Abstract
Objectives: to investigate the accuracy of transurethral resection of bladder tumours (TURBT) in detecting histological variants (BHV) at radical cystectomy (RC) and to evaluate the impact of TURBT before cystectomy on oncological outcomes. Methods: Data of 410 consecutive RCs were assessed. Positive and negative predictive values were used to assess the accuracy of TURBT in detecting BHV. Cohen’s Kappa coefficient was used to calculate the agreement grade. Logistic regression analysis predicted features based on the presence of BHV at TURBT. Multivariable backward conditional Cox regression analysis was used to estimate oncological outcomes. Results: A total of 73 patients (17.8%) showed BHV at TURBT as compared to 108 (26.3%) at RC. A moderate agreement in histological diagnosis was found between TURBT and RC (0.58). However, sensitivity and specificity in detecting BHV were 56% and 96%, respectively. Furthermore, positive predictive value (PPV) was 84.7% and negative predictive value (NPV) was 84.6%. Presence of BHV at TURBT was an independent predictor for pathologic upstage, albeit not a predictor for positive nodes or positive surgical margins. However, at multivariable analysis adjusted for all confounders, presence of BHV at TURBT was an independent predictor for recurrence after RC, but not for survival. Conversely, the presence of BHV at RC was an independent predictor for both recurrence and survival. Conclusion: There was a moderate agreement between TURBT and RC histopathological findings. TURBT, alone, could not provide an accurate and definitive histological diagnosis. Detection of BHV in TURBT specimens is not an independent predictor of oncological outcomes; indeed, only pathological features at RC are associated with worse survival. However, BHV presence in cystectomy specimens resulted as an independent predictor of both cancer-specific and overall mortality.
Highlights
Urothelial carcinoma of the bladder (UCB) may exhibit a wide range of histological differentiation besides the conventional pure UCB [1]
We evaluated the reliability of transurethral resection of bladder tumour (TURBT) in detecting bladder urothelial histological variants (BHV) in a cohort of patients who underwent radical cystectomy (RC) from a single-tertiary referral centre and the impact of findings at TURBT on survival and recurrence of patients subsequently treated with RC
We found that the presence of BHV at TURBT was associated with pathologic upstage, albeit not being a predictor for positive surgical margins and, unlike the paper from Abufaraj et al, we could not demonstrate that the presence of BHV at TURBT could be a predictor of nodal metastasis, even if a higher detection rate of BHV was present in our series (17.8% compared to 11%) [21]
Summary
Urothelial carcinoma of the bladder (UCB) may exhibit a wide range of histological differentiation besides the conventional pure UCB [1]. As a result of these studies, BHV could be a possible discriminant for neoadjuvant treatment versus direct RC. In this perspective, an early detection of BHV must be pursued to optimize the management, the treatment option and follow-up of the disease. An early detection of BHV must be pursued to optimize the management, the treatment option and follow-up of the disease For this purpose, the World Health Organization 2016 classification for bladder tumours recommend an accurate morphological description of all specimens, both from TURBT and RC [7].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
