We are grateful to Professors Tsuzuki 1 and Gondo 2 for sharing their thoughts on our work, along with their visions for how pathological findings might guide treatment for bladder cancer patients in the near future. Both professors recognized the two novel areas of inquiry addressed in our population-based study -factors associated with whether or not pathologists in routine practice report lymphovascular invasion (LVI) in cystectomy specimens, and the prognostic significance of LVI in routine practice as it applies to patients with muscle-invasive urothelial carcinoma. We would disagree slightly with Professor Gondo on one point. While Lotan et al. showed a correlation between LVI and advanced stage, we could find no previously published analysis in their work or elsewhere that reports factors that influence the likelihood that pathologists will address LVI (present or absent) in pathology reports. 3 We acknowledge that our study has limitations. Chief among them is that we did not address the true LVI status of each case, an undertaking that would be infeasible in a large populationbased study such as this one. Nevertheless, we found incomplete reporting of LVI by pathologists in routine practice, particularly in lower stage cancers. Reporting rates have increased over the years, but significant room for improvement remains. How will pathologists improve their practice? As discussed by Professor Tsuzuki, a variety of approaches have been developed to improve LVI assessment by pathologists, but no consensus has emerged regarding when or how to best use these tools. Pathologists have developed outstanding procedures for reaching consensus on such areas. The International Society of Urologic Pathologists is a leader in this area, having held consensus conferences on an annual basis for decades, and issuing a number of influential guidelines for the evaluation for bladder and other cancers.4-8 A consensus algorithm for identifying and reporting LVI would likely have a significant impact, particularly if published under the aegis of the International Society of Urologic Pathologists. We urge our pathology colleagues to organize appropriate meetings on this topic.We find it striking that LVI is among the most studied variables in muscle-invasive urothelial carcinoma, yet, as pointed out by Professors Tsuzuki and Gondo, many important questions remain. Chiefly, as pathologists improve their ability to detect LVI, how will urologists and oncologists use this information to choose optimal management for their patients? We strongly agree that more work is required to understand how often LVI can be ascertained in biopsy specimens, and whether it can be used to guide treatments, such as early cystectomy for superficially invasive patients, or neoadjuvant chemotherapy for patients with muscle-invasive urothelial carcinoma. We look forward to developments in this area, as they will enable us to deliver better outcomes to patients with this challenging disease.