UROLOGICAL SURVEY
Handling and reporting of transurethral resection specimens of the bladder in Europe: a web-based survey by the European Network of Uropathology (ENUP)
Lopez-Beltran A; Algaba F; Berney DM; Boccon-Gibod L; Camparo P; Griffiths D; Mikuz G; Montironi R; Varma M; Egevad L
Unit of Anatomic Pathology, Cordoba University Medical School, Cordoba, Spain
Histopathology. 2011; 58: 579-85. doi: 10.1111/j.1365-2559.2011.03784.x.
AIMS: To collect of information about European practices on handling and reporting of transurethral resection specimens of the bladder.
METHODS AND RESULTS: The European Network of Uropathology is a communication network that includes 335 pathology laboratories in 15 western European countries. A web-based questionnaire was answered by 52.2% of members. Some routines were adopted by a majority: formalin fixation (92.5%), separate containers for tumors and resection base (72%) and embedding of the entire specimen (60%). Cancer along/in adipose tissue would be reported as pT3a by 19.5% and non-invasive urothelial carcinoma in prostatic ducts/glands as pT4a by 16.1%. Papillary urothelial neoplasia of low malignant potential is recognized by 72.6% but rarely reported. Immunohistochemistry is rarely or sometimes used for diagnosing bladder cancer by 91.7%, and the most frequently used markers are CK20 (76.9%), CK7 (66.7%) and Ki67 (38.8%). Only 24.8% report prognostic markers, with Ki67 (84.4%) and p53 (64.4%) being most common. Only 50.9% use the International Society of Urological Pathology 1998/World Health Organization (WHO) 2004 grading system, followed by WHO 1973 (43.4%) and WHO 1999 (31.4%).
CONCLUSIONS: There is still variability in routine practice and a need for standardization of methodologies. These results may be helpful when judging what recommendations are reasonable to issue.
Editorial Comment
Surveys on handling and reporting of surgical specimens are very important tools for consensus conferences among pathologists. Due to the high frequency of transurethral resection specimens of the bladder, standardization of methodologies are of utmost importance.
In TUR resections of malignant neoplasias, the pathology report should inform:
1. The histologic diagnosis. Most of the tumors are urothelial carcinomas. Sarcomas are very rare. There are several histologic variants of urothelial carcinomas.
2. Configuration. Papillary, non papillary, inverted growth.
3. Differentiation. Squamous differentiation is more frequent than glandular differentiation. There are other rare types of differentiation. Tumors with differentiation, in general, show a higher stage at diagnosis.
4. Grading. Several systems may be used: grades 1, 2, and 3 (WHO); low-grade (corresponding to grade 1) and high-grade (corresponding to grades 2 and 3) (WHO/International Society of Urological Pathology); and combined numbers, e.g. 1+2 (low-grade in most areas + high-grade as a secondary grade, 1+1 (low-grade in all areas examined), etc.
5. Staging. According to the TNM: Tis (flat carcinoma in situ), Ta (papillary non invasive or papillary in situ), T1 (subepithelial connective tissue invasion), T2 (muscularis propria invasion). An important distinction for the pathologist is muscularis propria vs. muscularis mucosae. Invasion of the latter is still T1.
6. A very important information that should be included in the report is presence or not of sections of muscularis propria in the TUR. In cases of T1 without sections of muscularis propria, stage T2 cannot be excluded. A new TUR should be performed for an adequate staging.
Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br
Publication Dates
-
Publication in this collection
19 Oct 2011 -
Date of issue
Aug 2011
