Abstract
Introduction
Pathological staging of bladder cancer (BC) on trans-urethral bladder resection (TURB)
specimens is critical for the indication of radical cystectomy (RC).
Materials and Methods
We aimed to assess the inter-observer variability among dedicated and not dedicated
genito-urinary pathologists (GUP) and the predictive value of the amount of muscularis
propria (MP) in the TURB specimens to predict accurate staging in RC. We selected
101 patients with at least 1 diagnosis of pT1 high grade BC who underwent RC during
the history of disease. All the pathological TURB and RC specimens were reviewed by
3 GUPs, and concordance among them and with the original pathology report (OPR) was
made. The presence and the extent of MP was measured in all the TURB specimens and
correlated to stage at RC.
Results
Excellent (0.90 ≥ K ≥ 0.74) diagnostic concordance was reached among GUP while only
good (0.77 ≥ K ≥ 0.67) with the OPR on stage and grade in TURBs. We found a general
up-stage in the OPR compared with the GUP review. After histological review, 34.4%
cases were downstaged to pT1 from pT2 and 10.1% from pT1 to pTa. The presence of MP
was associated with a better discrimination of the stage at RC (P = .00065), and a trend towards correlation was found with its extent (area under
the curve-receiver operator characteristic = 0.752; best cut-off 3.69 mm).
Conclusion
The implementation of dedicated GUP can improve diagnostic sensitivity and specificity
in BC diagnosis. The amount of MP and perhaps its extent in pT1 TURB speciments can
predict more accurate cancer stage at RC.
Keywords
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Article info
Publication history
Published online: January 21, 2016
Accepted:
January 16,
2016
Received in revised form:
January 5,
2016
Received:
August 14,
2015
Footnotes
F.G. and R.P. contributed equally to this work as first authors.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
