Handling and staging of renal cell carcinoma: The International Society of Urological Pathology Consensus (ISUP) conference recommendations

Kiril Trpkov, David J. Grignon, Stephen M. Bonsib, Mahul B. Amin, Athanase Billis, Antonio Lopez-Beltran, Hemamali Samaratunga, Pheroze Tamboli, Brett Delahunt, Lars Egevad, Rodolfo Montironi, John R. Srigley, Anila Abraham, Adebowale Adeniran, Khalid Ahmed, Hikmat Al Ahmadie, Ferran Algaba, Robert Allan, Pedram Argani, Ulrika AxcronaMarc Barry, Dilek Baydar, Louis Bégin, Dan Berney, Peter Bethwaite, Ruth Birbe, David Bostwick, Fadi Brimo, Helen Cathro, Ying Bei Chen, Liang Cheng, John Cheville, Yong Mee Cho, Ai Ying Chuang, Cynthia Cohen, Henry Crist, Warick Delprado, Fang Ming Deng, Jonathan Epstein, Andrew Evans, Oluwole Fadare, Daniel Fajardo, Sara Falzarano, Samson Fine, Stewart Fleming, Eddie Fridman, Bungo Furusato, Masoud Ganji, Masoumeh Ghayouri, Giovanna Giannico, Neriman Gokden, David Griffiths, Nilesh Gupta, Omar Hameed, Ondrej Hes, Michelle Hirsch, Jiaoti Huang, Wei Huang, Christina Hulsbergen Van De Kaa, Peter Humphrey, Sundus Hussein, Kenneth Iczkowski, Rafael Jimenez, Edward Jones, Laura Irene Jufe, James Kench, Masatoshi Kida, Glen Kristiansen, Lakshmi Priya Kunju, Zhaoli Lane, Mathieu Latour, Claudio Lewin, Kathrine Lie, Josep Lloreta, Barbara Loftus, Fiona Maclean, Cristina Magi-Galluzzi, Guido Martignoni, Teresa McHale, Jesse McKenney, Maria Merino, Rose Miller, Hiroshi Miyamoto, Holger Moch, Hedwig Murphy, John Nacey, Tipu Nazeer, Gabriella Nesi, George Netto, Peter Nichols, Marie O'Donnell, Semra Olgac, Roberto Orozco, Adeboye Osunkoya, Aysim Ozagari, Chin Chen Pan, Anil Parwani, Joanna Perry-Keene, Constantina Petraki, Maria Picken, Maria Pyda-Karwicka, Victor Reuter, Katayoon Rezaei, Nathalie Rioux-Leclercq, Brian Robinson, Stephen Rohan, Ruben Ronchetti, Laurie Russell, Marina Scarpelli, Ahmed Shabaik, Rajal Shah, Jonathan Shanks, Steven Shen, Maria Shevchuk, Mathilde Sibony, Bhuvana Srinivasan, Martin Susani, Sueli Suzigan, Joan Sweet, Hiroyuki Takahashi, Puay Hoon Tan, Satish Tickoo, Isabel Trias, Larry True, Toyonori Tsuzuki, Funda Vakar-Lopez, Theo Van Der Kwast, Cheng Wang, Anne Warren, Jorge Yao, Asli Yilmaz, Jin Zhao, Ming Zhou, Debra Zynger

