Pathology Slide Review in Vulvar Cancer Does Not Change Patient Management

Hypothesis. Pathology slide review in vulvar cancer is only necessary in a restricted number of cases. Methods. A retrospective chart review of all cases of vulvar cancer treated in a tertiary centre between January 1, 2000, and April 1, 2006. Histopathology reports from the referring and tertiary centre were compared. Results. 121 pathology reports from 112 patients were reviewed. Of the original reports, 56% were deemed adequate, commenting on tumor type and depth of infiltration; of the reviews, 83% were adequate. Conclusion. There were no discrepancies that influenced patient management. We suggest that vulvar cancer biopsies need to be reviewed only when the tumor is less than 10？mm in linear extension, when the infiltration is 1？mm or less, when there is no residual tumor on inspection, and in any nonsquamous cancer. 1. Introduction Vulvar cancer accounts for 2–5% of gynecological cancers, and 90% of cases are squamous carcinoma. Tumor type and infiltration depth are crucial in determining treatment. Treatment of the groin nodes is recommended when infiltration depth is 1？mm or more or when tumor size is 2？cm or more (T1B tumors). In our institute, treatment of groin nodes consists of either a sentinel node procedure or an inguinal-femoral lymphadenectomy, depending on the size of the tumor and the number of tumor foci. Different treatment schedules are applicable for superficially invasive tumors (if smaller than 2？cm diameter) and for nonsquamous carcinomas. It is therefore clearly of importance that the biopsy report should, where possible, include tumor type and infiltration depth. These features, in combination with a clinical assessment of tumor diameter, should enable an appropriate decision about treatment to be made. In the Netherlands, patients with vulvar malignancies are referred to tertiary centers for treatment. In our tertiary institute the slides are reviewed by pathologists experienced in gynecopathology as part of the preoperative workup. The extra work and resources involved in reviewing all tumors are discussed and debated in several papers [1–5], although literature on this topic is relatively scarce. It is clear that review is costly and time consuming. Both laboratories have to organize the exchange of tissue blocks and slides, which is time consuming for administrative assistants. Reviewing slides costs time for the pathologist and the review may potentially delay treatment, increasing stress for patients and relatives. The objective of this paper is to determine the impact of pathology review on patient management in