Objectives. To review bladder specimens referred to our facility for secondary review to determine the frequency and degree of changes in pathological diagnoses, which could affect patient care. ...Methods. A retrospective review of 246 bladder specimens sent to our pathology department for second opinion pathological review was performed. All consultation specimens were reviewed by a single genitourinary (GU)-subspecialized surgical pathologist. Any changes in the pathological grade, stage, or histological tumor type were noted as well as patient demographic data. Statistical analysis was performed to determine the frequency and type of discrepancies in diagnoses and determine any associations with patient demographic parameters. Results. Secondary pathology consultation of 246 bladder specimens from 233 patients were reviewed and compared with the primary diagnosis. The diagnosis was altered in 91/246 cases (37.0%). The number of cases reviewed per patient and specimen type was not associated with a change in diagnosis (P = .19; P = .1). Of the cases with a change in diagnosis, 8 (8.8%) changed malignancy status, 46 (50.5%) changed stage, 16 (17.6%) changed tumor type (ie, change from urothelial carcinoma to prostate adenocarcinoma), 16 (17.6%) changed histological variant subtype, and 14 (15.4%) changed grade. There was no association noted between age, gender, or race and changes in diagnosis (P = .53; P = .41; P = .70). Conclusions. Secondary pathology review with a GU-subspecialized surgical pathologist can change the stage, grade, or histological subtype on bladder biopsy and tumor resection specimens in more than one-third of cases. Age and gender were not associated with the frequency of change in diagnosis on consultation review.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Abstract Optimized pretreatment staging of bladder urothelial carcinoma is essential in guiding appropriate treatment. This staging process relies heavily on tissue pathology from transurethral ...resection of bladder tumor as well as imaging for diagnosis of local, regional, nodal, or distant visceral spread. Accurate preoperative staging is critical for appropriate treatment decision making and patient counseling as these are based on the extent of disease involvement, largely classifying the cancer as having local, regional, or distant spread. Currently, the gold standard of transurethral resection of bladder tumor followed by computed tomography imaging with intravenous contrast provides excellent staging specificity in cases of more advanced bladder cancers with suspicion of spread; however, this often under stages patients that can lead to adverse oncologic outcomes in these patients undergoing radical cystectomy. Incorporation of novel imaging modalities including multiparametric magnetic resonance imaging and positron emission tomography imaging have shown promise in improving accuracy of staging for both local and distant disease in patients with bladder urothelial carcinoma.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Concerns about overtreatment of clinically indolent prostate cancer (PrCa) have led to recommendations that men who are diagnosed with low‐risk PrCa be managed by active surveillance (AS) rather than ...immediate definitive treatment. However the risk of underestimating the aggressiveness of a patient's PrCa can be a significant source of anxiety and a barrier to patient acceptance of AS. The uncertainty is particularly keen for African American (AA) men who are about 1.7 times more likely to be diagnosed with PrCa than European American (EA) men and about 2.4 times more likely to die of this disease. The AA population, as many other populations in the Americas, is genetically heterogeneous with varying degrees of admixture from West Africans (WAs), Europeans, and Native Americans (NAs). Recommendations for PrCa screening and management rarely consider potential differences in risk within the AA population. We compared WA genetic ancestry in AA men undergoing standard prostate biopsy who were diagnosed with no cancer, low‐grade PrCa (Gleason Sum 6), or higher grade PrCa (Gleason Sum 7‐10). We found that WA genetic ancestry was significantly higher in men who were diagnosed with PrCa on biopsy, compared to men who were cancer‐negative, and highest in men who were diagnosed with higher grade PrCa (Gleason Sum 7‐10). Incorporating WA ancestry into the guidelines for making decisions about when to obtain a biopsy and whether to choose AS may allow AA men to personalize their approach to PrCa screening and management.
African American men are at higher risk for prostate cancer but public health recommendations rarely consider potential differences in risk within the African American population. We found that in self‐identified African Americans, West African genetic ancestry was significantly higher in men who were diagnosed with PrCa on biopsy, compared to men who were cancer negative, and highest in men who were diagnosed with higher grade PrCa (Gleason Sum 7‐10). Incorporating West African ancestry into prostate cancer clinical guidelines may allow African American men to personalize their approach to screening and management.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To correlate the highest percentage core involvement (HPCI) and corresponding tumor length (CTL) on systematic 12-core biopsy (SBx) and targeted magnetic resonance imaging/transrectal ultrasonography ...(MRI/TRUS) fusion biopsy (TBx), with total MRI prostate cancer (PCa) tumor volume (TV).
Fifty patients meeting criteria for active surveillance (AS) based on outside SBx, who underwent 3.0T multiparametric prostate MRI (MP-MRI), followed by SBx and TBx during the same session at our institution were examined. PCa TVs were calculated using MP-MRI and then correlated using bivariate analysis with the HPCI and CTL for SBx and TBx.