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

The International Society of Urologic Pathology 2012 Consensus Conference on renal cancer, through working group 3, focused on the issues of staging and specimen handling of renal tumors. The conference was preceded by an online survey of the International Society of Urologic Pathology members, and the results of this were used to inform the focus of conference discussion. On formal voting a Z65% majority was considered a consensus agreement. For specimen handling it was agreed that with radical nephrectomy specimens the initial cut should be made along the long axis and that both radical and partial nephrectomy specimens should be inked. It was recommended that sampling of renal tumors should follow a general guideline of sampling 1 block/cm with a minimum of 3 blocks (subject to modification as needed in individual cases). When measuring a renal tumor, the length of a renal vein/caval thrombus should not be part of the measurement of the main tumor mass. In cases with multiple tumors, sampling should include at a minimum the 5 largest tumors. There was a consensus that perinephric fat invasion should be determined by examining multiple perpendicular sections of the tumor/perinephric fat interface and by sampling areas suspicious for invasion. Perinephric fat invasion was defined as either the tumor touching the fat or extending as irregular tongues into the perinephric tissue, with or without desmoplasia. It was agreed upon that renal sinus invasion is present when the tumor is in direct contact with the sinus fat or the loose connective tissue of the sinus, clearly beyond the renal parenchyma, or if there is involvement of any endothelium-lined spaces within the renal sinus, regardless of the size. When invasion of the renal sinus is uncertain, it was recommended that at least 3 blocks of the tumor-renal sinus interface should be submitted. If invasion is grossly evident, or obviously not present (small peripheral tumor), it was agreed that only 1 block was needed to confirm the gross impression. Other recommendations were that the renal vein margin be considered positive only when there is adherent tumor visible microscopically at the actual margin. When a specimen is submitted separately as "caval thrombus, "the recommended sampling strategy is to take 2 or more sections to look for the adherent caval wall tissue. It was also recommended that uninvolved renal parenchyma be sampled by including normal parenchyma with tumor and normal parenchyma distant from the tumor. There was consensus that radical nephrectomy specimens should be examined for the purpose of identifying lymph nodes by dissection/palpation of the fat in the hilar area only; however, it was acknowledged that lymph nodes are found in <10% of radical nephrectomy specimens.

Original languageEnglish (US)
Pages (from-to)1505-1517
Number of pages13
JournalAmerican Journal of Surgical Pathology
