Variant histologies in bladder cancer: Does the centre have an impact in detection accuracy?

Cimadamore, Alessia; Lonati, Chiara; Trapani, Ettore Di; Cobelli, O. De; Rink, Michael; Zamboni, Stefania; Simeone, Claudio; Soria, Francesco; Briganti, Alberto; Montorsi, Francesco; Afferi, Luca; Mattei, Agostino; Carando, Roberto; Ornaghi, Paola Irene; Tafuri, Alessandro; Antonelli, Alessandro; Karnes, R. Jeffrey; Colomer, Anna; Sánchez-Salas, Rafael; Contieri, Roberto; Hurle, Rodolfo; Poyet, Cédric; Simone, Giuseppe; D’Andrea, David; Shariat, Shahrokh F.; Galfano, Antonio; Umari, Paolo; Francavilla, Simone; Roumiguié, M.; Terrone, Carlo; Hendricksen, Kees; Krajewski, Wojciech; Buisán, O.; Laukhtina, Ekaterina; Xylinas, Évanguelos; Álvarez‐Maestro, Mario; Rouprêt, Morgan; Montironi, Rodolfo; Moschini, Marco

doi:10.1016/j.urolonc.2022.01.008

Cited by 10 publications

(13 citation statements)

References 30 publications

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“…Interestingly, sub-analyses among centres showed a wide variability in TURB accuracy, with 11 out of 18 centres (61%) reaching no agreement, 1 centre (5%) slight, 4 centres (22%) moderate, and 2 centres (11%) good and very good agreement. This wide heterogeneity among centres may potentially be attributable to interobserver variability among pathologists, sampling issues, and insufficient communication among pathologists and clinicians [14]. Compared with other variant histologies, MPBC achieved the poorest concordance rates between TURB and radical cystectomy specimen confirming previous literature [15,16] and the highest rate of no agreement among centres [14].…”

Section: Tumour Featuressupporting

confidence: 59%

“…This wide heterogeneity among centres may potentially be attributable to interobserver variability among pathologists, sampling issues, and insufficient communication among pathologists and clinicians [14]. Compared with other variant histologies, MPBC achieved the poorest concordance rates between TURB and radical cystectomy specimen confirming previous literature [15,16] and the highest rate of no agreement among centres [14].…”

Section: Tumour Featuressupporting

confidence: 59%

“…The reasons behind this discrepancy may be explained by TURB-related limitations, such as sampling bias, small specimens, thermal and retraction artifacts, which appear to make the TURB an inadequate tool for variant histology detection requesting additional diagnostic tools, such as DNA sequencing or immunohistochemical markers. Similarly, Cimadamore et al [14], considering a whole cohort of 3445 patients from 24 tertiary referral centres, confirmed slight agreement between TURB and radical cystectomy specimen (concordance: 95.4%; Cohen's kappa coefficient: 0.16), with only 26% of MPBC detected at TURB confirmed at subsequent radical cystectomy. Interestingly, sub-analyses among centres showed a wide variability in TURB accuracy, with 11 out of 18 centres (61%) reaching no agreement, 1 centre (5%) slight, 4 centres (22%) moderate, and 2 centres (11%) good and very good agreement.…”

Section: Evidence Synthesismentioning

confidence: 71%

“…The previous literature provides only weak evidence regarding the actual accuracy of TURB in detecting variant histology compared with radical cystectomy specimen [12,13]. Since the growing interest in variant histologies, recent literature specifically focused on MPBC, showing worrying results [14,15]. We recently analysed a multicentre dataset including 1881 patients treated with TURB and radical cystectomy for BCa in order to evaluate the accuracy of TURB in detecting variant histologies confirmed at subsequent radical cystectomy specimen [15].…”

Section: Accuracy Of Transurethral Resection Of the Bladder In Detect...mentioning

confidence: 99%

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Micropapillary bladder cancer: an evolving biology

Lonati

Simeone

Suardi

et al. 2022

Current Opinion in Urology

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Purpose of reviewTo summarize a comprehensive overview of more recent evidence on micropapillary bladder cancer (MPBC), focusing on actual incidence, clinical features, therapeutic strategies, and prognosis.Recent findingsMPBC generally exhibits an aggressive behaviour compared with pure urothelial carcinoma (pUC) with advances in tumour stage and nodal and distant spread at diagnosis. Due to its rarity and presence of only small sample size and retrospective studies, no consensus currently exists regarding the most effective therapeutic strategy to be performed among nonmuscle-invasive (conservative treatment versus immediate radical cystectomy) and muscle-invasive MPBC (neoadjuvant therapy versus upfront radical cystectomy versus adjuvant chemotherapy).SummaryThe incidence of MPBC is recently increased according to latter literature, ranging from 2.9 to 7.6% of all bladder cancer. Despite its aggressive behaviour at time of presentation, more recent evidence fails to demonstrate a significant association between MPBC and worse outcomes compared with pUC when adjusted for clinical and pathological features. According to latter evidence, MPBC pathological response to NAC appears to be unsatisfactory compared with pUC patients while neoadjuvant immunotherapy with Pembrolizumab may represent an effective treatment among MPBC patients, based on PD-L1 and TMB expression.

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Section: Tumour Featuressupporting

confidence: 59%

Section: Tumour Featuressupporting

confidence: 59%

Section: Evidence Synthesismentioning

confidence: 71%

Section: Accuracy Of Transurethral Resection Of the Bladder In Detect...mentioning

confidence: 99%

See 2 more Smart Citations

Micropapillary bladder cancer: an evolving biology

Lonati

Simeone

Suardi

et al. 2022

Current Opinion in Urology

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“…A correct histologic diagnosis is often challenging and requires a high level of expertise by the pathologist; thus, some of the divergent neuroendocrine histology reported could be misdiagnosed SCNEC. Consequently, it is strongly recommended to address these cases to neuroendocrine neoplasia referral centers to increase the quality of diagnostic and therapeutic management [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors of Survival for High-Grade Neuroendocrine Neoplasia of the Bladder: A SEER Database Analysis

et al. 2022

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Background: High-grade neuroendocrine carcinoma (NEC) is a rare and aggressive variant of bladder cancer. Considering its rarity, its therapeutic management is challenging and not standardized. Methods: We analyzed data extracted from the Surveillance, Epidemiology, and End Results (SEER) registry to evaluate prognostic factors for high-grade NEC of the bladder. Results: We extracted data on 1134 patients: 77.6% were small cell NEC, 14.6% were NEC, 5.5% were mixed neuro-endocrine non-neuroendocrine neoplasia, and 2.3% were large cell NEC. The stage at diagnosis was localized for 45% of patients, lymph nodal disease (N+M0) for 9.2% of patients, and metastatic disease for 26.1% of patients. The median overall survival (OS) was 12 months. Multivariate analysis detected that factors associated with worse OS were age being >72 years old (HR 1.94), lymph nodal involvement (HR 2.01), metastatic disease (HR 2.04), and the size of the primary tumor being >44.5 mm (HR 1.80). In the N0M0 populations, the size of the primary tumor being <44.5 mm, age being <72 years old, and major surgery were independently associated with a lower risk of death. In the N+M0 group, the size of the primary lesion was the only factor to retain an association with OS. Conclusions: Our SEER database analysis evidenced prognostic factors for high-grade NEC of the bladder that are of pivotal relevance to guide treatment and the decision-making process.

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