Specialized Pathology Review in Patients with Ovarian Cancer: Highly Recommended To Assure Adequate Treatment. Results from a Prospective Study
Stefan Kommoss, Jacobus Pfisterer, Alexander Reuss, Andreas du Bois, Joachim Diebold, Steffen Hauptmann, Dietmar Schmidt, Friedrich Kommoss. AGO Study Group, Wiesbaden, Germany
Background: In view of retrospective findings on second opinion pathology in ovarian cancer, it seems certain that a considerable number of ovarian borderline tumors (BOTs) or metastatic non-ovarian primaries are being erroneously diagnosed as ovarian carcinomas. If BOTs are misdiagnosed as cancer, patients may not only suffer from non-beneficial morbidity at unnecessary high cost but may have to cope with an incorrect diagnosis of cancer for the rest of their lives. In cases of metastatic disease mistaken for an ovarian primary, more adequate therapeutic modalities may be withheld from some patients. Finally, clinical trials may be biased through unintended disregarding of histological inclusion criteria. We hypothesized that 5% of all patients in clinical trials of ovarian carcinomas have lesions other than epithelial ovarian cancer, namely BOTs, non-epithelial or metastatic cancer. This is the first such study with a prospective approach.
Design: Patients who were enrolled into a chemotherapy trial of ovarian carcinoma were asked to consent to a translational subprotocol. Contributing pathologists were asked to submit all original slides as well as paraffin material. Specialized central pathology review of all cases was performed by two experienced gynecopathologists. In cases of clinically relevant diagnostic discrepancies, the contributing pathologist was contacted. If a given discrepancy could not be resolved, a panel of experts was available for clarification.
Results: 454 patients with an outside diagnosis of ovarian epithelial cancer were recruited. In 6.8% (n=31), a major diagnostic discrepancy of potential clinical relevance was found. Most frequently (n=15), serous BOTs had been misdiagnosed as invasive cancer. Ovarian metastases constituted the second most frequent misdiagnosis (n=12). As minor discrepancies, a divergent histological typing of ovarian carcinomas was found in 28.2% (n=128).
Conclusions: This study clearly shows that central pathology review by experienced gynecopathologists is highly recommendable if overtreatment with chemotherapy of patients with BOTs and inadequate treatment of patients with ovarian metastases is to be avoided in the future. Specialized pathology review should become standard procedure in study protocols prior to randomization. In order to further optimize the quality of care, a high throughput infrastructure for specialized pathology review will have to be established. The authors propose a new internet-based ovarian cancer network, capable of providing specialized second opinion pathology within 10 working days.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 8:30 AM
Platform Session: Section E, Tuesday Morning