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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

 Ji Eun Kwon  ;  Nam Hoon Cho  ;  Yeong-Jin Choi  ;  So Dug Lim  ;  Yong Mee Cho  ;  Sun Young Jun  ;  Sanghui Park  ;  Young A. Kim  ;  Sung-Sun Kim  ;  Mi Sun Choe  ;  Jung-dong Lee  ;  Dae Yong Kang  ;  Jae Y. Ro  ;  Hyun-Jung Kim 
 DIAGNOSTIC PATHOLOGY, Vol.12(1) : 54, 2017 
Journal Title
Issue Date
Aged ; Biopsy ; Carcinoma, Transitional Cell/pathology* ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Mitosis ; Neoplasm Grading/methods* ; Prognosis ; Republic of Korea ; Urinary Bladder Neoplasms/pathology*
Clinical outcome ; Mitotic level ; Papillary urothelial carcinoma ; Predictor
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.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Cho, Nam Hoon(조남훈) ORCID logo https://orcid.org/0000-0002-0045-6441
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