title: Grading and staging of bladder carcinoma in transurethral resection specimens. Correlation with 105 matched cystectomy specimens.
abstract: We compared the grading and staging of transurethral resection of the bladder (TURB) and cystectomy specimens for 105 patients who underwent radical cystectomy for urothelial carcinoma between 1980 and 1984. Of 105 patients, 96% underwent cystectomy within 100 days of TURB (median interval, 10 days). Grading was performed according to the 1998 World Health Organization/International Society of Urologic Pathology grading system and staging according to the 1997 TNM classification. Histologic grade was low-grade, 13; high-grade, 92 in TURB specimens; low-grade, 17; high-grade, 88 in cystectomy specimens. Pathologic stage was Ta, 15; T1, 55; and T2, 35 in TURB specimens; Ta, 5; T1, 19; T2, 19; T3, 46; and T4, 16 in cystectomy specimens. Histologic grade at TURB was associated with pathologic stage at cystectomy (P < .001). When all advanced-stage (muscle-invasive) carcinomas (pT2 or more) were considered together, 55 patients were understaged by TURB, 4 had higher stage in TURB than in cystectomy, and 46 were the same stage as by cystectomy. Forty-three of 55 patients with stage T1 carcinoma at TURB had advanced-stage carcinoma at cystectomy, including 34 who had extravesicular extension (pT3 or more). We found pathologic understanding by TURB occurs in a significant number of patients with bladder cancer; the newly proposed grading system predicted final pathologic stage.
authors.affiliation: Department of Pathology and Urology, Indiana University School of Medicine, Indianapolis 46202, USA.
authors.forename: L
authors.initials: L
authors.lastname: Cheng
authors.forename: R M
authors.initials: RM
authors.lastname: Neumann
authors.forename: A L
authors.initials: AL
authors.lastname: Weaver
authors.forename: J C
authors.initials: JC
authors.lastname: Cheville
authors.forename: B C
authors.initials: BC
authors.lastname: Leibovich
authors.forename: D M
authors.initials: DM
authors.lastname: Ramnani
authors.forename: B G
authors.initials: BG
authors.lastname: Scherer
authors.forename: A
authors.initials: A
authors.lastname: Nehra
authors.forename: H
authors.initials: H
authors.lastname: Zincke
authors.forename: D G
authors.initials: DG
authors.lastname: Bostwick
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*