Staging criteria for renal cell carcinoma differ from many other cancers, in that renal tumors are often spherical with subtle, finger-like extensions into veins, renal sinus, or perinephric tissue. We sought to study interobserver agreement in pathologic stage categories for challenging cases. An online survey was circulated to urologic pathologists interested in kidney tumors, yielding 89% response (31/35). Most questions included 1 to 4 images, focusing on: vascular and renal sinus invasion (n=24), perinephric invasion (n=9), and gross pathology/specimen handling (n=17). Responses were collapsed for analysis into positive and negative/equivocal for upstaging. Consensus was regarded as an agreement of 67% (2/3) of participants, which was reached in 20/33 (61%) evaluable scenarios regarding renal sinus, perinephric, or vein invasion, of which 13/33 (39%) had ≥80% consensus. Lack of agreement was especially encountered regarding small tumor protrusions into a possible vascular lumen, close to the tumor leading edge. For gross photographs, most were interpreted as suspicious but requiring histologic confirmation. Most participants (61%) rarely used special stains to evaluate vascular invasion, usually endothelial markers (81%). Most agreed that a spherical mass bulging well beyond the kidney parenchyma into the renal sinus (71%) or perinephric fat (90%) did not necessarily indicate invasion. Interobserver agreement in pathologic staging of renal cancer is relatively good among urologic pathologists interested in kidney tumors, even when selecting cases that test the earliest and borderline thresholds for extrarenal extension. Disagreements remain, however, particularly for tumors with small, finger-like protrusions, closely juxtaposed to the main mass.

Arkana Laboratories Little Rock AK

Cruces University Hospital Biocruces Institute University of the Basque Country Barakaldo Spain

Department for Pathology and Molecular Pathology University and University Hospital Zurich Zurich Switzerland

Department of Diagnostic Pathology Kochi Red Cross Hospital Kochi City Kochi Japan

Department of Pathology and Laboratory Medicine Henry Ford Cancer Institute Henry Ford Health System

Department of Pathology Brigham and Women's Hospital and Harvard Medical School Boston MA

Department of Pathology Cleveland Clinic Robert J Tomsich Pathology and Laboratory Medicine Institute Cleveland OH

Department of Pathology Indiana University School of Medicine Indianapolis IN

Department of Pathology Johns Hopkins Medical Institutions Baltimore MD

Department of Pathology Loyola University Medical Center Maywood IL

Department of Pathology Memorial Sloan Kettering Cancer Center New York NY

Department of Pathology University Hospital Plzen Charles University Plzen Czech Republic

Department of Pathology University of Dundee Dundee UK

Department of Pathology University of Michigan Ann Arbor MI

Department of Pathology University of Otago Wellington New Zealand

Department of Pathology University of Tennessee Health Science Center Memphis TN

Department of Pathology University of Texas Southwestern Medical Center Dallas TX

Department of Pathology University of Washington Seattle WA

Department of Pathology VCU School of Medicine Richmond VA

Department of Pathology Wayne State University School of Medicine Detroit

Douglass Hanly Moir Pathology Sydney NSW Australia

Hospital Pederzoli Verona and Department of Diagnostics and Public Health University of Verona Verona Italy

Trillium Health Partners Mississauga ON

University of Calgary and Calgary Laboratory Services Calgary AB Canada

University of Texas MD Anderson Cancer Center Houston

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