Comparison of pathological staging and grading of urothelial bladder carcinoma in post-transurethral resection and post-radical cystectomy specimens

Abstract

Staging and grading of bladder cancer have a substantial impact on patients' prognosis. However, due to the relatively low quality and quantity of specimens from transurethral resection (TUR), initial histopathological examination may not be fully reliable. The aim of this study was to assess the repeatability of staging and grading in post-TUR and post-radical cystectomy (RC) specimens. Staging and grading in TUR and RC specimens were compared in a group of 181 consecutive patients. All microscopic examinations were performed by dedicated uropathologists. Median time from TUR to RC was 45 days. Additionally, an attempt to identify potential clinical variables influencing the risk of discrepancies was made. In post-RC specimens, the disease was down-staged in 13.8% and up-staged in 54.6% of patients (K = -0.03, p < 0.02). Muscle-invasive bladder cancer was diagnosed in 67.6% of patients initially staged as T1. Cancer was down-graded in 10.3% and up-graded in 17.9% of patients (K = 0.44, p < 0.02). Early onset of disease, female sex and time interval from transurethral resection of bladder tumor (TURBT) to RC had no effect on incidence of discrepancies. Pathological post-TUR examination is not predictive for the final stage of cancer. The incidence of under-or overgrading of bladder cancer is significant, and efforts should be made to reduce it.

Immunohistochemical differentiation between muscularis mucosae and muscularis propria for improving the staging of bladder cancer in patients undergoing transurethral resection of bladder tumours

“…Orientation in the specimen and proper identification of histological structures is limited by the low volume of the available tissue, cau-tery-related artefacts, inflammatory responses, and the presence of MM, myofibroblasts, or intravesical adipose tissue. As an indirect result, bladder cancer diagnosed during microscopic examination of TUR specimens may be up-staged or down-staged after microscopic examination of radical cystectomy specimens in as many as 32-76.2% and 0-46.2% of cases, respectively [12,13,14,15,16,17,18]. Because of this, the opinion of a second pathologist is recommended during the primary diagnosis, especially in questionable cases [1].…”

Stage of bladder cancer in Central Europe – Polish perspective

“…In more recent analysis considering 2004 WHO/ISUP classification and covering 327 patients, Schned et al diagnosed high-grade tumors in 22.6% of cases with the agreement rate between pathologists of 83% [12]. The problem of discrepancies between pathologists opinion on tumor grade is both well known and unsolved, recently confirmed also in representative cohort of Polish population [13]. Simultaneously, the differences between the incidence of G3 and high-grade tumors outlines the core differences between 1973 WHO and 2004 WHO/ISUP classifications.…”

Contrast enhanced ultrasound in urothelial carcinoma of urinary bladder: An underutilized staging and grading modality

“…This demonstrates the variability in management of CAUB. Several factors including the resource setting can potentially modify the final treatment plan that the patient receives [5–8]. …”