Value of Supraregional Multidisciplinary Review for the Contemporary Management of Testicular Tumours

Abstract Purpose Testicular cancers are an uncommon and highly curable group of tumours that are typically managed by specialist multidisciplinary teams (MDTs). While recent guidelines emphasise the importance of tumour prognostic factors in predicting recurrence and personalising therapy in early stage disease, the role of central pathology review in determining these is unclear. Methods We compared referring histopathology reports with those obtained following expert central review for all cases reviewed by the UK Thames Valley Cancer Network testicular tumour MDT between August 2004 and September 2012. Where these differed, we recorded the impact of the alteration on estimates of patient prognosis and predicted clinical management according to international (ESMO) and local guidelines. Results Histopathology reports were altered following central review in 129 of 465 (27.7%) cases referred to the testicular tumour MDT during the study period, resulting in changes to estimation of prognosis in 42 patients (9.0% total), with predicted impact on management according to ESMO guidelines in 30 (6.5%) cases. These proportions were broadly similar for both seminomas and non-seminomas, although the reasons for discrepancies differenced between the two (principally errors in categorisation of rete testis invasion in seminomas, and of lymphovascular invasion in non-seminomas). Changes to tumour type were uncommon (two cases). Conclusion Central MDT review results in frequent, clinically relevant alterations to testicular tumour histopathology reports for testicular tumours. Our study demonstrates the importance of specialist MDTs to inform patient-centred care and ensure best practice in the management of these uncommon cancers.