For TBx, HPCI and CTL showed a positive correlation (R(2)=0.31, P<0.0001 and R(2)=0.37, P<0.0001, respectively) with total MRI PCa TV, whereas for SBx, these parameters showed a poor correlation (R(2)=0.00006, P=0.96 and R(2)=0.0004, P=0.89, respectively). For detection of patients with clinically significant MRI derived tumor burden greater than 500 mm(3), SBx was 25% sensitive, 90.9% specific (falsely elevated because of missed tumors and extremely low sensitivity), and 54% accurate in comparison with TBx, which was 53.6% sensitive, 86.4% specific, and 68% accurate.
HPCI and CTL on TBx positively correlates with total MRI PCa TV, whereas there was no correlation seen with SBx. TBx is superior to SBx for detecting tumor burden greater than 500 mm(3). When using biopsy positive MRI derived TVs, TBx better reflects overall disease burden, improving risk stratification among candidates for active surveillance.
Bladder cancer (BC) is the most common cancer of the urinary tract in the United States. Imaging plays a significant role in the management of patients with BC, including the locoregional staging and ...evaluation for distant metastatic disease, which cannot be assessed at the time of cystoscopy and biopsy/resection. We aim to review the current role of cross-sectional and molecular imaging modalities for the staging and restaging of BC and the potential advantages and limitations of each imaging modality. CT is the most widely available and frequently utilized imaging modality for BC and demonstrates good performance for the detection of nodal and visceral metastatic disease. MRI offers potential value for the locoregional staging and evaluation of muscular invasion of BC, which is critically important for prognostication and treatment decision-making. FDG-PET/MRI is a novel hybrid imaging modality combining the advantages of both MRI and FDG-PET/CT in a single-setting comprehensive staging examination and may represent the future of BC imaging evaluation.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
What's known on the subject? and What does the study add?
Laparoendoscopic single‐site (LESS) surgery has been used by urologists for a broad range of operations including LESS partial nephrectomy ...(LESS‐PN). To date, experiences of LESS‐PN have been presented as small series or as a subset of larger heterogeneous operative experiences, which have shown the overall feasibility and safety of this novel technique.
We report our experience with LESS‐PN with complete pathological resection and excellent short‐term oncological and renal functional outcomes in the select patient population who underwent this minimally invasive approach.
Objective
To present our experience of transumbilical laparoendoscopic single‐site (LESS) partial nephrectomy (PN) with pathological and short‐term oncological and renal functional outcomes.
Patients and Methods
In all, 15 LESS‐PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon.
All patients underwent transumbilical LESS using a 5‐mm flexible‐tip laparoscope and a combination of flexible and conventional laparoscopic instruments.
The technique for transperitoneal LESS‐PN otherwise replicated conventional laparoscopic PN.
Demographic, perioperative, and postoperative variables were recorded and analysed.
Results
Of the 14 patients (eight men), undergoing 15 distinct LESS‐PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2–4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins.
The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0–37) min; bull‐dog clamps were used for hilar‐control in nine cases with the remaining six cases done without hilar vascular clamping.
The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions.
The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg.
Follow‐up surveillance imaging showed no recurrence at a mean (sd, range) follow‐up of 18.3 (12.2; 6–36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow‐up of 17.1 (11.9; 1–36) months.
Conclusion
LESS‐PN is a feasible and effective operation, providing complete oncological resection along with excellent short‐term oncological and renal functional outcomes.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Prostate cancer can be difficult to appreciate grossly and therefore partial sampling of the gland can lead to incorrect grading, staging, or margin status. However, submitting the entire prostate is ...more time consuming and costly. We investigated the use of magnetic resonance imaging/ultrasound-targeted biopsy for the selective submission of prostatectomy specimens. We performed a retrospective review for patients with cancer on targeted prostate biopsy who underwent subsequent radical prostatectomy. Prostatectomy specimens were submitted in their entirety and assessed for Grade Group, extraprostatic extension (EPE), margins, and number of blocks. For Targeted-Grossing (TG) assessment, apex margin, bladder neck margin, seminal vesicles, and vas deferens sections were included. For the remainder of the prostate, only sections from areas shown to be positive for cancer on targeted biopsy were included in the analysis. With total tissue submission, EPE was found in 39/81 (48.1%) cases and positive margins in 19/81 (23.5%) cases. The TG method required significantly fewer blocks: 15.8 ± 5.9 versus 44.9 ± 11.9 (P < .0001). The TG method would have diagnosed the correct stage in 73/81 (90.1%) cases, Grade Group in 74/81 (91.4%) cases, and margin status in 79/81 (97.5%) cases. EPE was missed completely by the TG method in 7 cases (P = .008), of which 5/7 (71.4%) had focal EPE. There was no significant difference in stage (P = .24), Grade Group (P = .95), or margin status (P = .16) between the 2 methods. Grossing utilizing selective tissue submission from areas found to be positive for prostate cancer on magnetic resonance imaging/ultrasound-targeted prostate biopsy remains inferior to complete submission of tissue for radical prostatectomy specimens.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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