Volume37
Issue number10
DOIs
StatePublished - Jan 1 2013

Fingerprint

Renal Cell Carcinoma
Pathology
Kidney
Neoplasms
Fats
Nephrectomy
Venae Cavae
Specimen Handling
Renal Veins
Thrombosis
Kidney Neoplasms
Palpation
Politics
Lymph Node Excision
Tongue
Connective Tissue
Endothelium
Lymph Nodes
Guidelines

Keywords

  • Fat invasion
  • International Society of Urological Pathology
  • ISUP
  • Kidney
  • Pathology
  • Renal cell carcinoma
  • Renal sinus
  • Renal vein invasion
  • Specimen handling
  • Stage

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Handling and staging of renal cell carcinoma : The International Society of Urological Pathology Consensus (ISUP) conference recommendations. / Trpkov, Kiril; Grignon, David J.; Bonsib, Stephen M.; Amin, Mahul B.; Billis, Athanase; Lopez-Beltran, Antonio; Samaratunga, Hemamali; Tamboli, Pheroze; Delahunt, Brett; Egevad, Lars; Montironi, Rodolfo; Srigley, John R.; Abraham, Anila; Adeniran, Adebowale; Ahmed, Khalid; Al Ahmadie, Hikmat; Algaba, Ferran; Allan, Robert; Argani, Pedram; Axcrona, Ulrika; Barry, Marc; Baydar, Dilek; Bégin, Louis; Berney, Dan; Bethwaite, Peter; Birbe, Ruth; Bostwick, David; Brimo, Fadi; Cathro, Helen; Chen, Ying Bei; Cheng, Liang; Cheville, John; Cho, Yong Mee; Chuang, Ai Ying; Cohen, Cynthia; Crist, Henry; Delprado, Warick; Deng, Fang Ming; Epstein, Jonathan; Evans, Andrew; Fadare, Oluwole; Fajardo, Daniel; Falzarano, Sara; Fine, Samson; Fleming, Stewart; Fridman, Eddie; Furusato, Bungo; Ganji, Masoud; Ghayouri, Masoumeh; Giannico, Giovanna; Gokden, Neriman; Griffiths, David; Gupta, Nilesh; Hameed, Omar; Hes, Ondrej; Hirsch, Michelle; Huang, Jiaoti; Huang, Wei; Van De Kaa, Christina Hulsbergen; Humphrey, Peter; Hussein, Sundus; Iczkowski, Kenneth; Jimenez, Rafael; Jones, Edward; Jufe, Laura Irene; Kench, James; Kida, Masatoshi; Kristiansen, Glen; Kunju, Lakshmi Priya; Lane, Zhaoli; Latour, Mathieu; Lewin, Claudio; Lie, Kathrine; Lloreta, Josep; Loftus, Barbara; Maclean, Fiona; Magi-Galluzzi, Cristina; Martignoni, Guido; McHale, Teresa; McKenney, Jesse; Merino, Maria; Miller, Rose; Miyamoto, Hiroshi; Moch, Holger; Murphy, Hedwig; Nacey, John; Nazeer, Tipu; Nesi, Gabriella; Netto, George; Nichols, Peter; O'Donnell, Marie; Olgac, Semra; Orozco, Roberto; Osunkoya, Adeboye; Ozagari, Aysim; Pan, Chin Chen; Parwani, Anil; Perry-Keene, Joanna; Petraki, Constantina; Picken, Maria; Pyda-Karwicka, Maria; Reuter, Victor; Rezaei, Katayoon; Rioux-Leclercq, Nathalie; Robinson, Brian; Rohan, Stephen; Ronchetti, Ruben; Russell, Laurie; Scarpelli, Marina; Shabaik, Ahmed; Shah, Rajal; Shanks, Jonathan; Shen, Steven; Shevchuk, Maria; Sibony, Mathilde; Srinivasan, Bhuvana; Susani, Martin; Suzigan, Sueli; Sweet, Joan; Takahashi, Hiroyuki; Tan, Puay Hoon; Tickoo, Satish; Trias, Isabel; True, Larry; Tsuzuki, Toyonori; Vakar-Lopez, Funda; Van Der Kwast, Theo; Wang, Cheng; Warren, Anne; Yao, Jorge; Yilmaz, Asli; Zhao, Jin; Zhou, Ming; Zynger, Debra.

