Stenzl - Figure 17
Interobserver Reproducibility: 8 prominent pathologists, 25 cases, pT1
FIG. 17: Another problem is that it is sometimes very difficult to differentiate between a Ta and a T1 tumor or between a T1 and a T2 or even a T3 tumor in the specimen that was sent to the pathologist, because there is too little differentiation. Sometimes necrosis is present in tissue that has not been well handled between the time of resection and arrival at the pathology department.
As a result it cannot be a big surprise that when 8 eminent pathologists looked at data from Compérat’s group in Paris from 25 cases of initially diagnosed pT1 urothelial cancer, concordance was reached only 44% of cases.[11] This means that if you send a specimen diagnosed as a pT1 in one department, it may be read as maybe a T2 in another department, and in a third department it could be identified as a pTa high-grade tumor.
This shows that, despite the excellent work of our pathologists, there may be pitfalls that result in their giving us inaccurate information and to treatment strategies that may not be adequate – and as a result, sometimes it is prudent to get a second opinion.
References
Compérat E, Egevad L, Lopez-Beltran A, et al. An interobserver reproducibility study on invasiveness of bladder cancer using virtual microscopy and heatmaps. Histopathology. 2013;63:756−66 https://doi.org/10.1111/his.12214
