Improved diagnostic accuracy of testicular biopsies for infertility through simplified criteria and a dedicated pathologist.

OBJECTIVE

To examine whether simplified histopathologic criteria and a dedicated pathologist could influence the diagnostic accuracy of testicular biopsy.

STUDY DESIGN

Original reports from general pathologists on 99 consecutive testicular biopsies were retrospectively classified according to reported presence or absence of mature spermatids. A dedicated pathologist rediagnosed the material blindly according to the same criterion. The resulting data were compared with testicular sperm extraction (TESE) results from the in vitro fertilization laboratory.

RESULTS

General pathologists' diagnoses predicted TESE results with a positive predictive value (PPV) of 0.97 and a negative predictive value (NPV) of 0.78. The dedicated pathologist's diagnoses yielded a PPV of 1.0 and a significantly improved NPV of 0.96.

CONCLUSION

Visualization of mature spermatids in a testicular biopsy is an excellent predictor of TESE results, especially in the hands of a dedicated pathologist. We therefore recommend simplified pathology reporting on testicular biopsies from azoospermic men and examination by a dedicated pathologist.