In: American Journal of Surgical Pathology, Vol. 37, No. 10, 01.01.2013, p. 1505-1517.

Research output: Contribution to journalArticle

Trpkov, K, Grignon, DJ, Bonsib, SM, Amin, MB, Billis, A, Lopez-Beltran, A, Samaratunga, H, Tamboli, P, Delahunt, B, Egevad, L, Montironi, R, Srigley, JR, Abraham, A, Adeniran, A, Ahmed, K, Al Ahmadie, H, Algaba, F, Allan, R, Argani, P, Axcrona, U, Barry, M, Baydar, D, Bégin, L, Berney, D, Bethwaite, P, Birbe, R, Bostwick, D, Brimo, F, Cathro, H, Chen, YB, Cheng, L, Cheville, J, Cho, YM, Chuang, AY, Cohen, C, Crist, H, Delprado, W, Deng, FM, Epstein, J, Evans, A, Fadare, O, Fajardo, D, Falzarano, S, Fine, S, Fleming, S, Fridman, E, Furusato, B, Ganji, M, Ghayouri, M, Giannico, G, Gokden, N, Griffiths, D, Gupta, N, Hameed, O, Hes, O, Hirsch, M, Huang, J, Huang, W, Van De Kaa, CH, Humphrey, P, Hussein, S, Iczkowski, K, Jimenez, R, Jones, E, Jufe, LI, Kench, J, Kida, M, Kristiansen, G, Kunju, LP, Lane, Z, Latour, M, Lewin, C, Lie, K, Lloreta, J, Loftus, B, Maclean, F, Magi-Galluzzi, C, Martignoni, G, McHale, T, McKenney, J, Merino, M, Miller, R, Miyamoto, H, Moch, H, Murphy, H, Nacey, J, Nazeer, T, Nesi, G, Netto, G, Nichols, P, O'Donnell, M, Olgac, S, Orozco, R, Osunkoya, A, Ozagari, A, Pan, CC, Parwani, A, Perry-Keene, J, Petraki, C, Picken, M, Pyda-Karwicka, M, Reuter, V, Rezaei, K, Rioux-Leclercq, N, Robinson, B, Rohan, S, Ronchetti, R, Russell, L, Scarpelli, M, Shabaik, A, Shah, R, Shanks, J, Shen, S, Shevchuk, M, Sibony, M, Srinivasan, B, Susani, M, Suzigan, S, Sweet, J, Takahashi, H, Tan, PH, Tickoo, S, Trias, I, True, L, Tsuzuki, T, Vakar-Lopez, F, Van Der Kwast, T, Wang, C, Warren, A, Yao, J, Yilmaz, A, Zhao, J, Zhou, M & Zynger, D 2013, 'Handling and staging of renal cell carcinoma: The International Society of Urological Pathology Consensus (ISUP) conference recommendations', American Journal of Surgical Pathology, vol. 37, no. 10, pp. 1505-1517. https://doi.org/10.1097/PAS.0b013e31829a85d0
Trpkov, Kiril ; Grignon, David J. ; Bonsib, Stephen M. ; Amin, Mahul B. ; Billis, Athanase ; Lopez-Beltran, Antonio ; Samaratunga, Hemamali ; Tamboli, Pheroze ; Delahunt, Brett ; Egevad, Lars ; Montironi, Rodolfo ; Srigley, John R. ; Abraham, Anila ; Adeniran, Adebowale ; Ahmed, Khalid ; Al Ahmadie, Hikmat ; Algaba, Ferran ; Allan, Robert ; Argani, Pedram ; Axcrona, Ulrika ; Barry, Marc ; Baydar, Dilek ; Bégin, Louis ; Berney, Dan ; Bethwaite, Peter ; Birbe, Ruth ; Bostwick, David ; Brimo, Fadi ; Cathro, Helen ; Chen, Ying Bei ; Cheng, Liang ; Cheville, John ; Cho, Yong Mee ; Chuang, Ai Ying ; Cohen, Cynthia ; Crist, Henry ; Delprado, Warick ; Deng, Fang Ming ; Epstein, Jonathan ; Evans, Andrew ; Fadare, Oluwole ; Fajardo, Daniel ; Falzarano, Sara ; Fine, Samson ; Fleming, Stewart ; Fridman, Eddie ; Furusato, Bungo ; Ganji, Masoud ; Ghayouri, Masoumeh ; Giannico, Giovanna ; Gokden, Neriman ; Griffiths, David ; Gupta, Nilesh ; Hameed, Omar ; Hes, Ondrej ; Hirsch, Michelle ; Huang, Jiaoti ; Huang, Wei ; Van De Kaa, Christina Hulsbergen ; Humphrey, Peter ; Hussein, Sundus ; Iczkowski, Kenneth ; Jimenez, Rafael ; Jones, Edward ; Jufe, Laura Irene ; Kench, James ; Kida, Masatoshi ; Kristiansen, Glen ; Kunju, Lakshmi Priya ; Lane, Zhaoli ; Latour, Mathieu ; Lewin, Claudio ; Lie, Kathrine ; Lloreta, Josep ; Loftus, Barbara ; Maclean, Fiona ; Magi-Galluzzi, Cristina ; Martignoni, Guido ; McHale, Teresa ; McKenney, Jesse ; Merino, Maria ; Miller, Rose ; Miyamoto, Hiroshi ; Moch, Holger ; Murphy, Hedwig ; Nacey, John ; Nazeer, Tipu ; Nesi, Gabriella ; Netto, George ; Nichols, Peter ; O'Donnell, Marie ; Olgac, Semra ; Orozco, Roberto ; Osunkoya, Adeboye ; Ozagari, Aysim ; Pan, Chin Chen ; Parwani, Anil ; Perry-Keene, Joanna ; Petraki, Constantina ; Picken, Maria ; Pyda-Karwicka, Maria ; Reuter, Victor ; Rezaei, Katayoon ; Rioux-Leclercq, Nathalie ; Robinson, Brian ; Rohan, Stephen ; Ronchetti, Ruben ; Russell, Laurie ; Scarpelli, Marina ; Shabaik, Ahmed ; Shah, Rajal ; Shanks, Jonathan ; Shen, Steven ; Shevchuk, Maria ; Sibony, Mathilde ; Srinivasan, Bhuvana ; Susani, Martin ; Suzigan, Sueli ; Sweet, Joan ; Takahashi, Hiroyuki ; Tan, Puay Hoon ; Tickoo, Satish ; Trias, Isabel ; True, Larry ; Tsuzuki, Toyonori ; Vakar-Lopez, Funda ; Van Der Kwast, Theo ; Wang, Cheng ; Warren, Anne ; Yao, Jorge ; Yilmaz, Asli ; Zhao, Jin ; Zhou, Ming ; Zynger, Debra. / Handling and staging of renal cell carcinoma : The International Society of Urological Pathology Consensus (ISUP) conference recommendations. In: American Journal of Surgical Pathology. 2013 ; Vol. 37, No. 10. pp. 1505-1517.
@article{5572e2a10e8347b5bc5cf6939dcedf7d,
title = "Handling and staging of renal cell carcinoma: The International Society of Urological Pathology Consensus (ISUP) conference recommendations",
abstract = "The International Society of Urologic Pathology 2012 Consensus Conference on renal cancer, through working group 3, focused on the issues of staging and specimen handling of renal tumors. The conference was preceded by an online survey of the International Society of Urologic Pathology members, and the results of this were used to inform the focus of conference discussion. On formal voting a Z65{\%} majority was considered a consensus agreement. For specimen handling it was agreed that with radical nephrectomy specimens the initial cut should be made along the long axis and that both radical and partial nephrectomy specimens should be inked. It was recommended that sampling of renal tumors should follow a general guideline of sampling 1 block/cm with a minimum of 3 blocks (subject to modification as needed in individual cases). When measuring a renal tumor, the length of a renal vein/caval thrombus should not be part of the measurement of the main tumor mass. In cases with multiple tumors, sampling should include at a minimum the 5 largest tumors. There was a consensus that perinephric fat invasion should be determined by examining multiple perpendicular sections of the tumor/perinephric fat interface and by sampling areas suspicious for invasion. Perinephric fat invasion was defined as either the tumor touching the fat or extending as irregular tongues into the perinephric tissue, with or without desmoplasia. It was agreed upon that renal sinus invasion is present when the tumor is in direct contact with the sinus fat or the loose connective tissue of the sinus, clearly beyond the renal parenchyma, or if there is involvement of any endothelium-lined spaces within the renal sinus, regardless of the size. When invasion of the renal sinus is uncertain, it was recommended that at least 3 blocks of the tumor-renal sinus interface should be submitted. If invasion is grossly evident, or obviously not present (small peripheral tumor), it was agreed that only 1 block was needed to confirm the gross impression. Other recommendations were that the renal vein margin be considered positive only when there is adherent tumor visible microscopically at the actual margin. When a specimen is submitted separately as {"}caval thrombus, {"}the recommended