The following is a summary of “Impact of pathologic re-review on grade, clinical stage, and risk stratification for patients with nonmuscle invasive bladder cancer,” published in the June 2024 issue of Urology by Campbell et al.

Pathologic re-review of transurethral resection of bladder tumor (TURBT) specimens is a routine practice at the tertiary care center, yet its impact on disease risk stratification remains poorly understood. This study aimed to assess how re-evaluation of specimens initially diagnosed at outside institutions affected grading, clinical T (cT) staging, and American Urological Association (AUA) risk stratification in patients with non-muscle invasive bladder cancer (NMIBC).

From the laboratory information system, researchers identified 561 patients who underwent TURBT between 2021 and 2022. Of these, 173 patients met the inclusion criteria, comprising 113 with <cT2 disease (including 12 benign cases, 10 Tis, 46 Ta, and 45 T1) and 60 patients with cT2 disease. All patients underwent pathologic re-review of their original outside hospital specimens initiated by the institution’s physicians.

The results indicated that among patients with <cT2 disease, grading was upgraded in 12 cases (10%), downgraded in 8 cases (7%), and unchanged in 93 cases (82%). The clinical stage was increased in 6 cases (5%), decreased in 6 cases (5%), and remained unchanged in 101 cases (89%). For patients with cT2 disease, there were no changes in grading, no cases were upstaged, and 3 cases (5%) were downstaged. Risk stratification analysis showed that 15 patients with <cT2 disease (13%) experienced increased risk, while 9 patients (8%) experienced decreased risk. The primary reason for risk reclassification was grade changes. Variant histology identified during re-review contributed to risk reclassification in only 3 cases, whereas 4 cases initially diagnosed as high-grade urothelial carcinoma were reclassified as benign.

In conclusion, genitourinary pathologists’ dedicated re-review of TURBT pathology led to alterations in AUA NMIBC risk stratification in more than one-fifth of cases, suggesting potential implications for clinical management decisions. These findings underscore the importance of meticulous pathological evaluation in guiding treatment strategies for patients with NMIBC, highlighting the need for standardized protocols in pathologic assessment across healthcare settings.

Source: sciencedirect.com/science/article/pii/S107814392400494