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A practical guide to bladder cancer pathology

Nature Reviews Urology volume 15, pages 143–154 (2018)Cite this article

Subjects

Key Points

  • Providing details of a patient's clinical history to the pathologist is crucial to ensure correct assessment and reporting, especially if the patient received previous tumour-related treatments or has an ongoing inflammatory response

  • Providing urothelial tumour staging data to the treating clinician is essential, as patient prognosis and treatment selection are stage-dependent

  • Substaging of pT1 tumours has been introduced to the 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs blue book, and the International Collaboration on Cancer Reporting suggests several detailed models for recording the extent of invasion

  • According to the 2016 WHO classification, urothelial carcinoma can be categorized into low-grade and high-grade tumours; however, consensus guidance on how to report heterogeneous lesions is still lacking

  • No widely accepted standards exist for gross handling and examination of cystectomy and lymphadenectomy specimens, and only few protocols are available, leaving handling and sampling to the discretion of individual pathologists

  • Abundant data on the molecular characteristics of bladder cancer have been published, but how to integrate these findings to improve pathological assessment and patient management remains unclear; a consensus for a panel of markers is needed

Abstract

Pathological assessment of bladder cancer is becoming an increasingly complex task owing to the growing availability of molecular data for different histological subtypes and the appreciation of their importance in determining outcomes of neoadjuvant chemotherapy. Urologists are aware of the need to closely collaborate with pathologists, and comprehensive sharing of information is crucial to achieve optimal patient management. Numerous steps towards this goal have been made during the past years. Important advances in the assessment and reporting of grading and staging, especially substaging of pT1 urothelial carcinomas, have been made. As part of the International Collaboration on Cancer Reporting (ICCR), an international expert group has suggested worldwide reporting standards for urothelial lesions. Nevertheless, several issues remain unresolved, for example, regarding the reporting of heterogeneous lesions and substaging as well as the gross handling and the reporting for lymphadenectomy specimens. During the past few years, major insights have been gained into the molecular changes that occur during bladder cancer development, but a consensus on how to integrate these data into daily practice has not been achieved.

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Figure 1: Grade classification of urothelial carcinoma.
Figure 2: Staging of urothelial carcinoma.
Figure 3: Challenges in assessing tumour invasion and staging.
Figure 4: Tumour staging in cystectomy samples.
Figure 5: Schematic representation of intrinsic subtypes of bladder cancer.

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  1. Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, Paris, 75020

    Eva Compérat, Justine Varinot, Julien Moroch & Caroline Eymerit-Morin

  2. UPMC Paris VI, Sorbonne Universities, France

    Eva Compérat, Justine Varinot, Julien Moroch & Caroline Eymerit-Morin

  3. McGill University Health Center, Glen Site, Office E4-4188, 1001 Decarie Blvd, Montréal, H4A 3J1, Quebec, Canada

    Fadi Brimo

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E.C. researched data for the article. E.C. and F.B. made substantial contributions to discussion of the article content and wrote the manuscript. All authors reviewed and/or edited the manuscript before submission.

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Compérat, E., Varinot, J., Moroch, J. et al. A practical guide to bladder cancer pathology. Nat Rev Urol 15, 143–154 (2018). https://doi.org/10.1038/nrurol.2018.2

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