Impact of Bladder Biopsy Second Review on Pathological Stage and Subsequent Patient Management
R Dhir, AV Parwani, DL Zynger. University of Pittsburgh Medical Center, Pittsburgh, PA
Background: The interpretation of bladder biopsy and transurethral resections are fundamental to determining patient management with overstaging having the possible consequence of unnecessary radical cystectomy. Identifying and classifying diagnostic errors in these specimens may help reduce future mistakes. Little data exists on the impact of re-evaluation of referred bladder material on clinical management. As such, we compared referred diagnoses to an academic center, to determine the rate of diagnostic discrepancies, identify problematic areas in interpretation, and assess the impact on patient management.
Design: A retrospective review was performed of the previous 83 consecutive bladder biopsies and transurethral resections referred to our sub-specialized academic institution for patient treatment. Diagnoses from referring institution were compared to the subsequent review and discrepancies in presence of tumor, depth of invasion, tumor grade, and type of tumor were quantified. For specimens with multiple parts, the most malignant diagnosis from each institution was compared as differences in diagnoses between parts would not affect patient care.
Results: Major diagnostic discrepancies were identified in 12% of cases (10/83). Surprisingly, 9 of the 10 differences affected tumor stage. Only one discrepancy in grade was identified and this case also had a concurrent difference in level of invasion. The remaining case was misdiagnosed as prostatic instead of urothelial carcinoma. Our review resulted in upstaging 3 patients (T0 to Tis, n=1; Ta to T1, n=2) and downstaging 6 patients (Ta to T0, n=1; T1 to Ta, n=2; T2 to T1, n=3). In total, misinterpretation of depth of invasion accounted for 70% of the discrepant diagnoses (n=7). Additional transurethral resections of the 3 tumors downstaged from T2 to T1 have shown muscularis propria invasion in 1 specimen. This patient received a cystectomy while the other 2 patients were able to avoid radical surgery.
Conclusions: A significant number of discrepant diagnoses were identified upon review of bladder biopsies and transurethral resections. Most discrepancies were due to misinterpretation of depth of invasion, with overcalls being more frequent than undercalls. Review of bladder specimens changed the clinical management in a substantial portion of our patient cohort.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 145, Tuesday Afternoon