Interobserver variation in grading and staging of squamous cell carcinoma of the penis in relation to the clinical outcome

Department of Urology and Paediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Arnold Heller Str. 7, D-24105 Kiel, Germany.
BJU International (Impact Factor: 3.53). 03/2009; 103(12):1660-5. DOI: 10.1111/j.1464-410X.2009.08362.x
Source: PubMed


To examine interobserver variations in assessing grade and stage of penile squamous cell carcinoma (SCC).
We retrospectively reviewed the pathological features and clinical outcome in 75 patients with SCC of the penis, who were treated in participating urological centres between 1996 and 2005; the assessments of the local pathologists and the review pathologists were compared.
There was conformity in tumour grade in 67% and the assessment of tumour stage conformed in 84%; the combination assessment of both grade and stage conformed in 56%.
Accurate histological subtyping by the surgical pathologist demands standardized guidelines, in particular for histological grading, which is crucial for clinical treatment, but shows significant interobserver variation.

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    • "Our results are in agreement with a previous study evaluating penile tumors invading 5–10 mm, in which histological grade had more influence on prognosis than depth of tumor invasion (Velazquez et al. 2008). Given its importance and clinical implications histological grading should be carried out using uniform and comparable criteria, moreover considering that a significant interobserver variability has been reported for histological grading in penile carcinomas (Naumann et al. 2009). For patients included in this study, histological grading was carried out using strict (and previously validated) morphologic criteria (Chaux et al. 2009). "
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    ABSTRACT: To report the clinicopathologic and outcome features of superficial high-grade and deep low-grade penile squamous cell carcinomas. From a retrospectively-collected series of patients with penile cancer we identified 41 cases corresponding to 12 superficial high-grade tumors and 29 deep low-grade tumors. As outcomes we evaluated inguinal lymph node status, presence of tumor relapse, final nodal status, and cancer-specific death. Follow-up ranged from 0.8 to 386.7 months (mean 152.5 months, median 157.3 months). Clinicopathologic features were similar between superficial high-grade and deep low-grade tumors, except for a tendency (Fisher's exact [Formula: see text]) of the former to include tumors with a verruciform pattern of growth. A significantly higher proportion of inguinal lymph node metastasis was found in superficial high-grade tumors compared to deep low-grade tumors [4/5 (80%) vs. 1/5 (20%) respectively, Fisher's exact [Formula: see text]]. No significant differences were found regarding tumor relapse (Fisher's exact [Formula: see text]), final nodal status (Mantel-Cox's [Formula: see text]), or cancer-related death (Mantel-Cox's [Formula: see text]). Patients with superficial high-grade tumors had a significantly higher proportion of inguinal lymph node metastasis compared to patients with deep low-grade tumors. On this regard, prophylactic inguinal lymphadenectomy might be indicated in cases of superficial tumors with high-grade histology while in deeply invasive low-grade penile carcinomas a more conservative approach may be considered.
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