sampling strategy is to take 2 or more sections to look for the adherent caval wall tissue. It was also recommended that uninvolved renal parenchyma be sampled by including normal parenchyma with tumor and normal parenchyma distant from the tumor. There was consensus that radical nephrectomy specimens should be examined for the purpose of identifying lymph nodes by dissection/palpation of the fat in the hilar area only; however, it was acknowledged that lymph nodes are found in <10{\%} of radical nephrectomy specimens.",
keywords = "Fat invasion, International Society of Urological Pathology, ISUP, Kidney, Pathology, Renal cell carcinoma, Renal sinus, Renal vein invasion, Specimen handling, Stage",
author = "Kiril Trpkov and Grignon, {David J.} and Bonsib, {Stephen M.} and Amin, {Mahul B.} and Athanase Billis and Antonio Lopez-Beltran and Hemamali Samaratunga and Pheroze Tamboli and Brett Delahunt and Lars Egevad and Rodolfo Montironi and Srigley, {John R.} and Anila Abraham and Adebowale Adeniran and Khalid Ahmed and {Al Ahmadie}, Hikmat and Ferran Algaba and Robert Allan and Pedram Argani and Ulrika Axcrona and Marc Barry and Dilek Baydar and Louis B{\'e}gin and Dan Berney and Peter Bethwaite and Ruth Birbe and David Bostwick and Fadi Brimo and Helen Cathro and Chen, {Ying Bei} and Liang Cheng and John Cheville and Cho, {Yong Mee} and Chuang, {Ai Ying} and Cynthia Cohen and Henry Crist and Warick Delprado and Deng, {Fang Ming} and Jonathan Epstein and Andrew Evans and Oluwole Fadare and Daniel Fajardo and Sara Falzarano and Samson Fine and Stewart Fleming and Eddie Fridman and Bungo Furusato and Masoud Ganji and Masoumeh Ghayouri and Giovanna Giannico and Neriman Gokden and David Griffiths and Nilesh Gupta and Omar Hameed and Ondrej Hes and Michelle Hirsch and Jiaoti Huang and Wei Huang and {Van De Kaa}, {Christina Hulsbergen} and Peter Humphrey and Sundus Hussein and Kenneth Iczkowski and Rafael Jimenez and Edward Jones and Jufe, {Laura Irene} and James Kench and Masatoshi Kida and Glen Kristiansen and Kunju, {Lakshmi Priya} and Zhaoli Lane and Mathieu Latour and Claudio Lewin and Kathrine Lie and Josep Lloreta and Barbara Loftus and Fiona Maclean and Cristina Magi-Galluzzi and Guido Martignoni and Teresa McHale and Jesse McKenney and Maria Merino and Rose Miller and Hiroshi Miyamoto and Holger Moch and Hedwig Murphy and John Nacey and Tipu Nazeer and Gabriella Nesi and George Netto and Peter Nichols and Marie O'Donnell and Semra Olgac and Roberto Orozco and Adeboye Osunkoya and Aysim Ozagari and Pan, {Chin Chen} and Anil Parwani and Joanna Perry-Keene and Constantina Petraki and Maria Picken and Maria Pyda-Karwicka and Victor Reuter and Katayoon Rezaei and Nathalie Rioux-Leclercq and Brian Robinson and Stephen Rohan and Ruben Ronchetti and Laurie Russell and Marina Scarpelli and Ahmed Shabaik and Rajal Shah and Jonathan Shanks and Steven Shen and Maria Shevchuk and Mathilde Sibony and Bhuvana Srinivasan and Martin Susani and Sueli Suzigan and Joan Sweet and Hiroyuki Takahashi and Tan, {Puay Hoon} and Satish Tickoo and Isabel Trias and Larry True and Toyonori Tsuzuki and Funda Vakar-Lopez and {Van Der Kwast}, Theo and Cheng Wang and Anne Warren and Jorge Yao and Asli Yilmaz and Jin Zhao and Ming Zhou and Debra Zynger",
year = "2013",
month = "1",
day = "1",
doi = "10.1097/PAS.0b013e31829a85d0",
language = "English (US)",
volume = "37",
pages = "1505--1517",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Handling and staging of renal cell carcinoma

