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Evaluation of a protocol for examining nephrectomy specimens with renal cell carcinoma

¹ Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
² Department of Histopathology, Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ, UK
³ Department of Histopathology, Morriston Hospital, Swansea SA6 6NL, UK
⁴ Department of Histopathology, Royal Gwent Hospital, Newport NP20 2UB, UK
⁵ Department of Histopathology, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, South Yorkshire DN2 5LT, UK

Correspondence to:
Dr D F R Griffiths, Department of Pathology, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK;
griffithsdfr{at}cf.ac.uk Aims: To evaluate the practicality of use and the effectiveness of a standard protocol for examining nephrectomy specimens for renal cell carcinoma (RCC), with emphasis on the identification of vascular invasion.

Methods: A standard protocol, devised to identify the major prognostic determinants, was used to examine 79 consecutive tumours submitted to four histopathology departments. The incidence of vascular invasion found was compared with the incidence in a historical series of tumours.

Results: The protocol proved easy to follow, and appeared to increase the incidence of observed vascular invasion (40 of 69 cases compared with 69 of 176 cases in the historical series; p = 0.059, Fishers exact test, one sided)

Conclusions: If pathological prognostic determinants are to be used for clinical management, then it is important that they are identified and recorded consistently. The protocol described provides a method of examining nephrectomy specimens that can be used in routine practice and would probably reliably identify recognised prognostic variables.

Keywords: renal cell cancer; pathology; technical methods; prognostic indices; nephrectomy

Abbreviations: IVC, inferior vena cava; IVCI, inferior vena cava invasion; MVI, microvascular invasion; RCC, renal cell carcinoma; RVI, renal vein invasion

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