Low-grade papillary urothelial carcinoma of the urinary bladder

A clinicopathologic analysis of a post-world Health Organization/International Society of Urological Pathology classification cohort from a single academic center

Hiroshi Miyamoto, Fadi Brimo, Luciana Schultz, Huihui Ye, Jeremy S. Miller, Daniel A. Fajardo, Thomas K. Lee, Jonathan Ira Epstein, George J. Netto

Research output: Contribution to journalArticle

Abstract

Context: Few large cohort studies have addressed outcome in patients with noninvasive low-grade papillary urothelial carcinoma (LG-UrCa) following implementation of the 2004 World Health Organization/International Society of Urological Pathology (WHO/ISUP) consensus classification. Objective: To evaluate our cohort of LG-UrCa cases classified according to 2004 WHO/ISUP to reassess outcome and interobserver agreement. Design: Files were searched for all patients diagnosed with LG-UrCa between 1998 and 2008. All sections were reevaluated for accuracy of classification. Results: A total of 112 cases initially diagnosed as LG-UrCa were identified. Of those, 8 of 55 cases (15%) initially diagnosed by nonurologic pathologists were reclassified as high-grade papillary urothelial carcinoma and were excluded. The mean length of follow-up was 40.1 months (range, 2-113 months). Tumor recurrence was encountered in 56 of 104 patients (53.8%), including 37 (35.6%) with LG-UrCa or lower-grade tumors and 19 (18.3%) with high-grade papillary urothelial carcinoma. Of the 19 patients demonstrating grade progression, 7 (37%) also developed stage progression (invasive carcinoma, n = 5; metastatic carcinoma, n = 2). Seven patients eventually underwent radical cystectomy. None of the 104 patients died of bladder cancer. The mean number of recurrence episodes was 3.11. The mean durations of time to first recurrence and time to grade progression were 13.9 months and 25.1 months, respectively. The mean size of initial tumors was 1.73 cm. There was no significant correlation between tumor size, patient age, sex, or smoking history and the likelihood for recurrence or grade progression. A significantly higher rate of recurrence was seen in patients with multiple tumors at initial diagnosis (P =.04). Conclusions: A tendency to underdiagnose high-grade papillary urothelial carcinoma continues to exist. More than half (53.8%) of patients with LG-UrCa developed recurrence, with an 18.3% incidence of grade progression and a 6.7% incidence of stage progression. Patients with multiple initial tumors had significantly higher risk of developing recurrence.

Original languageEnglish (US)
Pages (from-to)1160-1163
Number of pages4
JournalArchives of Pathology and Laboratory Medicine
Volume134
Issue number8
StatePublished - Aug 2010

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Papillary Carcinoma
Urinary Bladder
Pathology
Recurrence
Neoplasms
Carcinoma
Cystectomy
Incidence
Urinary Bladder Neoplasms
Consensus
Cohort Studies
Smoking
History

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

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Low-grade papillary urothelial carcinoma of the urinary bladder : A clinicopathologic analysis of a post-world Health Organization/International Society of Urological Pathology classification cohort from a single academic center. / Miyamoto, Hiroshi; Brimo, Fadi; Schultz, Luciana; Ye, Huihui; Miller, Jeremy S.; Fajardo, Daniel A.; Lee, Thomas K.; Epstein, Jonathan Ira; Netto, George J.

In: Archives of Pathology and Laboratory Medicine, Vol. 134, No. 8, 08.2010, p. 1160-1163.

Research output: Contribution to journalArticle

@article{227f6e6695974d41ad177a731bbd3a07,
title = "Low-grade papillary urothelial carcinoma of the urinary bladder: A clinicopathologic analysis of a post-world Health Organization/International Society of Urological Pathology classification cohort from a single academic center",
abstract = "Context: Few large cohort studies have addressed outcome in patients with noninvasive low-grade papillary urothelial carcinoma (LG-UrCa) following implementation of the 2004 World Health Organization/International Society of Urological Pathology (WHO/ISUP) consensus classification. Objective: To evaluate our cohort of LG-UrCa cases classified according to 2004 WHO/ISUP to reassess outcome and interobserver agreement. Design: Files were searched for all patients diagnosed with LG-UrCa between 1998 and 2008. All sections were reevaluated for accuracy of classification. Results: A total of 112 cases initially diagnosed as LG-UrCa were identified. Of those, 8 of 55 cases (15{\%}) initially diagnosed by nonurologic pathologists were reclassified as high-grade papillary urothelial carcinoma and were excluded. The mean length of follow-up was 40.1 months (range, 2-113 months). Tumor recurrence was encountered in 56 of 104 patients (53.8{\%}), including 37 (35.6{\%}) with LG-UrCa or lower-grade tumors and 19 (18.3{\%}) with high-grade papillary urothelial carcinoma. Of the 19 patients demonstrating grade progression, 7 (37{\%}) also developed stage progression (invasive carcinoma, n = 5; metastatic carcinoma, n = 2). Seven patients eventually underwent radical cystectomy. None of the 104 patients died of bladder cancer. The mean number of recurrence episodes was 3.11. The mean durations of time to first recurrence and time to grade progression were 13.9 months and 25.1 months, respectively. The mean size of initial tumors was 1.73 cm. There was no significant correlation between tumor size, patient age, sex, or smoking history and the likelihood for recurrence or grade progression. A significantly higher rate of recurrence was seen in patients with multiple tumors at initial diagnosis (P =.04). Conclusions: A tendency to underdiagnose high-grade papillary urothelial carcinoma continues to exist. More than half (53.8{\%}) of patients with LG-UrCa developed recurrence, with an 18.3{\%} incidence of grade progression and a 6.7{\%} incidence of stage progression. Patients with multiple initial tumors had significantly higher risk of developing recurrence.",
author = "Hiroshi Miyamoto and Fadi Brimo and Luciana Schultz and Huihui Ye and Miller, {Jeremy S.} and Fajardo, {Daniel A.} and Lee, {Thomas K.} and Epstein, {Jonathan Ira} and Netto, {George J.}",
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T2 - A clinicopathologic analysis of a post-world Health Organization/International Society of Urological Pathology classification cohort from a single academic center

