AIM: We evaluate the accuracy of reporting of the Leibovich score (LS) by general pathologists at our centre by comparing the LS in their initial reports with the LS in subsequent review reports by our Specialist Urological Pathologists.
We also assess whether a revision in the LS and subsequently the risk group on the revision of LS has a significant impact on the patients prognosis with regards to the recruitment into clinical trials in patients with intermediate and high-risk disease.
PATIENTS AND METHODS: Fifty-four consecutive patients had had their initial histology following nephrectomy reported by a general pathologist between August 2008 and March 2012. The histological slides were subsequently re-reviewed by the two specialist urological pathologists and revised LS were given if appropriate. These cases were then discussed at the Uro-oncology Multi-disciplinary Team (MDT) meeting and the reason for the revised LS was discussed with the panel and only once the reason for the change in the LS was confirmed the patients were stratified into a new prognostic group if appropriate.
RESULTS: The general pathologist had allocated the 54 patients into the low risk (n=13), intermediate risk (n=25) and high risk (n-16). Following a review of the slides by the specialist urological pathologist and discussion at the MDT meeting the LS was revised in a total of 23 patients (42.59%) of patients. The 23 patients who had their LS revised were divided into 2 groups for the purpose of this study. On revision of the LS a total of 8 patients (14.8%) changed their prognostic group. Amongst these patients, 8 patients (14.8%) had their prognostic group changed. The change in the prognostic group in 8 patients was increased from intermediate to high risk in 4 patients. There was a reduction in the LS in 4 patients, which was from high to intermediate risk group in 1 patients and intermediate to low risk in 3 patients.
CONCLUSION: Our data suggests that risk stratification by a general pathologist can be associated with inappropriate risk assignment. In the current study, histopathology review by specialist urological pathologist led to a change in LS in 42.6% of cases leading a change in risk grouping in about 14.8% of cases. This level of discrepancy is not insignificant. However, the small number of cases evaluated in this study does limit robust conclusions and further studies are needed to investigate this issue so that recommendations can be to enhance diagnostic accuracy and reproducibility.
Written by:
Vasdev N, Altal Y, Mafeld S, Wong K, Chadwick D, Gowda BD, Mutton A, Nagarajan S, Bhatti A. Are you the author?
Department of Urology, James Cook University Hospital, Middlesbrough, UK.
Reference: BJU Int. 2013 Jul 1. Epub ahead of print.
doi: 10.1111/bju.12337
PubMed Abstract
PMID: 24053353
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