OBJECTIVE: To assess the role of centralised pathology review in penile cancer management.
MATERIALS AND METHODS: Newly diagnosed squamous cell carcinomas (SCC) of the penis, including squamous cell carcinoma-in-situ (CIS) from biopsy specimens that were referred from fifteen centres, to the regional Sn-MDT between 1st January 2008 and 30th March 2011 were included. Biopsy histology reports and slides, from the respective referring hospitals were reviewed by the Sn-MDT pathologists. The biopsy specimens' histological type, grade and stage reported by the Sn-MDT pathologist were compared with the referring hospital pathology report, as well as definitive surgery histology. The changes in histological diagnosis were further sub-divided into critical changes (i.e. could alter management) and non-critical changes (i.e. would not affect management).
RESULTS: 155 cases of SCC or CIS of the penis were referred from 15 different centres in North West England. After Sn-MDT histology review, the histological diagnosis was changed in 31% of cases and found to be statistical significant. 60.4% of the changes were deemed to be critical changes that resulted in a significant change in management. When comparing the initial biopsy histology, as reported by the Sn-MDT to the final histology from the definitive surgical specimens, it showed generally a good correlation.
CONCLUSIONS: In this study a significant proportion of penile cancer histology reports were revised following review in the Sn-MDT. Many of these changes altered patient management. This provides evidence that accurate pathological diagnosis plays a crucial role in determining the correct treatment and maximising the potential for good clinical outcomes in penile cancer. In the case of histopathology, centralisation has increased exposure to penile cancer and diagnostic accuracy, and should therefore be considered the gold standard.
Written by:
Tang V, Clarke L, Gall Z, Shanks J, Nonaka D, Parr N, Elliott P, Clarke N, Ramani V, Lau M, Sangar V. Are you the author?
The Christie NHS Foundation Trust, UK.
Reference: BJU Int. 2013 Sep 5. Epub ahead of print.
doi: 10.1111/bju.12449
PubMed Abstract
PMID: 24053106
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