Department of Urology, Spedali Civili of Brescia, Brescia, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
Eur Urol Focus. 2022 Mar;8(2):457-464. doi: 10.1016/j.euf.2021.04.005. Epub 2021 Apr 16.
Correct identification of variant histologies (VHs) of bladder cancer (BCa) at transurethral resection of the bladder (TURB) could drive the subsequent treatment.
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.
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.
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.
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.
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.
在经尿道膀胱肿瘤切除术（TURB）中正确识别膀胱癌（BCa）的变体组织学（VH）可以指导后续治疗。
评估 TURB 和 BCa 患者根治性膀胱切除术（RC）标本中 VH 的检测一致性。
设计、设置和参与者：我们回顾性分析了 1980 年至 2018 年间在七个三级护理中心接受 TURB 和随后 RC 的 1881 例 BCa 患者。VH 分为肉瘤样、淋巴上皮样、神经内分泌、鳞状、微乳头状、腺、腺癌、巢状和其他变体。
TURB 和 RC 之间的一致性定义为在 TURB 中能够达到在 RC 标本中确认的组织学亚型的能力，并根据 Cohen 的 kappa 系数表示。
在这些患者中，分别有 14.6%和 21%在 TURB 和 RC 标本中诊断出 VH。TURB 最常见的 VH 是鳞状、神经内分泌和微乳头状癌（分别为 5.2%、1.5%和 1.5%）。在 RC 中，最常见的 VH 是鳞状、微乳头状和肉瘤样癌（分别为 7.2%、3.0%和 2.7%）。检测 VH 的总体一致性定义为轻微一致性（系数：0.18）。神经内分泌、腺癌和鳞状细胞癌的一致性为中度（系数：0.49、0.47 和 0.41）。微乳头状、腺和其他变体显示出轻微的一致性（系数：0.05、0.17 和 0.12），而巢状和肉瘤样癌显示出适度的一致性（系数：0.32 和 0.26）。结果可能受到缺乏集中病理分析的限制。
相当一部分患者在 TURB 和 RC 中均被诊断为 VH。TURB 在检测 VH 方面的准确性相对较低，从较差到中度不等。我们的研究强调了需要额外的诊断工具，以便在术前正确识别 VH，并改善患者的生存结果。
在本报告中，我们强调了经尿道膀胱肿瘤切除术在检测变体组织学方面的低准确性以及对额外诊断工具的需求。
