MP56-09 HIGH QUALITY RESECTION AT INITIAL TRANSURETHRAL RESECTION OF BLADDER TUMOR REDUCES THE LIKELIHOOD OF UPSTAGING AT RE-RESECTION: A CONTEMPORARY SERIES

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 2014MP56-09 HIGH QUALITY RESECTION AT INITIAL TRANSURETHRAL RESECTION OF BLADDER TUMOR REDUCES THE LIKELIHOOD OF UPSTAGING AT RE-RESECTION: A CONTEMPORARY SERIES Rasha Gendy, Manish Patel, Warick Delprado, Philip Brenner, Andrew Brooks, Graham Coombes, Paul Cozzi, and Peter Nash Rasha GendyRasha Gendy More articles by this author , Manish PatelManish Patel More articles by this author , Warick DelpradoWarick Delprado More articles by this author , Philip BrennerPhilip Brenner More articles by this author , Andrew BrooksAndrew Brooks More articles by this author , Graham CoombesGraham Coombes More articles by this author , Paul CozziPaul Cozzi More articles by this author , and Peter NashPeter Nash More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1577AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives An accurate assessment of tumour stage at initial resection of a bladder tumour can only be achieved with a complete resection containing muscularis propria in the specimen. Under-staging at the time of the initial transurethral resection is possible for patients with high-risk non-muscle-invasive bladder cancer and can delay the accurate diagnosis and definitive treatment. The rate of upstaging on the repeat transurethral resection from T1 to T2 disease ranges from 0-28%, but is even higher, up to 49%, when muscularis propria is absent from the specimen. We evaluated the quality of transurethral resection of bladder tumours (TURBT) and analysed the rates of upstaging on re-resection by the quality of resection, with the presence of muscularis propria in the resection specimen being the key quality indicator. Methods Between October 2008 and February 2013, 1209 TURBT specimens were retrieved by a single, major reporting pathology centre, Douglas Hanly Moir, servicing a group of high-volume Sydney urologists. We examined the quality of TURBT and rates of upstaging based on the presence or absence muscularis propria in the initial resection specimen. Results 1209 transurethral resection specimens retrieved during this period were analysed. There were 162 (13.4%) T1 specimens and 631 (52.2%) Ta specimens, 218 (34.5%) of which were high grade. Muscularis propria was present in 506 (41.9%) specimens in total and in only 151 (39.7%) of 380 high-risk specimens (high-grade Ta, T1). Of the 37 high-grade Ta specimens and 48 T1 specimens, 2 (5%) and 7 (15%) respectively were upstaged to muscle-invasive (T2) disease upon re-resection. If muscle was present in the specimen, 0/17 (0%) high-grade Ta and 1/22 (5%) T1 specimens were upstaged and if muscularis propria was absent 2/18 (11%) high-grade Ta and 6/24 (25%) T1 specimens were upstaged. Four specimen reports did not comment on the presence or absence of muscularis propria. Conclusions The very low rate of upstaging if muscularis propria is present in the specimen in this contemporary series reinforces the importance of achieving a good quality initial resection. Table 1. Quality of TURBT for high-risk non-muscle-invasive bladder cancer Muscularis propria Ta high grade (%) T1 (%) Total (%) Yes 79 (36.2) 72 (44.4) 151 (39.7) No 118 (54.1) 79 (48.8) 197 (51.8) N/A 21 (9.6) 11 (6.8) 32 (8.4) 218 (100) 162 (100) 380 (100) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e566-e567 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Rasha Gendy More articles by this author Manish Patel More articles by this author Warick Delprado More articles by this author Philip Brenner More articles by this author Andrew Brooks More articles by this author Graham Coombes More articles by this author Paul Cozzi More articles by this author Peter Nash More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...