Grading in Superficial Bladder Cancer. (1) Morphological Criteria

Pauwels, R.P.E.; Schapers, R.F.M.; Smeets, A. W. G. B.; Debruyne, F.M.J.; Geraedts, J. P. M.

doi:10.1111/j.1464-410x.1988.tb05060.x

Cited by 86 publications

(39 citation statements)

References 15 publications

(11 reference statements)

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“…The present findings suggest that the distribution of tumor types may vary by gender and age, and thus the demographics of the selected referral population could affect the distribution of tumor types. Table III compares pathological stage distribution between the present population-based study and representative previously reported studies [8][9][10][11][12][13][14]21,22], all but one of which [14] were based on selected, hospital-or clinic-based patient populations. The hospital-or clinic-based series show a range of non-invasive (stage pTa) tumors between 30 and 49%, compared with 66% in this population-based sample.…”

Section: Discussionmentioning

confidence: 98%

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Histological classification and stage of newly diagnosed bladder cancer in a population-based study from the Northeastern United States

Schned

Andrew

Marsit

et al. 2008

Scandinavian Journal of Urology and Nephrology

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Objective-There are limited data on the distribution of bladder cancers in the general population, classified by World Health Organization (WHO)/International Society of Urological Pathology (ISUP) criteria. This study evaluated the classification and stage of bladder cancers as part of a population-based epidemiological study of bladder cancer in the Northeastern United States.Material and methods-All New Hampshire residents with bladder cancer newly diagnosed from 1998 to 2000 were identified through the state cancer registry. All slides were reviewed by a single pathologist. Tumors were classified by two sets of standard criteria.Results-The retrieval rate for cases was over 90%. Of 342 cases reviewed, 15 were excluded for technical reasons or because malignancy was not definitively diagnosed. According to WHO/ISUP criteria, 25.7% of tumors were papillary urothelial neoplasms of low malignant potential (PUNLMP), 34.3% low-grade papillary carcinomas, 22.6% high-grade papillary carcinomas, 10.1% non-papillary urothelial carcinomas and 5.5% carcinoma in situ. By WHO (1973) criteria, 52.5% of tumors were grade 1, 21.4% grade 2 and 26.1% grade 3. Two-thirds of all tumors were stage Ta, 20.8% stage T1 and 7.6% stage ≥T2. 100% of PUNLMPs were non-invasive, 6.3% of low-grade carcinomas were invasive and 64.9% of high-grade carcinomas were invasive.Conclusions-Compared to clinic or hospital referral-based series, this study documents a higher percentage of non-invasive tumors and a lower percentage of muscle-invasive tumors. There was also a higher percentage of PUNLMP tumors and fewer high-grade papillary carcinomas than in other series. These results may more accurately reflect prevalence data for bladder cancer grade and stage, although geographic variability may exist.

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Section: Discussionmentioning

confidence: 98%

“…Historically, most of the data on the distribution of grade and stage of bladder cancer have been derived from retrospective studies on selected, often hospital-or clinic-based, patient populations [8][9][10][11][12][13]. Such studies are likely to include a disproportionate number of patients with more aggressive or advanced stage tumors.…”

Section: Introductionmentioning

confidence: 99%

Histological classification and stage of newly diagnosed bladder cancer in a population-based study from the Northeastern United States

Schned

Andrew

Marsit

et al. 2008

Scandinavian Journal of Urology and Nephrology

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“…The actuarial risk of dying within 5 years after diagnosis was 25% (95% CI: 23-27%) (Figure 4 (Jordan et al, 1987;Pauwels et al, 1988;Richards et al, 1991). Although the stage distribution is believed to be a better measure for comparison, different interpretations of the pT category by different pathologists are also possible (Abel et al, 1988a;Kurth et al, 1989;Parmar et al, 1989;Herr & Jakse, 1991 For comparison the Dutch population was given the same age and sex distribution as the study population Figure 4 Actuarial survival (%) in patients with superficial TCC of the bladder (with 95% confidence interval) compared to the Dutch population.…”

