1
|
Amin MB, Comperat E, Epstein JI, True LD, Hansel D, Paner GP, Al-Ahmadie H, Baydar D, Bivalacqua T, Brimo F, Cheng L, Cheville J, Dalbagni G, Falzarano S, Gordetsky J, Guo CC, Gupta S, Hes O, Iyer G, Kaushal S, Kunju L, Magi-Galluzzi C, Matoso A, Netto G, Osunkoya AO, Pan CC, Pivovarcikova K, Raspollini MR, Reis H, Rosenberg J, Roupret M, Shah RB, Shariat S, Trpkov K, Weyerer V, Zhou M, McKenney J, Reuter VE. The Genitourinary Pathology Society Update on Classification and Grading of Flat and Papillary Urothelial Neoplasia With New Reporting Recommendations and Approach to Lesions With Mixed and Early Patterns of Neoplasia. Adv Anat Pathol 2021; 28:179-195. [PMID: 34128483 DOI: 10.1097/pap.0000000000000308] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Genitourinary Pathology Society (GUPS) undertook a critical review of the recent advances in bladder neoplasia with a focus on issues relevant to the practicing surgical pathologist for the understanding and effective reporting of bladder cancer, emphasizing particularly on the newly accumulated evidence post-2016 World Health Organization (WHO) classification. The work is presented in 2 manuscripts. Here, in the first, we revisit the nomenclature and classification system used for grading flat and papillary urothelial lesions centering on clinical relevance, and on dilemmas related to application in routine reporting. As patients of noninvasive bladder cancer frequently undergo cystoscopy and biopsy in their typically prolonged clinical course and for surveillance of disease, we discuss morphologies presented in these scenarios which may not have readily applicable diagnostic terms in the WHO classification. The topic of inverted patterns in urothelial neoplasia, particularly when prominent or exclusive, and beyond inverted papilloma has not been addressed formally in the WHO classification. Herein we provide a through review and suggest guidelines for when and how to report such lesions. In promulgating these GUPS recommendations, we aim to provide clarity on the clinical application of these not so uncommon diagnostically challenging situations encountered in routine practice, while also importantly advocating consistent terminology which would inform future work.
Collapse
Affiliation(s)
- Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science, Memphis
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Eva Comperat
- Department of Pathology, Vienna General Hospital
- Medical University Department of Pathology, Hôpital Tenon, Sorbonne University
| | - Jonathan I Epstein
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lawrence D True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Donna Hansel
- Department of Pathology, Oregon Health Science University, OR
| | | | - Hikmat Al-Ahmadie
- Departments of Pathology
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dilek Baydar
- Department of Pathology, Koc University School of Medicine, Istanbul, Turkey
| | | | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | | | | | - Jennifer Gordetsky
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center
| | - Sounak Gupta
- Department of Pathology, Mayo Clinic, Rochester, MN
| | - Ondra Hes
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | | | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Lakshmi Kunju
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | | | - Andres Matoso
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - George Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Adeboye O Osunkoya
- Departments of Pathology and Laboratory Medicine
- Urology, Emory University School of Medicine, Atlanta, GA
| | - Chin Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kristina Pivovarcikova
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | - Maria R Raspollini
- Department of Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | - Henning Reis
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, Essen
| | | | - Morgan Roupret
- GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Rajal B Shah
- Departments of Pathology
- Urology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shahrokh Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Veronika Weyerer
- Department of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, MA
| | - Jesse McKenney
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | | |
Collapse
|
2
|
McKenney JK. Urothelial carcinoma in situ: diagnostic update. Pathology 2020; 53:86-95. [PMID: 33234229 DOI: 10.1016/j.pathol.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/21/2020] [Indexed: 01/15/2023]
Abstract
Based on the current WHO 2016 classification, the spectrum of flat urothelial lesions with atypia includes reactive urothelial atypia, urothelial atypia of unknown significance, urothelial dysplasia, and urothelial carcinoma in situ (CIS). Classification along this continuous spectrum of atypia can be one of the most challenging areas in all genitourinary pathology. This review will focus on the diagnosis of urothelial CIS in routine clinical practice, emphasising histological criteria, histological spectrum (i.e., 'variant' types), adjunctive immunohistochemistry, intraoperative evaluation, and distinction from its morphological mimics.
Collapse
Affiliation(s)
- Jesse K McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
3
|
Alshaikh S, Lapadat R, Atieh MK, Mehrotra S, Barkan GA, Wojcik EM, Pambuccian SE. The utilization and utility of immunostains in body fluid cytology. Cancer Cytopathol 2020; 128:384-391. [PMID: 32163239 DOI: 10.1002/cncy.22256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Body fluid cytology (BFC) is an important tool in the diagnosis and staging of malignancy and is aided by the judicious use of immunohistochemistry (IHC). The aim of this study was to determine the usage rates of IHC stains in BFC, their type and indications, and their diagnostic impact. We also attempted to estimate the optimal rate of IHC use in BFC by comparing the entire laboratory's and each individual cytopathologist's IHC use rates with their respective indeterminate and malignant diagnosis rates. METHODS We conducted a retrospective study of IHC stain use in BFC during a 5.5-year interval (2013-2018) and determined the laboratory's and each individual cytopathologist's IHC usage patterns according to the final diagnosis, site, and indications for their use. RESULTS A total of 477 out of 4144 (11.5%) BFC cases had 2128 individual immunostains performed, with an average of 4.5 immunostains per case. Individual cytopathologists used IHC stains on 6.7% to 22% of their BFC cases. Pathologists with higher rates of IHC stain use than the laboratory's mean were less experienced and had higher rates of indeterminate but not of malignant diagnoses. The most common indication for the use of IHC stains was differentiating mesothelial from malignant cells. MOC31, calretinin, Ber-EP4, CD68, and D2-40 were the most commonly used of the 67 different IHC stains used in BFC. CONCLUSIONS The laboratory's mean may represent the optimal IHC use rate, as higher IHC use rates did not lead to more diagnostic certainty or higher pickup rates of malignant cells.
Collapse
Affiliation(s)
| | - Razvan Lapadat
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Mohammed K Atieh
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| |
Collapse
|