Testis Surgery Unit, Surgery Department, Istituto Nazionale dei Tumori, Milano, Italy.
J Urol. 2011 Oct;186(4):1298-302. doi: 10.1016/j.juro.2011.05.070. Epub 2011 Aug 17.
We reviewed the slides of patients with clinical stage I nonseminomatous germ cell testicular tumors who underwent retroperitoneal lymph node dissection to evaluate the concordance between original and reviewed vascular invasion status, and other histological correlates.
Between 2002 and 2007 at our institution 202 consecutive patients underwent retroperitoneal lymph node dissection. We requested the slides of 183 patients who underwent orchiectomy elsewhere. The risk of nodal metastasis was considered high in those with vascular invasion and/or greater than 90% embryonal carcinoma, and low in those with no vascular invasion and embryonal carcinoma less than 90%. Using Cohen's κ we assessed the concordance index between original and reviewed parameters (vascular invasion and risk category). Using the chi-square test we also evaluated the association between nodal status at retroperitoneal lymph node dissection and original vs reviewed parameters.
The original report did not contain vascular invasion information on 98 of 183 cases (53.4%). A total of 164 patients were evaluable since we had no slides for 19. Vascular invasion absence and presence were confirmed in 27 (73.0%) and 30 (78.9%) of 37 patients, respectively (Cohen's κ = 0.16). Low and high risk status was confirmed in 20 of 28 patients (71.4%) and in 47 of 64 (50.6%), respectively (Cohen's κ = 0.22). Reviewed vascular invasion and risk category were significantly associated with nodal status at retroperitoneal lymph node dissection (chi-square test p = 0.03 and 0.01, respectively), although the original parameters were not.
In half of the patients no information was available on vascular invasion in the original reports. Concordance between original and reviewed reports was generally poor. Reviewed parameters better predicted nodal status at retroperitoneal lymph node dissection. These findings may have important implications in clinical practice.
我们回顾了临床 I 期非精原细胞瘤生殖细胞睾丸肿瘤患者的幻灯片，以评估原始和复查的血管侵犯状态以及其他组织学相关性之间的一致性。
在我们机构，2002 年至 2007 年间，202 例连续患者接受了腹膜后淋巴结清扫术。我们要求在其他地方进行睾丸切除术的 183 例患者的切片。在有血管侵犯和/或大于 90%胚胎癌的患者中，淋巴结转移的风险被认为较高，而在无血管侵犯和胚胎癌小于 90%的患者中，风险较低。使用 Cohen's κ 评估原始和复查参数（血管侵犯和风险类别）之间的一致性指数。使用卡方检验还评估了腹膜后淋巴结清扫术时的淋巴结状态与原始和复查参数之间的关系。
原始报告未包含 183 例中的 98 例（53.4%）的血管侵犯信息。由于我们没有 19 例患者的切片，因此共有 164 例患者可评估。在 37 例患者中，分别有 27 例（73.0%）和 30 例（78.9%）证实了血管侵犯缺失和存在（Cohen's κ = 0.16）。在 28 例患者中，分别有 20 例（71.4%）和 47 例（50.6%）证实了低危和高危状态（Cohen's κ = 0.22）。复查的血管侵犯和风险类别与腹膜后淋巴结清扫术时的淋巴结状态显著相关（卡方检验 p = 0.03 和 0.01），尽管原始参数并非如此。
在一半的患者中，原始报告中没有血管侵犯的信息。原始和复查报告之间的一致性通常较差。复查参数更好地预测了腹膜后淋巴结清扫术时的淋巴结状态。这些发现可能对临床实践具有重要意义。
