This article contains recommendations from the European Association of Urology Guidelines Panel on Testicular Cancer and argues that centralised review of orchiectomy specimens by expert genitourinary pathologists would contribute to better patient management. Accurate pathological assessment is fundamental to the optimal management of urological malignancies, particularly in centres managing moderate case volumes (approximately 30 cases annually). Pathology reports must adhere strictly to nationally and internationally recommended datasets to ensure consistency, prognostic accuracy and appropriate treatment planning. Standardisation of reporting enhances multidisciplinary decision-making and facilitates meaningful comparison of outcomes across institutions. Each pathology report should clearly define the type of specimen submitted, as this determines the scope of assessment and interpretation. The report must document tumour focality, distinguishing between unifocal and multifocal disease, as this may influence staging and risk stratification. The maximum tumour diameter should be measured and recorded precisely, given its prognostic relevance and role in staging systems. Accurate classification of the histological subtype is essential, as tumour biology and therapeutic response vary significantly between subtypes. The extent of invasion must be carefully described, including depth and anatomical structures involved, since this directly informs pathological staging. Identification of lymphovascular invasion is a critical prognostic indicator and should always be explicitly reported. The presence or absence of germ cell neoplasia in situ (GCNIS) must be documented where relevant, as it has implications for surveillance and contralateral risk. Surgical margin status is another core element, requiring clear designation as positive or negative, with anatomical localisation where applicable. Finally, an accurate pathological stage (pTNM) should be assigned in accordance with the latest staging classification. Inclusion of these core parameters ensures comprehensive, reproducible and clinically actionable pathology reporting, ultimately supporting high-quality patient care and audit standards. This article contains recommendations from the European Association of Urology Guidelines Panel on Testicular Cancer and argues that centralised review of orchiectomy specimens by expert genitourinary pathologists would contribute to better patient management. Accurate pathological assessment is fundamental to the optimal management of urological malignancies, particularly in centres managing moderate case volumes (approximately 30 cases annually). Pathology reports must adhere strictly to nationally and internationally recommended datasets to ensure consistency, prognostic accuracy and appropriate treatment planning. Standardisation of reporting enhances multidisciplinary decision-making and facilitates meaningful comparison of outcomes across institutions. Each pathology report should clearly define the type of specimen submitted, as this determines the scope of assessment and interpretation. The report must document tumour focality, distinguishing between unifocal and multifocal disease, as this may influence staging and risk stratification. The maximum tumour diameter should be measured and recorded precisely, given its prognostic relevance and role in staging systems. Accurate classification of the histological subtype is essential, as tumour biology and therapeutic response vary significantly between subtypes. The extent of invasion must be carefully described, including depth and anatomical structures involved, since this directly informs pathological staging. Identification of lymphovascular invasion is a critical prognostic indicator and should always be explicitly reported. The presence or absence of germ cell neoplasia in situ (GCNIS) must be documented where relevant, as it has implications for surveillance and contralateral risk. Surgical margin status is another core element, requiring clear designation as positive or negative, with anatomical localisation where applicable. Finally, an accurate pathological stage (pTNM) should be assigned in accordance with the latest staging classification. Inclusion of these core parameters ensures comprehensive, reproducible and clinically actionable pathology reporting, ultimately supporting high-quality patient care and audit standards.
Should expert genitourinary pathology review of orchiectomy specimens be mandatory?
Reviewed by Asif H Ansari
Expert Genitourinary Pathology Review of Orchiectomy Specimens Should Be Mandatory for Optimal Management. Recommendations from the European Association of Urology Guidelines Panel on Testicular Cancer.
