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

Abstract

Emerging data on T1 bladder cancer subcategorization (aka substaging) suggests a correlation with oncological outcomes. The International Society of Urological Pathology (ISUP) organized the 2022 consensus conference in Basel, Switzerland to focus on current issues in bladder cancer and tasked working group 3 to make recommendations for T1 subcategorization in transurethral bladder resections. For this purpose, the ISUP developed and circulated a survey to their membership querying approaches to T1 bladder cancer subcategorization. In particular, clinical relevance, pathological reporting, and endorsement of T1 subcategorization in the daily practice of pathology were surveyed. Of the respondents of the premeeting survey, about 40% do not routinely report T1 subcategory. We reviewed literature on bladder T1 subcategorization, and screened selected articles for clinical performance and practicality of T1 subcategorization methods. Published literature offered evidence of the clinical rationale for T1 subcategorization and at the conference consensus (83% of conference attendants) was obtained to report routinely T1 subcategorization of transurethral resections. Semiquantitative T1 subcategorization was favored (37%) over histoanatomic methods (4%). This is in line with literature findings on practicality and prognostic impact, that is, a shift of publications from histoanatomic to semiquantitative methods or by reports incorporating both methodologies is apparent over the last decade. However, 59% of participants had no preference for either methodology. They would add a comment in the report briefly stating applied method, interpretation criteria (including cutoff), and potential limitations. When queried on the terminology of T1 subcategorization, 34% and 20% of participants were in favor of T1 (microinvasive) versus T1 (extensive) or T1 (focal) versus T1 (nonfocal), respectively.

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

“…Significant progresses have been made in bladder carcinoma pathology over the last decade. The ISUP Consensus Conference on Current Issues in Bladder Cancer 5–8 offers a comprehensive literature review with practical recommendations and guidance for future research in the field.…”

“…T1 bladder carcinomas show high variability in clinical behavior. Although reporting of T1 subcategorization is strongly encouraged by several guidelines, the premeeting ISUP survey revealed that it is not a common practice 7 . The methodologies for T1 subcategorization can be separated roughly on the basis of histoanatomic landmarks and semiquantitative assessment.…”

“…A consensus was reached at the conference that T1 subcategorization has clinical benefit and should be recommended. Most attendees have agreed, based on head-to-head comparative studies, that a semiquantitative methodology was preferred over histoanatomic substaging, both in terms of practicality and general applicability 7 …”

“…To address the above issues, the International Society of Urological Pathology (ISUP) organized the 2022 Consensus Conference on Current Issues in Bladder Cancer in Basel, Switzerland. Recommendations on these topics, based on a comprehensive literature review, while taking into account current practices, premeeting survey findings, and discussions at the conference are published in the current issue 5–8 …”