T2 - The International Society of Urological Pathology Consensus (ISUP) conference recommendations

AU - Trpkov, Kiril

AU - Grignon, David J.

AU - Bonsib, Stephen M.

AU - Amin, Mahul B.

AU - Billis, Athanase

AU - Lopez-Beltran, Antonio

AU - Samaratunga, Hemamali

AU - Tamboli, Pheroze

AU - Delahunt, Brett

AU - Egevad, Lars

AU - Montironi, Rodolfo

AU - Srigley, John R.

AU - Abraham, Anila

AU - Adeniran, Adebowale

AU - Ahmed, Khalid

AU - Al Ahmadie, Hikmat

AU - Algaba, Ferran

AU - Allan, Robert

AU - Argani, Pedram

AU - Axcrona, Ulrika

AU - Barry, Marc

AU - Baydar, Dilek

AU - Bégin, Louis

AU - Berney, Dan

AU - Bethwaite, Peter

AU - Birbe, Ruth

AU - Bostwick, David

AU - Brimo, Fadi

AU - Cathro, Helen

AU - Chen, Ying Bei

AU - Cheng, Liang

AU - Cheville, John

AU - Cho, Yong Mee

AU - Chuang, Ai Ying

AU - Cohen, Cynthia

AU - Crist, Henry

AU - Delprado, Warick

AU - Deng, Fang Ming

AU - Epstein, Jonathan

AU - Evans, Andrew

AU - Fadare, Oluwole

AU - Fajardo, Daniel

AU - Falzarano, Sara

AU - Fine, Samson

AU - Fleming, Stewart

AU - Fridman, Eddie

AU - Furusato, Bungo

AU - Ganji, Masoud

AU - Ghayouri, Masoumeh

AU - Giannico, Giovanna

AU - Gokden, Neriman

AU - Griffiths, David

AU - Gupta, Nilesh

AU - Hameed, Omar

AU - Hes, Ondrej

AU - Hirsch, Michelle

AU - Huang, Jiaoti

AU - Huang, Wei

AU - Van De Kaa, Christina Hulsbergen

AU - Humphrey, Peter

AU - Hussein, Sundus

AU - Iczkowski, Kenneth

AU - Jimenez, Rafael

AU - Jones, Edward

AU - Jufe, Laura Irene

AU - Kench, James

AU - Kida, Masatoshi

AU - Kristiansen, Glen

AU - Kunju, Lakshmi Priya

AU - Lane, Zhaoli

AU - Latour, Mathieu

AU - Lewin, Claudio

AU - Lie, Kathrine

AU - Lloreta, Josep

AU - Loftus, Barbara

AU - Maclean, Fiona

AU - Magi-Galluzzi, Cristina

AU - Martignoni, Guido

AU - McHale, Teresa

AU - McKenney, Jesse

AU - Merino, Maria

AU - Miller, Rose

AU - Miyamoto, Hiroshi

AU - Moch, Holger

AU - Murphy, Hedwig

AU - Nacey, John

AU - Nazeer, Tipu

AU - Nesi, Gabriella

AU - Netto, George

AU - Nichols, Peter

AU - O'Donnell, Marie

AU - Olgac, Semra

AU - Orozco, Roberto

AU - Osunkoya, Adeboye

AU - Ozagari, Aysim

AU - Pan, Chin Chen

AU - Parwani, Anil

AU - Perry-Keene, Joanna

AU - Petraki, Constantina

AU - Picken, Maria

AU - Pyda-Karwicka, Maria

AU - Reuter, Victor

AU - Rezaei, Katayoon

AU - Rioux-Leclercq, Nathalie

AU - Robinson, Brian

AU - Rohan, Stephen

AU - Ronchetti, Ruben

AU - Russell, Laurie

AU - Scarpelli, Marina

AU - Shabaik, Ahmed

AU - Shah, Rajal

AU - Shanks, Jonathan

AU - Shen, Steven

AU - Shevchuk, Maria

AU - Sibony, Mathilde

AU - Srinivasan, Bhuvana

AU - Susani, Martin

AU - Suzigan, Sueli

AU - Sweet, Joan

AU - Takahashi, Hiroyuki

AU - Tan, Puay Hoon

AU - Tickoo, Satish

AU - Trias, Isabel

AU - True, Larry

AU - Tsuzuki, Toyonori

AU - Vakar-Lopez, Funda

AU - Van Der Kwast, Theo

AU - Wang, Cheng

AU - Warren, Anne

AU - Yao, Jorge

AU - Yilmaz, Asli

AU - Zhao, Jin

AU - Zhou, Ming

AU - Zynger, Debra

PY - 2013/1/1

Y1 - 2013/1/1

N2 - The International Society of Urologic Pathology 2012 Consensus Conference on renal cancer, through working group 3, focused on the issues of staging and specimen handling of renal tumors. The conference was preceded by an online survey of the International Society of Urologic Pathology members, and the results of this were used to inform the focus of conference discussion. On formal voting a Z65% majority was considered a consensus agreement. For specimen handling it was agreed that with radical nephrectomy specimens the initial cut should be made along the long axis and that both radical and partial nephrectomy specimens should be inked. It was recommended that sampling of renal tumors should follow a general guideline of sampling 1 block/cm with a minimum of 3 blocks (subject to modification as needed in individual cases). When measuring a renal tumor, the length of a renal vein/caval thrombus should not be part of the measurement of the main tumor mass. In cases with multiple tumors, sampling should include at a minimum the 5 largest tumors. There was a consensus that perinephric fat invasion should be determined by examining multiple perpendicular sections of the tumor/perinephric fat interface and by sampling areas suspicious for invasion. Perinephric fat invasion was defined as either the tumor touching the fat or extending as irregular tongues into the perinephric tissue, with or without desmoplasia. It was agreed upon that renal sinus invasion is present when the tumor is in direct contact with the sinus fat or the loose