Histopathology and Molecular Diagnostics, University Hospital Careggi, Viale Pieraccini, 6, 50139, Florence, Italy.
Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
Virchows Arch. 2020 Jul;477(1):3-16. doi: 10.1007/s00428-020-02808-6. Epub 2020 Apr 15.
Most patients with bladder carcinoma are diagnosed with non-muscle-invasive disease, stage Ta, and pT1. Stage remains as the single most important prognostic indicator in urothelial carcinoma. Among the pT1 bladder cancer patients, recurrence and progression of disease occur in 50% and 10%, respectively. The identification of high-risk patients within the pT1 subgroup remains an important clinical goal and an active field of research. Substaging of pT1 disease has been claimed as important histologic discriminator by the 2016 World Health Organization (WHO) classification of the genitourinary tract tumors and by the 8th edition of the American Joint Committee on Cancer (AJCC) staging manual supporting its implementation in clinical practice. Interobserver variation in pT1 diagnosis and the associated pitfalls in pT1 assessment are the critical pathological issues. The aim of this review paper is to provide the practicing pathologist with the state of the art of morphological and immunohistochemical features useful for the diagnosis of early invasive bladder carcinomas, including practical clues on how to avoid relevant interpretative pitfalls, and to summarize the current status of pT1 substaging.
大多数膀胱癌患者被诊断为非肌肉浸润性疾病，Ta 期和 pT1 期。分期仍然是尿路上皮癌最重要的单一预后指标。在 pT1 膀胱癌患者中，疾病分别有 50%和 10%的复发和进展。在 pT1 亚组中识别高危患者仍然是一个重要的临床目标和一个活跃的研究领域。2016 年世界卫生组织（WHO）泌尿系统肿瘤分类和第 8 版美国癌症联合委员会（AJCC）分期手册都声称 pT1 疾病的亚分期是重要的组织学鉴别因素，支持其在临床实践中的应用。pT1 诊断中的观察者间变异和 pT1 评估中的相关陷阱是关键的病理问题。本文的目的是为临床病理医生提供用于诊断早期浸润性膀胱癌的形态学和免疫组织化学特征的最新技术，包括如何避免相关解释陷阱的实用线索，并总结目前 pT1 亚分期的现状。