Section: Survivalmentioning

confidence: 99%

The clinical epidemiology of superficial bladder cancer

Kiemeney

Witjes²,

Verbeek³

et al. 1993

Br J Cancer

127

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Summary Even though the majority of patients with bladder malignancies initially present with low stage disease, the clinical epidemiology of these so-called superficial bladder tumours is not well known. In this paper, disease characteristics at initial presentation and during follow-up are described in 1,745 primary cases documented prospectively in the Netherlands. The risk of recurrent disease after primary treatment is very high: in 60% of cases, at least one recurrence is diagnosed within 5 years (95% CI: 58-62% Society, 1991). Therefore, the greatest concern in these patients is not to reduce mortality but to lower and postpone the number of recurrences (which are very common in superficial TCC) and thereby to prevent progression to invasive disease (and document) at least four random quadrant biopsies in macroscopically normal-looking urothelium (left and right lateral wall, trigone and dome) at the time of resection of the tumour(s). The therapy to be applied was transurethral resection of the tumour (TUR) in all patients. Urologists were advised to consider adjuvant intravesical instillations with chemotherapy or BCG vaccine in the case of multiple tumours. In pTI grade 3 patients more aggressive therapy, such as radical surgery or external or interstitial radiotherapy, would have to be considered. To detect recurrences, cystoscopy and urine cytology were used every 3 months in the first year after treatment. From the second year onwards, this check-up was performed every 6 months. Follow-up data concerning disease and life status were collected for each patient once every year.Between 1983 and 1990, 2,805 cases were documented. In 1991, all the data in the documentation project were reviewed using the medical files. After this check, the records of 100 cases were excluded. Of these, 30 had an inverted papilloma (which was considered to be benign), 58 had recurrent instead of primary disease at first registration, five did not have TCC in the bladder but in the upper urinary tract. In the records of seven cases, there were major inconsistences, which could not be corrected with information from the medical files. Of the remaining 2,705 cases, 1,745 (64.5%) had superficial TCC. 'Superficial' is defined as tumour extension limited to the mucosa (pTa) or the lamina propria (pTl) of the bladder wall with or without carcinoma in situ in random biopsies. In urology practice, primary carcinoma in situ (pTis) is considered to be very different from pTa and pTI tumours because of its relatively aggressive clinical behaviour. For that reason, patients with primary pTis (n = 52 in our series) were not evaluated in this study. Survival free of recurrence, survival free of progression and survival itself were measured from the data of histological diagnosis to the date of first recurrence, first evidence of disease progression and the date of death, respectively. Survival curves were based on the life table method, statistical significance being determined by the log rank test. The independence of host and tum...

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“…There is a lack of uniformity in definitions, reflected in the number of different classification/grading systems which have been proposed for these neoplasms. 1,[25][26][27][28][29][30][31][32][33] Until a few years ago, the 1973 World Health Organization (WHO) 27 scheme appeared to be the most widely recognized and utilized. In an attempt to provide a method of categorization that more accurately reflects a tumor's biologic behavior, and to establish greater uniformity in defining urothelial lesions, the WHO/International Society of Urological Pathology (WHO/ISUP) 32 issued a consensus statement in 1998 regarding the classification of urothelial lesions.…”

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confidence: 99%

Impact of the 1998 World Health Organization/International Society of Urological Pathology classification system for urothelial neoplasms of the kidney

et al. 2005

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The classification of urothelial neoplasms of the kidney traditionally has been similar to that of urinary bladder tumors. Several years ago, the classification of papillary urothelial neoplasms was revised. The current study focuses on the application of the 1998 World Health Organization (WHO)/International Society of Urological Pathology classification system to 102 renal pelvic urothelial neoplasms and compares it to the 1973 WHO classification scheme. In this study, all tumors were classified as urothelial carcinomas, and the majority (85%) were papillary. Most patients with papillary tumors presented with 'superficial' disease (rpT1). With the 1998 system, most papillary carcinomas were high grade, and were more often invasive as compared to low-grade tumors. Only 34% were low-grade papillary tumors and, of these, most (93%) were noninvasive. With the 1973 system, most papillary tumors were grade 2 or 3, with invasion more common in grade 3 tumors. By 1973 criteria, grade 2 tumors were a heterogeneous group; with 1998 criteria, nearly one-half were high grade and the other half low grade. The grade of papillary urothelial carcinomas with both the 1973 and 1998 grading methods was associated with stage (P ¼ 0.001). Our study reveals that papillomas and papillary urothelial neoplasms of low malignant potential are uncommon tumors in the kidney. Renal pelvic papillary urothelial neoplasms are most often carcinomas and are more commonly high grade than low grade. Although both the 1973 and 1998 systems showed a significant association with tumor stage, grade 2 papillary carcinomas are a heterogeneous group by 1973 criteria. The 1998 system provides useful information in that it more clearly defines a papillary tumor's grade and selects for a group of tumors, namely low-grade papillary urothelial carcinomas, for which a low likelihood of invasion can be predicted.

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Grading in Superficial Bladder Cancer. (1) Morphological Criteria

Cited by 86 publications

References 15 publications

Histological classification and stage of newly diagnosed bladder cancer in a population-based study from the Northeastern United States

Histological classification and stage of newly diagnosed bladder cancer in a population-based study from the Northeastern United States

The clinical epidemiology of superficial bladder cancer

Impact of the 1998 World Health Organization/International Society of Urological Pathology classification system for urothelial neoplasms of the kidney

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