DIAGNOSIS AND GRADING OF BLADDER CANCER AND ASSOCIATED LESIONS

https://doi.org/10.1016/S0094-0143(05)70197-XGet rights and content

Substantial progress has occurred in the classification and grading of urothelial neoplasms during the past year, chiefly as a result of a consensus effort by pathologists representing the World Health Organization (WHO) and the International Society of Urologic Pathology (ISUP).34 The results of these collaborative efforts are presented in the WHO/ISUP 1998 consensus report, with standardized terminology that allows a valid comparison of results from around the world.34 The consensus opinion expressed in this report is considered a work in progress that has not yet been formally evaluated and endorsed by urologists, cancer registrars, or others.

The term transitional cell was formally discouraged and the term urothelial or urothelium recommended; thus urothelial neoplasms are referred to as urothelial carcinoma rather than transitional cell carcinoma. This suggestion resulted from an awareness of the unique nature of the urothelial lining; it is not a transition from one type of epithelial cell to another. The term superficial was also abandoned. The consensus group unanimously approved the recommendation to avoid imprecise language that lumps two tumor, node, and metastasis (TNM) stages (Ta and T1) into a single diagnostic “bin.” The classification of flat neoplastic lesions of the bladder is presented in Table 1 and the classification of papillary neoplastic lesions in Table 2.

Section snippets

FLAT NEOPLASTIC LESIONS OF THE UROTHELIUM

Intraepithelial neoplasia of the bladder is strongly linked with invasive carcinoma, including flat lesions [dysplasia and carcinoma in situ (CIS)] and papillary lesions (noninvasive papillary carcinoma). Related lesions such as inverted papilloma, papillary hyperplasia, and a variety of metaplastic lesions may also be linked with carcinoma, but the evidence is inconclusive; these related lesions are not discussed herein.

PAPILLARY NEOPLASMS OF THE UROTHELIUM

The classification of papillary neoplasms proposed by the WHO/ISUP 1998 consensus group34 parallels the previous recommendations of the WHO in 197382 (see Table 2). Papilloma was considered a valid and unique diagnostic entity, although the strict criteria for diagnosis proposed by the WHO in 1973 were reconfirmed. The term urothelial neoplasm of low malignant potential was introduced to replace the term grade 1 carcinoma in recognition of the unlikely event of recurrence or progression of

SUMMARY

Standardized classification and grading of urothelial carcinoma has now been achieved internationally. Uniformity of pathologic reporting should improve the comparability of different studies and therapies and provide more accurate information to urologists in managing patients.

References (108)

  • N.M. Heney

    Natural history of superficial bladder cancer: Prognostic features and long-term disease course

    Urol Clin North Am

    (1992)
  • S. Holmang et al.

    The relationship among multiple recurrences, progression and prognosis of patients with stages TA and T1 transitional cell cancer of the bladder followed for at least 20 years

    J Urol

    (1995)
  • M.A. Hudson et al.

    Carcinoma in situ of the bladder

    J Urol

    (1995)
  • K.A. Itoku et al.

    Superficial bladder cancer

    Hematol Oncol Clin North Am

    (1992)
  • T.M. Jaeger et al.

    Tumor angiogenesis correlates with lymph node metastases in invasive bladder cancer

    J Urol

    (1995)
  • H.J. Jewett

    Carcinoma of the bladder: Influence of depth of infiltration on the 5–year results following complete extirpation of the primary growth

    J Urol

    (1952)
  • S. Kaubisch et al.

    Stage T1 bladder cancer: Grade is the primary determinant for risk of muscle invasion

    J Urol

    (1991)
  • L.A. Kiemeney et al.

    Dysplasia in normal-looking urothelium increases the risk of tumor progression in primary superficial bladder cancer

    Eur J Cancer

    (1994)
  • L.A. Kiemeney et al.

    Predictability of recurrent and progressive disease in individual patients with primary superficial bladder cancer

    J Urol

    (1993)
  • W. Lutzeyer et al.

    Prognostic parameters in superficial bladder cancer: An analysis of 315 cases

    J Urol

    (1982)
  • U. Norming et al.

    Deoxyribonucleic acid profile and tumor progression in primary carcinoma in situ of the bladder: A study of 63 patients with grade 3 lesions

    J Urol

    (1992)
  • U. Norming et al.

