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Level of mitoses in non-muscle invasive papillary urothelial carcinomas (pTa and pT1) at initial bladder biopsy is a simple and powerful predictor of clinical outcome: a multi-center study in South Korea

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Author(s)
Ji Eun KwonNam Hoon ChoYeong-Jin ChoiSo Dug LimYong Mee ChoSun Young JunSanghui ParkYoung A. KimSung-Sun KimMi Sun ChoeJung-dong LeeDae Yong KangJae Y. Ro13Hyun-Jung Kim
Keimyung Author(s)
Choe, Mi Sun
Department
Dept. of Pathology (병리학)
Journal Title
Diagnostic Pathology
Issued Date
2017
Volume
12
Issue
1
Keyword
Clinical outcomeMitotic levelPapillary urothelial carcinomaPredictor
Abstract
BACKGROUND:
Histologic grade is the most important predictor of the clinical outcome of non-muscle invasive (Ta, T1) papillary urothelial carcinoma (NMIPUCa), but its ambiguous criteria diminish its power to predict recurrence/progression for individual patients. We attempted to find an objective and reproducible histologic predictor of NMIPUCa that correlates well with the clinical outcome.

METHODS:
A total of 296 PUCas were collected from the Departments of Surgical Pathology of 11 institutions in South Korea. The clinical outcome was grouped into no event (NE), recurrence (R), and progression (P) categories. All 25 histological parameters were numerically redefined. The clinical pathology of each case was reviewed individually by 11 pathologists from 11 institutions based on the 2004 WHO criteria and afterwards blindly evaluated by two participants, based on our proposed parameters. Univariate and multivariate logistic regression analyses were performed using the R software package.

RESULTS:
The level of mitoses was the most reliable parameter for predicting the clinical outcome. We propose a four-tiered grading system based on mitotic count (> 10/10 high-power fields), nuclear pleomorphism (smallest-to-largest ratio of tumor nuclei >20), presence of divergent histology, and capillary proliferation (> 20 capillary lumina per papillary core).

CONCLUSIONS:
The level of mitoses at the initial bladder biopsy and transurethral resection (TUR) specimen appeared to be an independent predictor of the Ta PUCa outcome. Other parameters include the number of mitoses, nuclear pleomorphism, divergent histology, and capillary proliferation within the fibrovascular core. These findings may improve selection of patients for a therapeutic strategy as compared to previous grading systems.
Keimyung Author(s)(Kor)
최미선
Publisher
School of Medicine (의과대학)
Citation
Ji Eun Kwon et al. (2017). Level of mitoses in non-muscle invasive papillary urothelial carcinomas (pTa and pT1) at initial bladder biopsy is a simple and powerful predictor of clinical outcome: a multi-center study in South Korea. Diagnostic Pathology, 12(1), 54–54. doi: 10.1186/s13000-017-0639-y
Type
Article
ISSN
1746-1596
DOI
10.1186/s13000-017-0639-y
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41332
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Pathology (병리학)
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