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International Society of Urological Pathology Expert Opinion on Grading of Urothelial Carcinoma

van der Kwast, Theo ; Liedberg, Fredrik LU ; Black, Peter C. ; Kamat, Ashish ; van Rhijn, Bas W.G. ; Algaba, Ferran ; Berman, David M. ; Hartmann, Arndt ; Lopez-Beltran, Antonio and Samaratunga, Hemamali , et al. (2021) In European Urology Focus
Abstract

Context: Grading is the mainstay for treatment decisions for patients with non–muscle-invasive bladder cancer (NMIBC). Objective: To determine the requirements for an optimal grading system for NMIBC via expert opinion. Evidence acquisition: A multidisciplinary working group established by the International Society of Urological Pathology reviewed available clinical, histopathological, and molecular evidence for an optimal grading system for bladder cancer. Evidence synthesis: Bladder cancer grading is a continuum and five different grading systems based on historical grounds could be envisaged. Splitting of the World Health Organization (WHO) 2004 low-grade class for NMIBC lacks diagnostic reproducibility and molecular-genetic support,... (More)

Context: Grading is the mainstay for treatment decisions for patients with non–muscle-invasive bladder cancer (NMIBC). Objective: To determine the requirements for an optimal grading system for NMIBC via expert opinion. Evidence acquisition: A multidisciplinary working group established by the International Society of Urological Pathology reviewed available clinical, histopathological, and molecular evidence for an optimal grading system for bladder cancer. Evidence synthesis: Bladder cancer grading is a continuum and five different grading systems based on historical grounds could be envisaged. Splitting of the World Health Organization (WHO) 2004 low-grade class for NMIBC lacks diagnostic reproducibility and molecular-genetic support, while showing little difference in progression rate. Subdividing the clinically heterogeneous WHO 2004 high-grade class for NMIBC into intermediate and high risk categories using the WHO 1973 grading is supported by both clinical and molecular-genetic findings. Grading criteria for the WHO 1973 scheme were detailed on the basis of literature findings and expert opinion. Conclusions: Splitting of the WHO 2004 high-grade category into WHO 1973 grade 2 and 3 subsets is recommended. Provision of more detailed histological criteria for the WHO 1973 grading might facilitate the general acceptance of a hybrid four-tiered grading system or—as a preferred option—a more reproducible three-tiered system distinguishing low-, intermediate (high)-, and high-grade NMIBC. Patient summary: Improvement of the current systems for grading bladder cancer may result in better informed treatment decisions for patients with bladder cancer. A three-tiered grading system for non–muscle invasive bladder cancer derived by splitting the heterogeneous World Health Organization (WHO) 2004 high-grade category into WHO 1973 grade 2 and 3 subsets is recommended, as this may result in more informed treatment decisions.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Bladder cancer, Expert opinion, Grading system, Non-muscle invasive bladder cancer, Pathology, WHO 1973, WHO 2004
in
European Urology Focus
publisher
Elsevier
external identifiers
  • pmid:33771477
  • scopus:85103107200
ISSN
2405-4569
DOI
10.1016/j.euf.2021.03.017
language
English
LU publication?
yes
id
b0be8c33-2889-486b-b87d-2d49844c4146
date added to LUP
2021-04-08 13:28:34
date last changed
2021-04-09 03:00:12
@article{b0be8c33-2889-486b-b87d-2d49844c4146,
  abstract     = {<p>Context: Grading is the mainstay for treatment decisions for patients with non–muscle-invasive bladder cancer (NMIBC). Objective: To determine the requirements for an optimal grading system for NMIBC via expert opinion. Evidence acquisition: A multidisciplinary working group established by the International Society of Urological Pathology reviewed available clinical, histopathological, and molecular evidence for an optimal grading system for bladder cancer. Evidence synthesis: Bladder cancer grading is a continuum and five different grading systems based on historical grounds could be envisaged. Splitting of the World Health Organization (WHO) 2004 low-grade class for NMIBC lacks diagnostic reproducibility and molecular-genetic support, while showing little difference in progression rate. Subdividing the clinically heterogeneous WHO 2004 high-grade class for NMIBC into intermediate and high risk categories using the WHO 1973 grading is supported by both clinical and molecular-genetic findings. Grading criteria for the WHO 1973 scheme were detailed on the basis of literature findings and expert opinion. Conclusions: Splitting of the WHO 2004 high-grade category into WHO 1973 grade 2 and 3 subsets is recommended. Provision of more detailed histological criteria for the WHO 1973 grading might facilitate the general acceptance of a hybrid four-tiered grading system or—as a preferred option—a more reproducible three-tiered system distinguishing low-, intermediate (high)-, and high-grade NMIBC. Patient summary: Improvement of the current systems for grading bladder cancer may result in better informed treatment decisions for patients with bladder cancer. A three-tiered grading system for non–muscle invasive bladder cancer derived by splitting the heterogeneous World Health Organization (WHO) 2004 high-grade category into WHO 1973 grade 2 and 3 subsets is recommended, as this may result in more informed treatment decisions.</p>},
  author       = {van der Kwast, Theo and Liedberg, Fredrik and Black, Peter C. and Kamat, Ashish and van Rhijn, Bas W.G. and Algaba, Ferran and Berman, David M. and Hartmann, Arndt and Lopez-Beltran, Antonio and Samaratunga, Hemamali and Varma, Murali and Cheng, Liang},
  issn         = {2405-4569},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {European Urology Focus},
  title        = {International Society of Urological Pathology Expert Opinion on Grading of Urothelial Carcinoma},
  url          = {http://dx.doi.org/10.1016/j.euf.2021.03.017},
  doi          = {10.1016/j.euf.2021.03.017},
  year         = {2021},
}