and staging assignments used International Society of Urological Pathology (ISUP) criteria. Statistical analyses for each specimen type included the percent disagreement. Cohen\'s kappa analysis was done to measure interrater reliability on the prostate biopsies, prostatectomies, and the bladder biopsies/resections. In addition, for the prostate biopsies, the potential for change in treatment candidacy calculation (CTC), was assessed as sum of changes from cancer to non-malignant tissue or the reverse, plus changes from Gleason Grade group (GG)1 to GG ≥ 2 (3 +4 =7) or the reverse.
RESULTS: Overall mean disagreement rate for all specimens was 15.2%. The highest rate was among 1545 prostate biopsy cases, where 410 contained disagreements (26.5%). 118 (7.6%) met criteria for CTC: 10 cases were altered from cancer to non-cancer, 38 cases downgraded from GG≥ 2 to GG1, and 70 upgraded from GG1 to GG≥ 2. Second opinion downgraded the overall highest GG more often than it upgraded it, with downgrade:upgrade ratios of 64:37 for the GG1/GG2 threshold, 79:67 for the GG2/GG3, and 14:0 for the GG3/GG4. 146 specimen parts had disagreements as to cancer vs. suspicious vs. benign, with 85 undercalled and 61 overcalled. Other rates of disagreement included: prostatectomy 34/198 (17.2%); bladder resection or biopsy 68/591 (11.5%); kidney 27/175 (15.4%); and orchiectomy 9/82 (11.0%). In bladder specimens, overgrading was 6X more frequent than undergrading; and overstaging muscularis propria invasion was 6X more frequent than understaging.
CONCLUSIONS: The review of uropathologic materials before definitive therapy can lead to changes that impact clinical decisions significantly. As an example, for prostate biopsies, candidacy for active surveillance versus definitive treatment hinges on GG1 versus 2 and this distinction constituted most CTC cases. The above findings highlight aspects of urological pathology to be emphasized to residents in training, and pathologists in practice.
摘要：
目的：评估当代泌尿外科第二意见咨询服务中分歧的频率和类型，以提高病理学家的认识。
方法：在截至2021年10月30日的7年中，保留了我们部门在会诊外和不同意病例的总泌尿外科记录。根据样本类型和冲突性质对分歧进行分类。所有分级和分期分配均使用国际泌尿外科病理学会（ISUP）标准。每种样本类型的统计分析包括分歧百分比。Cohen的kappa分析是为了测量前列腺活检的评分者间可靠性，前列腺切除术,和膀胱活检/切除。此外,前列腺活检，治疗候选人计算(CTC)变化的潜力，被评估为从癌症到非恶性组织或逆转的变化的总和，再加上从格里森等级组(GG)1到GG≥2(3+4=7)或相反的变化。
结果：所有标本的总体平均不一致率为15.2%。1545例前列腺穿刺活检率最高。其中410人存在分歧(26.5%)。118例（7.6％）符合CTC标准：10例从癌症改变为非癌症，38例GG≥2降级为GG1，70例GG1升级为GG≥2。第二意见下调总体最高GG的频率高于升级，降级：GG1/GG2阈值的升级比率为64:37，GG2/GG3为79:67，GG3/GG4为14:0。146个样本零件在癌症与癌症方面存在分歧可疑vs.良性,85次被低估，61次被高估。其他分歧率包括：前列腺切除术34/198（17.2％）;膀胱切除术或活检68/591（11.5％）;肾脏27/175（15.4％）;和睾丸切除术9/82（11.0％）。在膀胱标本中，过度升级比降级频繁6X；过度升级固有肌层入侵比降级频繁6X。
结论：在确定治疗前对泌尿系病理学材料进行回顾可以导致显著影响临床决策的变化。作为一个例子,前列腺活检，主动监测与最终治疗的候选资格取决于GG1和2，这种区别构成了大多数CTC病例。以上发现突出了泌尿外科病理方面应在培训中强调住院医师，和实践中的病理学家。
方法：在截至2021年10月30日的7年中，保留了我们部门在会诊外和不同意病例的总泌尿外科记录。根据样本类型和冲突性质对分歧进行分类。所有分级和分期分配均使用国际泌尿外科病理学会（ISUP）标准。每种样本类型的统计分析包括分歧百分比。Cohen的kappa分析是为了测量前列腺活检的评分者间可靠性，前列腺切除术,和膀胱活检/切除。此外,前列腺活检，治疗候选人计算(CTC)变化的潜力，被评估为从癌症到非恶性组织或逆转的变化的总和，再加上从格里森等级组(GG)1到GG≥2(3+4=7)或相反的变化。
结果：所有标本的总体平均不一致率为15.2%。1545例前列腺穿刺活检率最高。其中410人存在分歧(26.5%)。118例（7.6％）符合CTC标准：10例从癌症改变为非癌症，38例GG≥2降级为GG1，70例GG1升级为GG≥2。第二意见下调总体最高GG的频率高于升级，降级：GG1/GG2阈值的升级比率为64:37，GG2/GG3为79:67，GG3/GG4为14:0。146个样本零件在癌症与癌症方面存在分歧可疑vs.良性,85次被低估，61次被高估。其他分歧率包括：前列腺切除术34/198（17.2％）;膀胱切除术或活检68/591（11.5％）;肾脏27/175（15.4％）;和睾丸切除术9/82（11.0％）。在膀胱标本中，过度升级比降级频繁6X；过度升级固有肌层入侵比降级频繁6X。
结论：在确定治疗前对泌尿系病理学材料进行回顾可以导致显著影响临床决策的变化。作为一个例子,前列腺活检，主动监测与最终治疗的候选资格取决于GG1和2，这种区别构成了大多数CTC病例。以上发现突出了泌尿外科病理方面应在培训中强调住院医师，和实践中的病理学家。
