Value of Supraregional Multidisciplinary Review for the Contemporary Management of Testicular Tumors.
Testicular cancers are an uncommon and highly curable group of tumors that are typically managed by specialist multidisciplinary teams (MDTs). Although recent guidelines have emphasized the importance of tumor prognostic factors in predicting recurrence and personalizing therapy in early-stage disease, the role of central pathology review in determining these factors is unclear.



We compared the referral histopathology reports with those obtained after expert central review for all cases reviewed by the UK Thames Valley Cancer Network testicular tumor MDT from August 2004 to September 2012. For cases in which the findings differed, we recorded the effect of the alteration on the estimates of patient prognosis and predicted clinical management using international (European Society of Medical Oncology [ESMO]) and local guidelines.



The histopathology reports were altered after central review in 129 of 465 cases (27.7%) referred to the testicular tumor MDT during the study period. These resulted in changes in the estimation of prognosis for 42 patients (9.0% total), with a predicted affect on management according to the ESMO guidelines in 30 cases (6.5%). These proportions were broadly similar for both seminoma and nonseminoma, although the reasons for the discrepancies differed between the 2 (principally errors in categorization of rete testis invasion in seminoma and of lymphovascular invasion in nonseminoma). Changes to the tumor type were uncommon (2 cases).



Central MDT review results in frequent, clinically relevant alterations to testicular tumor histopathology reports for testicular tumors. The results of our study demonstrate the importance of specialist MDTs to inform patient-centered care and ensure best practice in the management of these uncommon cancers.
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Karin
K
Purshouse
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Robert A
RA
Watson
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK; Oxford Centre for Cancer Gene Research, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. Electronic address: dchurch@well.ox.ac.uk.
David N
DN
Church
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Charlotte
C
Richardson
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Gemma
G
Crane
Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Zoe
Z
Traill
Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Mark
M
Sullivan
Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Ian
I
Roberts
Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Lisa
L
Browning
Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Gareth
G
Turner
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK; Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Vishnu
V
Parameshwaran
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Joseph
J
Johnson
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Meenali
M
Chitnis
Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Andrew
A
Protheroe
Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Clare
C
Verrill
D019468:Disease Management; D006801:Humans; D008297:Male; D010348:Patient Care Team; D018802:Patient-Centered Care; D011379:Prognosis; D018239:Seminoma / Q000473:pathology*; D013736:Testicular Neoplasms / Q000145:classification* / Q000473:pathology*
Germ cell tumor; Histopathology review