Prostatic Biopsy and Transurethral Resections for Primary Bladder Urothelial Carcinoma: Challenges and Ambiguities in Pathologic Reporting
Carmen M Perrino, Eric J Fichtenbaum, Kamal S Pohar, Debra L Zynger. Ohio State University Medical Center, Columbus, OH
Background: Primary bladder urothelial carcinoma (UC) may involve the prostate with differing prognosis and treatment depending on the extent. Given that accurate assessment of the prostate is necessary for optimal treatment, an effective system for describing prostatic involvement is clinically relevant. We aim to identify challenges in the reporting of prostatic biopsy/TUR samples obtained in the work-up of primary bladder UC.
Design: A retrospective review was performed between 2007 and 2010 to identify patients with a history of UC who underwent prostate biopsy/TUR. All reports and available slides were reviewed to confirm the diagnosis, presence of prostatic and/or bladder tissue, and pT classification.
Results: 129 patients with primary bladder UC underwent prostate biopsy/TUR, of which 50.4% (65/129) were given a neoplastic and 49.6% (64/129) a non-neoplastic diagnosis. On review, definitive prostate tissue was present in 84.6% (77/91) of cases. 9 urologists performed the prostate biopsy/TUR, and the rate of prostate tissue present was comparable among the 3 surgeons performing the highest number of procedures (75.0%-83.1%). On review of neoplastic specimens, prostate tissue was absent in 22.2% of cases, yet 87.5% of original reports did not note the absence. Diagnostic concordance of UC versus a non-neoplastic diagnosis was 97.8%, with discordant cases initially diagnosed as non-neoplastic but having in situ UC on review. 19.4% of tumors designated as invasive did not specify depth in the original reports. 13.9% of cases were assigned a discordant stage on review with the most frequent discrepancy being pT4a in the report vs pTis on review. Terminology typically used for bladder anatomy (muscularis propria and/or lamina propria) without explicit reference to the bladder or prostate was found in 23.1% of reports.
Conclusions: Prostate biopsy/TUR is a relatively common specimen obtained in the work-up of UC. Within prostate biopsies/TUR performed in patients with UC, our data suggests that reports lack clarity when identifying the organ of origin, invasion is occasionally overcalled, and depth of invasion is not always specified.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 9:15 AM
Proffered Papers: Section A, Tuesday Morning