title: Change in Management Based on Pathologic Second Opinion Among Bladder Cancer Patients Presenting to a Comprehensive Cancer Center: Implications for Clinical Practice.
abstract: OBJECTIVE
  To evaluate the incidence and degree of change from a pathologic second opinion of bladder biopsies at a Comprehensive Cancer Center that were initially performed at referring community hospitals. The secondary objective was to determine the impact the potential changes would have on a patient's treatment.
  
  
  METHODS
  Dedicated genitourinary pathologists reviewed 1191 transurethral biopsies of the bladder and/or prostatic urethra from 2008 to 2013. Major and minor treatment changes were defined as altering recommendations for cystectomy, systemic chemotherapy, or primary cancer diagnosis, and alterations in intravesical regimens, respectively.
  
  
  RESULTS
  There were 326/1191 patients (27.4%) with a pathologic change on second opinion: grade (62/1191, 5.2%), stage (115/1191, 9.7%), muscle in the specimen (29/1191, 2.4%), presence or absence of carcinoma in situ (34/1191, 2.9%). Outside pathology did not address the presence or absence of lymphovascular invasion in 620/759 (81.7%) of invasive cases (≥cT1), of which 35/620 (5.6%) had lymphovascular invasion. There were 212 mixed, variant, or nonurothelial histologies detected in 199/1191 (16.7%) patients, with 114/212 (53.7%) resulting in reclassification by our pathologists. Potential treatment alterations accounted for 182/1191 (15.3%) of cases, with 141/1191 (11.8%) imparting major changes. There were 82/1191 (6.8%) changes in recommendation for a radical cystectomy, 38/1191 (3.2%) had a complete change in primary tumor type, and 21/1191 (1.8%) for change in chemotherapy regimen.
  
  
  CONCLUSIONS
  The amount and degree of pathologic changes and its potential impact on treatment emphasize the importance of bladder cancer patients having their histology reviewed by genitourinary-dedicated pathologists. In our cohort, 15.3% of patients could see a treatment alteration, with 11.8% being a major change.
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL. Electronic address: adam.luchey@hsc.wvu.edu.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Luchey
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Manimala
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Dickinson
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Jasreman
authors.initials: J
authors.lastname: Dhillon
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Gautum
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Lockhart
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Gilbert
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Poch
mesh_terms: D002173:Cancer Care Facilities; D000066491:Clinical Decision-Making; D006801:Humans; D012017:Referral and Consultation; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy*