TY - JOUR
T1 - Accuracy of Transurethral Resection of the Bladder in Detecting Variant Histology of Bladder Cancer Compared with Radical Cystectomy
AU - Lonati, Chiara
AU - Baumeister, Philipp
AU - Ornaghi, Paola Irene
AU - Di Trapani, Ettore
AU - De Cobelli, Ottavio
AU - Rink, Michael
AU - Karnes, Robert Jeffrey
AU - Poyet, Cédric
AU - Simone, Giuseppe
AU - Afferi, Luca
AU - Necchi, Andrea
AU - Briganti, Alberto
AU - Montorsi, Francesco
AU - Krajewski, Wojciech
AU - Antonelli, Alessandro
AU - Cerruto, Maria Angela
AU - Zamboni, Stefania
AU - Simeone, Claudio
AU - Mordasini, Livio
AU - Mattei, Agostino
AU - Moschini, Marco
N1 - Publisher Copyright:
© 2021 European Association of Urology
PY - 2022/3
Y1 - 2022/3
N2 - Background: Correct identification of variant histologies (VHs) of bladder cancer (BCa) at transurethral resection of the bladder (TURB) could drive the subsequent treatment. Objective: To evaluate the concordance in detecting VHs between TURB and radical cystectomy (RC) specimens in BCa patients. Design, setting, and participants: We retrospectively analyzed 1881 BCa patients who underwent TURB and subsequent RC at seven tertiary care centers between 1980 and 2018. VHs were classified as sarcomatoid, lymphoepithelioma-like, neuroendocrine, squamous, micropapillary, glandular, adenocarcinoma, nested, and other variants. Outcome measurements and statistical analysis: Concordance between TURB and RC was defined as the ability to achieve histological subtypes at TURB confirmed at RC specimen, and was expressed according to Cohen's kappa coefficient. Results and limitations: Of the patients, 14.6% and 21% were diagnosed with VH at TURB and RC specimens, respectively. The most common VHs at TURB were squamous, neuroendocrine, and micropapillary carcinoma (5.2%, 1.5%, and 1.5%, respectively). At RC, the most frequent VHs were squamous, micropapillary, and sarcomatoid carcinoma (7.2%, 3.0%, and 2.7%, respectively). The overall concordance in detecting VH was defined as slight concordance (coefficient: 0.18). Moderate concordance was found for neuroendocrine, adenocarcinoma, and squamous carcinoma (coefficient: 0.49, 0.47, and 0.41, respectively). Micropapillary, glandular, and other variants showed slight concordance (coefficient: 0.05, 0.17, and 0.12, respectively), while nested and sarcomatoid carcinoma showed fair concordance (coefficient: 0.32 and 0.26, respectively). Results may be limited by the absence of centralized pathological analysis. Conclusions: A non-negligible percentage of patients were diagnosed with VH at both TURB and RC. TURB showed relatively low accuracy, ranging from poor to moderate, in detecting VHs. Our study underlines the need of additional diagnostic tools in order to identify VHs properly at precystectomy time and to improve patient survival outcomes. Patient summary: In this report, we underlined the low accuracy of transurethral resection of the bladder in detecting variant histologies and the need for additional diagnostic tools.
AB - Background: Correct identification of variant histologies (VHs) of bladder cancer (BCa) at transurethral resection of the bladder (TURB) could drive the subsequent treatment. Objective: To evaluate the concordance in detecting VHs between TURB and radical cystectomy (RC) specimens in BCa patients. Design, setting, and participants: We retrospectively analyzed 1881 BCa patients who underwent TURB and subsequent RC at seven tertiary care centers between 1980 and 2018. VHs were classified as sarcomatoid, lymphoepithelioma-like, neuroendocrine, squamous, micropapillary, glandular, adenocarcinoma, nested, and other variants. Outcome measurements and statistical analysis: Concordance between TURB and RC was defined as the ability to achieve histological subtypes at TURB confirmed at RC specimen, and was expressed according to Cohen's kappa coefficient. Results and limitations: Of the patients, 14.6% and 21% were diagnosed with VH at TURB and RC specimens, respectively. The most common VHs at TURB were squamous, neuroendocrine, and micropapillary carcinoma (5.2%, 1.5%, and 1.5%, respectively). At RC, the most frequent VHs were squamous, micropapillary, and sarcomatoid carcinoma (7.2%, 3.0%, and 2.7%, respectively). The overall concordance in detecting VH was defined as slight concordance (coefficient: 0.18). Moderate concordance was found for neuroendocrine, adenocarcinoma, and squamous carcinoma (coefficient: 0.49, 0.47, and 0.41, respectively). Micropapillary, glandular, and other variants showed slight concordance (coefficient: 0.05, 0.17, and 0.12, respectively), while nested and sarcomatoid carcinoma showed fair concordance (coefficient: 0.32 and 0.26, respectively). Results may be limited by the absence of centralized pathological analysis. Conclusions: A non-negligible percentage of patients were diagnosed with VH at both TURB and RC. TURB showed relatively low accuracy, ranging from poor to moderate, in detecting VHs. Our study underlines the need of additional diagnostic tools in order to identify VHs properly at precystectomy time and to improve patient survival outcomes. Patient summary: In this report, we underlined the low accuracy of transurethral resection of the bladder in detecting variant histologies and the need for additional diagnostic tools.
KW - Bladder cancer
KW - Histological variants
KW - Radical cystectomy
KW - Transurethral resection
KW - Urothelial carcinoma
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U2 - 10.1016/j.euf.2021.04.005
DO - 10.1016/j.euf.2021.04.005
M3 - Article
C2 - 33867307
AN - SCOPUS:85104349534
SN - 2405-4569
VL - 8
SP - 457
EP - 464
JO - European Urology Focus
JF - European Urology Focus
IS - 2
ER -