Editorial Comment from Dr Tsuzuki to Reporting trends and prognostic significance of lymphovascular invasion in muscle‐invasive urothelial carcinoma: A population‐based study

Abstract

Supporting informationAdditional Supporting Information may be found in the online version of this article at the publisher's web-site: Editorial Comment Editorial Comment from Dr Tsuzuki to Reporting trends and prognostic significance of lymphovascular invasion in muscle-invasive urothelial carcinoma: A population-based studyLymphovascular invasion (LVI) is one of the most important prognostic factors in bladder cancer. 1 It remains unclear whether LVI is assessed effectively in community-based hospitals, as the usefulness of LVI was proven only through data obtained from tertiary academic centers. In addition, although reporting the LVI status is generally recommended, it is unclear whether all pathologists report this. 2In the current issue of the International Journal of Urology, Berman et al. assessed the reporting trends and prognostic significance of LVI based on information collected from a database in Ontario, Canada.3 They showed that LVI was also an independent prognostic factor in community-based practices, and that high-volume hospitals tended to report LVI status more frequently compared with low-volume hospitals. Interestingly, LVI reporting by pathologists improved from 1994 to 2008. The reporting rate depended on pathological stage and lymph node status, and the authors suggested that education is one of the main reasons for this improvement. Further education regarding the usefulness of LVI reporting is necessary to improve the precision in predicting patient outcome. Furthermore, improved assessment of LVI might also help physicians to identify the patients who could benefit from adjuvant therapy after radical cystectomy.This study had several limitations. First, the study was retrospective in nature. Second, the pathology data were collected from several institutions over a long period of time. Therefore, procedures for handling cystectomy specimens were not uniform, even in the same institution. Third, the assessments of pathologists might use ancillary techniques, such as Elastic Van Gieson staining, CD31, CD34 and D2-40 immunostaining for equivocal cases, which other pathologists would not do. 4 However, there is no information on how many cases were diagnosed with LVI status using these ancillary techniques. Therefore, these differences might influence the present study data. Nevertheless, this article encourages pathologists to report LVI status in all cystectomy specimens.Finally, LVI is also one of the well-known important prognostic factors in transurethral resection of bladder tumor specimens.5 Therefore, a report of LVI status in transurethral resection of bladder tumor specimens is also strongly recommended.

Response to Editorial Comments to Reporting trends and prognostic significance of lymphovascular invasion in muscle‐invasive urothelial carcinoma: A population‐based study

“…We are grateful to Professors Tsuzuki and Gondo 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.…”

“…David M Berman M.D., Ph.D., 1,2 Atsunari Kawashima M.D., Ph.D., 1,2 Yingwei Peng Ph.D., 3 William J Mackillop M.D., 3,4,5 D Robert Siemens M.D. 6 and Christopher M Booth M.D.…”