AU - Miyamoto, Hiroshi

AU - Brimo, Fadi

AU - Schultz, Luciana

AU - Ye, Huihui

AU - Miller, Jeremy S.

AU - Fajardo, Daniel A.

AU - Lee, Thomas K.

AU - Epstein, Jonathan Ira

AU - Netto, George J.

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N2 - Context: Few large cohort studies have addressed outcome in patients with noninvasive low-grade papillary urothelial carcinoma (LG-UrCa) following implementation of the 2004 World Health Organization/International Society of Urological Pathology (WHO/ISUP) consensus classification. Objective: To evaluate our cohort of LG-UrCa cases classified according to 2004 WHO/ISUP to reassess outcome and interobserver agreement. Design: Files were searched for all patients diagnosed with LG-UrCa between 1998 and 2008. All sections were reevaluated for accuracy of classification. Results: A total of 112 cases initially diagnosed as LG-UrCa were identified. Of those, 8 of 55 cases (15%) initially diagnosed by nonurologic pathologists were reclassified as high-grade papillary urothelial carcinoma and were excluded. The mean length of follow-up was 40.1 months (range, 2-113 months). Tumor recurrence was encountered in 56 of 104 patients (53.8%), including 37 (35.6%) with LG-UrCa or lower-grade tumors and 19 (18.3%) with high-grade papillary urothelial carcinoma. Of the 19 patients demonstrating grade progression, 7 (37%) also developed stage progression (invasive carcinoma, n = 5; metastatic carcinoma, n = 2). Seven patients eventually underwent radical cystectomy. None of the 104 patients died of bladder cancer. The mean number of recurrence episodes was 3.11. The mean durations of time to first recurrence and time to grade progression were 13.9 months and 25.1 months, respectively. The mean size of initial tumors was 1.73 cm. There was no significant correlation between tumor size, patient age, sex, or smoking history and the likelihood for recurrence or grade progression. A significantly higher rate of recurrence was seen in patients with multiple tumors at initial diagnosis (P =.04). Conclusions: A tendency to underdiagnose high-grade papillary urothelial carcinoma continues to exist. More than half (53.8%) of patients with LG-UrCa developed recurrence, with an 18.3% incidence of grade progression and a 6.7% incidence of stage progression. Patients with multiple initial tumors had significantly higher risk of developing recurrence.

AB - Context: Few large cohort studies have addressed outcome in patients with noninvasive low-grade papillary urothelial carcinoma (LG-UrCa) following implementation of the 2004 World Health Organization/International Society of Urological Pathology (WHO/ISUP) consensus classification. Objective: To evaluate our cohort of LG-UrCa cases classified according to 2004 WHO/ISUP to reassess outcome and interobserver agreement. Design: Files were searched for all patients diagnosed with LG-UrCa between 1998 and 2008. All sections were reevaluated for accuracy of classification. Results: A total of 112 cases initially diagnosed as LG-UrCa were identified. Of those, 8 of 55 cases (15%) initially diagnosed by nonurologic pathologists were reclassified as high-grade papillary urothelial carcinoma and were excluded. The mean length of follow-up was 40.1 months (range, 2-113 months). Tumor recurrence was encountered in 56 of 104 patients (53.8%), including 37 (35.6%) with LG-UrCa or lower-grade tumors and 19 (18.3%) with high-grade papillary urothelial carcinoma. Of the 19 patients demonstrating grade progression, 7 (37%) also developed stage progression (invasive carcinoma, n = 5; metastatic carcinoma, n = 2). Seven patients eventually underwent radical cystectomy. None of the 104 patients died of bladder cancer. The mean number of recurrence episodes was 3.11. The mean durations of time to first recurrence and time to grade progression were 13.9 months and 25.1 months, respectively. The mean size of initial tumors was 1.73 cm. There was no significant correlation between tumor size, patient age, sex, or smoking history and the likelihood for recurrence or grade progression. A significantly higher rate of recurrence was seen in patients with multiple tumors at initial diagnosis (P =.04). Conclusions: A tendency to underdiagnose high-grade papillary urothelial carcinoma continues to exist. More than half (53.8%) of patients with LG-UrCa developed recurrence, with an 18.3% incidence of grade progression and a 6.7% incidence of stage progression. Patients with multiple initial tumors had significantly higher risk of developing recurrence.

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