Grading in superficial papillary bladder carcinoma, with an emphasis on nuclear orientation.
OBJECTIVE
To develop a computerized analysis method that could reflect not only cellular anaplasia but also the orientation (PV) of neoplastic elements and could allow the separation of low (grade G 1 and G 2a) and high (G 2b) grades of superficial papillary bladder tumors (SPBTs).


METHODS
Cellular anaplasia is based on classic morphometric parameters, such as mean and standard deviation of area, perimeter, roundness and aspect ratio (length/width ratio) of 50 papillary bladder tumors (16 G 1, 10 G 2a and 24 G 2b according to Pauwels). Orientation of the major axis of each nucleus with respect to the true basal membrane was calculated using the SD of valve distribution.


RESULTS
No statistically significant differences were found between cases showing contiguous grades (G 1 versus G 2a or G 2a versus G 2b). PV, SD of the area and SD of the perimeter were the parameters that could significantly distinguish between G 1 and G 2b and between G 1 plus G 2a and G 2b (P < .05). When comparing G 1 with G 2a plus G 2b, only PV and SD of the area were statistically significant.


CONCLUSIONS
Quantification of the irregularities in the orientation of nuclei with respect to the basal membrane may improve morphometric classification of low grade SPBTs.
Dalla Palma
P
P
Pathological Anatomy Service, S. Chiara Hospital, Italy.
Mauri
M F
MF
Forti
S
S
Eccher
C
C
Antolini
R
R
D002467:Cell Nucleus / Q000648:ultrastructure; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000145:classification* / Q000473:pathology*