Format

Send to

Choose Destination
Diagn Pathol. 2017 Jul 24;12(1):54. doi: 10.1186/s13000-017-0639-y.

Level of mitoses in non-muscle invasive papillary urothelial carcinomas (pTa and pT1) at initial bladder biopsy is a simple and powerful predictor of clinical outcome: a multi-center study in South Korea.

Author information

1
Department of Pathology, Ajou University school of Medicine, Suwon, South Korea.
2
Department of Pathology, Yonsei Medical College of Medicine, Seoul, South Korea.
3
Department of Pathology, Seoul St Mary's Hospital, The Catholic University, Seoul, South Korea.
4
Department of Pathology, Konkuk University Medical center, Konkuk University School of Medicine, Seoul, South Korea.
5
Department of Pathology, Asan Medical Center, Ulsan College of Medicine, Seoul, South Korea.
6
Department of Pathology, Inchun St. Mary's Hospital, The Catholic University, Incheon, South Korea.
7
Department of Pathology, College of Medicine, Ewha Womens University, Seoul, South Korea.
8
Department of Pathology, SMG-SNU Boramae Medical Center, Seoul, South Korea.
9
Departments of Pathology, Chonnam National University Medical school, Gwangju, South Korea.
10
Department of Pathology, Keimyung University School of Medicine, Daegu, South Korea.
11
Office of Biostatistics, Ajou University, School of Medicine, Suwon, South Korea.
12
Department of Pathology, Houston Methodist Hospital, Weill Medical College of Cornell University, New York, USA.
13
Department of Pathology, Inje University Sanggye Paik Hospital, 1342, Dongilro, Nowon-gu, Seoul, South Korea. hjkim@paik.ac.kr.

Abstract

BACKGROUND:

Histologic grade is the most important predictor of the clinical outcome of non-muscle invasive (Ta, T1) papillary urothelial carcinoma (NMIPUCa), but its ambiguous criteria diminish its power to predict recurrence/progression for individual patients. We attempted to find an objective and reproducible histologic predictor of NMIPUCa that correlates well with the clinical outcome.

METHODS:

A total of 296 PUCas were collected from the Departments of Surgical Pathology of 11 institutions in South Korea. The clinical outcome was grouped into no event (NE), recurrence (R), and progression (P) categories. All 25 histological parameters were numerically redefined. The clinical pathology of each case was reviewed individually by 11 pathologists from 11 institutions based on the 2004 WHO criteria and afterwards blindly evaluated by two participants, based on our proposed parameters. Univariate and multivariate logistic regression analyses were performed using the R software package.

RESULTS:

The level of mitoses was the most reliable parameter for predicting the clinical outcome. We propose a four-tiered grading system based on mitotic count (> 10/10 high-power fields), nuclear pleomorphism (smallest-to-largest ratio of tumor nuclei >20), presence of divergent histology, and capillary proliferation (> 20 capillary lumina per papillary core).

CONCLUSIONS:

The level of mitoses at the initial bladder biopsy and transurethral resection (TUR) specimen appeared to be an independent predictor of the Ta PUCa outcome. Other parameters include the number of mitoses, nuclear pleomorphism, divergent histology, and capillary proliferation within the fibrovascular core. These findings may improve selection of patients for a therapeutic strategy as compared to previous grading systems.

KEYWORDS:

Clinical outcome; Mitotic level; Papillary urothelial carcinoma; Predictor

PMID:
28738880
PMCID:
PMC5525253
DOI:
10.1186/s13000-017-0639-y
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center