    Prognostic significance of mucosal aneuploidy in stage Ta/T1 grade 3 carcinoma of the bladder

    J Urol

    (1992)
  • G.R. Prout et al.

    Treated history of noninvasive grade 1 transitional cell carcinoma

    J Urol

    (1992)
  • K.M. Abou Farha et al.

    Value of immunohistochemical laminin staining in transitional cell carcinoma of human bladder

    Urol Int

    (1993)
  • N.V. Adsay et al.

    Flat-type transitional cell carcinoma in situ

    Pathol Case Rev

    (1997)
  • M.B. Amin et al.

    Urothelial transitional cell carcinoma with endophytic growth patterns: A discussion of patterns of invasion and problems associated with assessment of invasion in 18 cases

    Am J Surg Pathol

    (1997)
  • C.L. Amling et al.

    Radical cystectomy for stages TA, TIS, and T1 transitional cell carcinoma of the bladder

    J Urol

    (1994)
  • J.E. Batista et al.

    Significance of ureteral carcinoma in situ in specimens of cystectomy

    Eur Urol

    (1994)
  • L.R. Begin et al.

    Pagetoid carcinomatous involvement of the penile urethra in association with high-grade transitional cell carcinoma of the urinary bladder

    Arch Pathol Lab Med

    (1991)
  • D.G. Bostwick

    Natural history of early bladder cancer

    J Cell Biochem (suppl)

    (1992)
  • D.G. Bostwick et al.

    Bladder Biopsy Interpretation

    (1999)
  • P.N. Brawn

    The origin of invasive carcinoma of the bladder

    Cancer

    (1982)
  • N.C. Briggs et al.

    Age as a predictor of an aggressive clinical course for superficial bladder cancer in men

    Cancer

    (1992)
  • P.T. Bruce

    Bladder papilloma in young patients

    Med J Aust

    (1982)
  • K.M. Cameron et al.

    Inverted papilloma of the lower urinary tract

    Br J Urol

    (1976)
  • S.S. Chen et al.

    The significance of tumor grade in predicting disease progression in stage Ta transitional cell carcinoma of the urinary bladder

    Br J Urol

    (1996)
  • L. Cheng et al.

    Natural history of urothelial dysplasia of the bladder

    Am J Surg Pathol

    (1999)
  • L. Cheng et al.

    Survival in patients with carcinoma in situ of the urinary bladder

    Cancer

    (1999)
  • Cheng L, Darson M, Cheville JC, et alm: Natural history of urothelial papilloma of the bladder. Cancer, in...
  • Cheng L, Neumann RM, Bostwick DG: Natural history of papillary urothelial neoplasm of low malignant potential. Cancer,...
  • L. Cheng et al.

    Cancer size predicts survival in stage T2 bladder cancer: Critical evaluation of depth of muscle invasion

    Cancer

    (1999)
  • ChengL. et al.

    Substaging of T1 bladder carcinoma based on depth of invasion measured by micrometer: A new proposal

    Cancer

    (1999)
  • J.C. Cheville et al.

    Transitional cell carcinoma of the prostate: Clinicopathologic study of 50 cases

    Cancer

    (1998)
  • M. Curtis et al.

    Papillary transitional cell carcinoma of the bladder with lymphangiectasia in an 8-year-old boy

    J Urol

    (1996)
  • J.J. Daly

    Carcinoma in situ of the urothelium

    Urol Clin North Am

    (1976)
  • P.J. Dean et al.

    Carcinoma in situ and dysplasia of the bladder urothelium

    World J Urol

    (1987)
  • S. Deen et al.

    Basement membrane and extracellular interstitial matrix components in bladder neoplasia—evidence of angiogenesis

    Histopathology

    (1994)
  • J.N. Eble et al.

    Benign and low grade papillary lesions of the urinary bladder: A review of the papilloma-papillary carcinoma controversy, and a report of five typical papillomas

    Semin Diagn Pathol

    (1989)
  • M. El Ouakdi et al.

    T1 bladder tumors: Can they be considered superficial?

    J Urol (Paris)

    (1991)
  • G.B. Elliot et al.

    Denuding cystitis and in situ urothelial carcinoma

    Arch Pathol

    (1973)
  • Cited by (0)

    Address reprint requests to David G. Bostwick, MD, Bostwick Laboratories, 6722 Patterson Avenue, Richmond, VA 23226, e-mail: [email protected]

    View full text