Impact of pathologic re-review on grade, clinical stage, and risk stratification for patients with nonmuscle invasive bladder cancer

Abstract

Objectives: Pathologic re-review of transurethral resection of bladder tumor (TURBT) specimen is a common practice at our tertiary care center, but its impact on disease risk stratification remains unknown. We sought to determine how pathologic re-review of specimen initially read at an outside institution changed grade, clinical T (cT) stage, and AUA non-muscle-invasive bladder cancer (NMIBC) risk stratification.

Methods and materials: The laboratory information system was searched for patients who underwent TURBT from 2021 to 2022, yielding 561 records. 173 patients met inclusion criteria: 113 with <cT2 disease (12 benign, 10 Tis, 46 Ta, 45 T1) and 60 patients with cT2. All patients had pathologic re-review of their original outside hospital specimen initiated by a physician at our institution.

Results: For <cT2 disease, upgrading was observed in 12/113 (10%), downgrading in 8/113 (7%), and no change in grade in 93/113 (82%). Increased clinical stage was demonstrated in 6/113 (5%), decreased in 6/113 (5%) and no change in 101/113 (89%). For cT2 disease, grade did not change in any cases, none were upstaged and 3/60 (5%) were downstaged. For <cT2 disease, 15/112 (13%) experienced increased and 9/112 (8%) experienced decreased risk stratification. The most common reason for change in risk was grade. Addition of variant histology on re-review only led to change in risk stratification in 3/15 cases. Four cases were reclassified from high-grade urothelial carcinoma to benign on pathologic re-review.

Conclusions: Re-review of TURBT pathology by a dedicated GU pathologist led to change in AUA NMIBC risk stratification in over one-fifth of patients, with potential for changing management.

Keywords: Non-muscle-invasive bladder cancer; Pathologic grade; Risk stratification.