Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection.
OBJECTIVE
To determine whether center to center discrepancies in the ability to locate sperm in infertile testes with abnormal histology stems in part from inconsistencies in pathologists' readings of testis biopsies.


METHODS
Prospective cohort study.


METHODS
Academic male infertility practice.


METHODS
Consecutive series of azoospermic men referred with testis biopsy slides between 1998 and 2003.


METHODS
Testis biopsy histologies on azoospermic patients referred for infertility care were re-reviewed by a single pathologist blinded to the original reading. Subsequent infertility care was guided by the findings from the second histologic reading.


METHODS
Agreement between the outside and in-house review of testis biopsy readings was assessed with the kappa statistic. Pregnancy outcomes that resulted from clinical decisions informed by the second histologic readings were also assessed.


RESULTS
Among 113 histologic specimens, re-review was complicated by fixation artifacts in 18 cases (16%) and insufficient biopsy sample size in 13 cases (12%). The kappa score for interobserver agreement in readings was 0.43 (95% CI 0.32-0.054). Mixed histology patterns in particular were underappreciated by outside pathologists (13% of cases on original reading, 36% of cases on review). In 27% of all cases, the differences in biopsy readings had a significant impact on clinical management.


CONCLUSIONS
A correlation between independent testis histology readings in azoospermic men demonstrates frequent inconsistencies. These differences contribute to inaccurate phenotyping of male infertility and can significantly impact the direction of infertility care. These findings highlight the need for a standardized approach to testis histologic review.
Cooperberg
Matthew R
MR
Department of Urology, University of California San Francisco, California, USA.
Chi
Thomas
T
Jad
Amir
A
Cha
Imok
I
Turek
Paul J
PJ
D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000473:pathology*; D008297:Male; D009845:Oligospermia / Q000473:pathology; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D015203:Reproducibility of Results; D013076:Sperm Count / Q000706:statistics & numerical data; D020554:Sperm Injections, Intracytoplasmic / Q000706:statistics & numerical data*; D013737:Testis / Q000473:pathology*