International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 1

Abstract

Grade is a key prognostic factor in determining progression in nonmuscle invasive papillary urothelial carcinomas. The 2 most common grading methods in use worldwide are the World Health Organization (WHO) 2004 and 1973 schemes. The International Society of Urological Pathology (ISUP) organized the 2022 consensus conference in Basel, Switzerland on current issues in bladder cancer and tasked working group 1 to make recommendations for future iterations of bladder cancer grading. For this purpose, the ISUP developed in collaboration with the European Association of Urology a 10-question survey for their memberships to understand the current use of grading schemes by pathologists and urologists and to ascertain the areas of potential improvements. An additional survey was circulated to the ISUP membership for their opinion on interobserver variability in grading, reporting of urine cytology, and challenges encountered in grade assignment. Comprehensive literature reviews were performed on bladder cancer grading prognosis and interobserver variability along with The Paris System for urine cytology. There are notable differences in practice patterns between North American and European pathologists in terms of used grading scheme and diagnosis of papillary urothelial neoplasm of low malignant potential. Areas of common ground include difficulty in grade From the

Long‐term outcomes and cost savings of office fulguration of papillary Ta low‐grade bladder cancer

“…A cost-minimisation analysis was also performed. The costs of TURBT, cystodiathermy probes, ER visits and readmissions after TURBT amounted to $2306.76, $125, $304, and $842 dollars, respectively [22][23][24][25]. The rate of ER visitation after a TURBT (17%) was taken from a recent study at a Canadian academic institution and the rate of admission (2.7% for small tumours) from a National Surgical Quality Improvement Program study on TURBT complications [26,27].…”

“…Rates of ER visits [19], rehospitalisation, and associated costs were derived from the literature [20,21]. We used the WHO 1973 and WHO 2004/2016 classification systems for tumour grading [22]. NMIBC-prognostic-factor risk groups were used to determine optimal follow-up schedules [3].…”

Head‐to‐head: how many categories for grading urothelial carcinoma?

“…Data adapted from van Rhijn et al 20 the WHO 1973 grading. 22 In the case of urothelial subtype morphology, the proposed hybrid three-tier grading system would only be applicable for the conventional urothelial carcinoma component in addition to the reporting of the subtype (e.g. nested or plasmacytoid).…”

“…For T1 bladder cancer, several studies showed a minimal impact of WHO 2004 grading, as T1 LG bladder cancers are exceedingly rare, whereas the WHO 1973 grading system was a consistent prognostic parameter for stage progression 20,21 . The hybrid three‐tier grading system retains this advantage of the WHO 1973 grading 22 . In the case of urothelial subtype morphology, the proposed hybrid three‐tier grading system would only be applicable for the conventional urothelial carcinoma component in addition to the reporting of the subtype (e.g.…”

Editorial Comment on Does intensity‐modulated radiation therapy by helical tomotherapy for prostate cancer increase the subsequent risk of bladder cancer? A propensity score‐matched analysis

“…17 Wu VW, Kwong DL, Sham JS. Target dose conformity in 3 1 In the propensity score-matched cohort between IMRT and surgery, 5-year bladder cancer incidence was significantly higher (approximately 4 times greater risk) in the IMRT group (2.3%) compared to the RP group (0.6%) (p = 0.013). 1 Patients with prostate cancer treated with radiotherapy had a higher bladder and rectal cancer incidence than the general population.…”