connective tissue of the sinus, clearly beyond the renal parenchyma, or if there is involvement of any endothelium-lined spaces within the renal sinus, regardless of the size. When invasion of the renal sinus is uncertain, it was recommended that at least 3 blocks of the tumor-renal sinus interface should be submitted. If invasion is grossly evident, or obviously not present (small peripheral tumor), it was agreed that only 1 block was needed to confirm the gross impression. Other recommendations were that the renal vein margin be considered positive only when there is adherent tumor visible microscopically at the actual margin. When a specimen is submitted separately as "caval thrombus, "the recommended sampling strategy is to take 2 or more sections to look for the adherent caval wall tissue. It was also recommended that uninvolved renal parenchyma be sampled by including normal parenchyma with tumor and normal parenchyma distant from the tumor. There was consensus that radical nephrectomy specimens should be examined for the purpose of identifying lymph nodes by dissection/palpation of the fat in the hilar area only; however, it was acknowledged that lymph nodes are found in <10% of radical nephrectomy specimens.

AB - The International Society of Urologic Pathology 2012 Consensus Conference on renal cancer, through working group 3, focused on the issues of staging and specimen handling of renal tumors. The conference was preceded by an online survey of the International Society of Urologic Pathology members, and the results of this were used to inform the focus of conference discussion. On formal voting a Z65% majority was considered a consensus agreement. For specimen handling it was agreed that with radical nephrectomy specimens the initial cut should be made along the long axis and that both radical and partial nephrectomy specimens should be inked. It was recommended that sampling of renal tumors should follow a general guideline of sampling 1 block/cm with a minimum of 3 blocks (subject to modification as needed in individual cases). When measuring a renal tumor, the length of a renal vein/caval thrombus should not be part of the measurement of the main tumor mass. In cases with multiple tumors, sampling should include at a minimum the 5 largest tumors. There was a consensus that perinephric fat invasion should be determined by examining multiple perpendicular sections of the tumor/perinephric fat interface and by sampling areas suspicious for invasion. Perinephric fat invasion was defined as either the tumor touching the fat or extending as irregular tongues into the perinephric tissue, with or without desmoplasia. It was agreed upon that renal sinus invasion is present when the tumor is in direct contact with the sinus fat or the loose connective tissue of the sinus, clearly beyond the renal parenchyma, or if there is involvement of any endothelium-lined spaces within the renal sinus, regardless of the size. When invasion of the renal sinus is uncertain, it was recommended that at least 3 blocks of the tumor-renal sinus interface should be submitted. If invasion is grossly evident, or obviously not present (small peripheral tumor), it was agreed that only 1 block was needed to confirm the gross impression. Other recommendations were that the renal vein margin be considered positive only when there is adherent tumor visible microscopically at the actual margin. When a specimen is submitted separately as "caval thrombus, "the recommended sampling strategy is to take 2 or more sections to look for the adherent caval wall tissue. It was also recommended that uninvolved renal parenchyma be sampled by including normal parenchyma with tumor and normal parenchyma distant from the tumor. There was consensus that radical nephrectomy specimens should be examined for the purpose of identifying lymph nodes by dissection/palpation of the fat in the hilar area only; however, it was acknowledged that lymph nodes are found in <10% of radical nephrectomy specimens.

KW - Fat invasion

KW - International Society of Urological Pathology

KW - ISUP

KW - Kidney

KW - Pathology

KW - Renal cell carcinoma

KW - Renal sinus

KW - Renal vein invasion

KW - Specimen handling

KW - Stage

UR - http://www.scopus.com/inward/record.url?scp=84900446855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84900446855&partnerID=8YFLogxK

U2 - 10.1097/PAS.0b013e31829a85d0

DO - 10.1097/PAS.0b013e31829a85d0

M3 - Article

C2 - 24025521

AN - SCOPUS:84900446855

VL - 37

SP - 1505

EP - 1517

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 10

ER -