Improved diagnostic accuracy of testicular biopsies for infertility through simplified criteria and a dedicated pathologist.

Objective: To examine whether simplified histopathologic criteria and a dedicated pathologist could influence the diagnostic accuracy of testicular biopsy.

Study design: Original reports from general pathologists on 99 consecutive testicular biopsies were retrospectively classified according to reported presence or absence of mature spermatids. A dedicated pathologist rediagnosed the material blindly according to the same criterion. The resulting data were compared with testicular sperm extraction (TESE) results from the in vitro fertilization laboratory.

Results: General pathologists' diagnoses predicted TESE results with a positive predictive value (PPV) of 0.97 and a negative predictive value (NPV) of 0.78. The dedicated pathologist's diagnoses yielded a PPV of 1.0 and a significantly improved NPV of 0.96.

Conclusion: Visualization of mature spermatids in a testicular biopsy is an excellent predictor of TESE results, especially in the hands of a dedicated pathologist. We therefore recommend simplified pathology reporting on testicular biopsies from azoospermic men and examination by a dedicated pathologist.