Pathology review impacts clinical management of patients with T1‒T2 bladder cancer

Abstract

Introduction: We sought to evaluate the contemporary role of a pathology review on management implications of patients with bladder cancer. Methods: A total of 98 consecutive specimens from transurethral resections in patients with suspected bladder tumours were reviewed at our institution by genitourinary pathologist. Patients were classified into risk groups according to pathology reports obtained before and after review. A management course was proposed according to local institutional practice patterns and main urological guidelines. Results: Overall, 34.7% of pathological reviews had significant changes associated with management implications, the majority of which were due to changes in risk category (and/or stage). On review pathology, 12 patients were recommended radical cystectomy instead of conservative management and two patients avoided radical cystectomy. Six patients initially staged as T1 and whose staging did not change after review had a proposed change in management in the form of early cystectomy as a treatment option, as they were deemed very high-risk secondary to high-risk features (such as carcinoma in situ or lymphovascular invasion found on review). Ten patients initially staged as T2 demonstrated high-risk features on review. Conclusions: Review by genitourinary pathologist remains important, as it defines more clearly the tumour risk category and influences the management of T1-T2 bladder cancer patients. A complete initial pathological report has the potential to further decrease the discrepancy between initial and review reports.

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

“…Diagnostic confirmation of muscle invasion (T2) is obtained by transurethral resection of bladder tumor (TURBT) and cystoscopic examination under anesthesia. Inter-observer variation of staging based on TURBT specimens may be considerable [42][43][44]. Therefore, review by an experienced GU pathologist is advised whenever possible, in line with prior Canadian recommendations [45].…”

“…Variant histology is often challenging to identify on TURBT specimens [48,55]. As a result, pathology review by an experienced GU pathologist can be informative, and lead to major changes in management [43,44].…”