title: Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection.
abstract: 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.
authors.affiliation: Department of Urology, University of California San Francisco, California, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Chi
authors.forename: Amir
authors.initials: A
authors.lastname: Jad
authors.forename: Imok
authors.initials: I
authors.lastname: Cha
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Turek
mesh_terms: 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*