Impact of pathologic re-review on grade, clinical stage, and risk stratification for patients with nonmuscle invasive bladder cancer.

OBJECTIVES

Pathologic re-review of transurethral resection of bladder tumor (TURBT) specimen is a common practice at our tertiary care center, but its impact on disease risk stratification remains unknown. We sought to determine how pathologic re-review of specimen initially read at an outside institution changed grade, clinical T (cT) stage, and AUA non-muscle-invasive bladder cancer (NMIBC) risk stratification.

METHODS AND MATERIALS

The laboratory information system was searched for patients who underwent TURBT from 2021 to 2022, yielding 561 records. 173 patients met inclusion criteria: 113 with <cT2 disease (12 benign, 10 Tis, 46 Ta, 45 T1) and 60 patients with cT2. All patients had pathologic re-review of their original outside hospital specimen initiated by a physician at our institution.

RESULTS

For <cT2 disease, upgrading was observed in 12/113 (10%), downgrading in 8/113 (7%), and no change in grade in 93/113 (82%). Increased clinical stage was demonstrated in 6/113 (5%), decreased in 6/113 (5%) and no change in 101/113 (89%). For cT2 disease, grade did not change in any cases, none were upstaged and 3/60 (5%) were downstaged. For <cT2 disease, 15/112 (13%) experienced increased and 9/112 (8%) experienced decreased risk stratification. The most common reason for change in risk was grade. Addition of variant histology on re-review only led to change in risk stratification in 3/15 cases. Four cases were reclassified from high-grade urothelial carcinoma to benign on pathologic re-review.

CONCLUSIONS

Re-review of TURBT pathology by a dedicated GU pathologist led to change in AUA NMIBC risk stratification in over one-fifth of patients, with potential for changing management.