Diagnostic algorithm for papillary urothelial tumors in the urinary bladder

Abstract

Papillary urothelial neoplasms with deceptively bland cytology cannot be easily classified. We aimed to design a new algorithm that could differentiate between these neoplasms based on a scoring system. We proposed a new scoring system that enables to reproducibly diagnose non-invasive papillary urothelial tumors. In this system, each lesion was given individual scores from 0 to 3 for mitosis and cellular thickness, from 0 to 2 for cellular atypia, and an additional score for papillary fusion. These scores were combined to form a summed score allowing the tumors to be ranked as follows: 0-1 = UP, 2-4 = low malignant potential (LMP), 5-7 = low-grade transitional cell carcinoma (TCC), and 8-9 = high-grade TCC. In addition to the scoring system, ancillary studies of MIB and p53 indexes with CK20 expression pattern analyses were compared together with clinical parameters. The MIB index was strongly correlated with disease progression. Four of the 22 LMP patients (18.2%) had late recurrences, two of these four (9.1%) had progression to low-grade carcinoma. The MIB index for LMP patients was strongly associated with recurrence (recurrence vs. non-recurrence, 16.5 vs. 8.1, p < 0.001). The proposed scoring system could enhance the reproducibility to distinguish papillary urothelial neoplasms.

Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma

“…The histological assessment was performed at the center-specific pathology department and was based on the WHO-grading system and TNM classification as approved by the AJCC [4]. The pathologic macro-and microscopic evaluation of specimens included cross-sectioning of the entire specimen with immunohistochemical staining to identify the presence of urothelial, squamous cell, adenocarcinoma or other histological variants [5]. Clinical staging was based on biopsy, bimanual examination, and cross-sectional imaging findings.…”

Interobserver reproducibility of pathological variables in patients with high grade non-muscle invasive bladder cancer

“…Определение степени злокачественности ПКР проводили с использованием систем ВОЗ, 1973 [6], и ВОЗ, 2004 [7], а также диагностического алгоритма для папиллярных уротелиальных опухолей [8]. Соглас-но указанному алгоритму каждому признаку присва-ивались индивидуальные баллы (от 0 до 3 баллов для количества митозов и количества клеточных сло-ев, от 0 до 2 баллов для степени выраженности клеточ-ной атипии и дополнительный балл для описания характера роста папиллярной опухоли).…”

“…Эти баллы суммировали, что позволило разделить опухоли сле-дующим образом: 0-1 балл -уротелиальная папилло-ма, 2-4 балла -опухоль с низким злокачественным потенциалом, 5-7 баллов -низкозлокачественный и 8-9 баллов -высокозлокачественный папиллярный ПКР (табл. 1, 2) [8].…”

Prognostic Significance of Incidental Prostate Cancer at Radical Cystoprostatectomy for Bladder Cancer

“…The pathological macro- and microscopic evaluation of cystoprostatectomy specimens included cross-sectioning of the entire prostate at 4-5-mm intervals with immunohistochemical staining to identify the presence of bladder [12] and PC [13]. Prostate specimens were processed according to the Stanford protocol [13].…”