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

Ji Eun Kwon, Namhoon Cho, Yeong Jin Choi, So Dug Lim, Yong Mee Cho, Sun Young Jun, Sanghui Park, Young A. Kim, Sung Sun Kim, Mi Sun Choe, Jung dong Lee, Dae Yong Kang, Jae Y. Ro, Hyun Jung Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
Article number54
JournalDiagnostic Pathology
Volume12
Issue number1
DOIs
Publication statusPublished - 2017 Jul 24

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Republic of Korea
Papillary Carcinoma
Mitosis
Urinary Bladder
Biopsy
Histology
Recurrence
Surgical Pathology
Clinical Pathology
Patient Selection
Software
Logistic Models
Regression Analysis
Neoplasms
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Histology

Cite this

Kwon, Ji Eun ; Cho, Namhoon ; Choi, Yeong Jin ; Lim, So Dug ; Cho, Yong Mee ; Jun, Sun Young ; Park, Sanghui ; Kim, Young A. ; Kim, Sung Sun ; Choe, Mi Sun ; Lee, Jung dong ; Kang, Dae Yong ; Ro, Jae Y. ; Kim, Hyun Jung. / 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. In: Diagnostic Pathology. 2017 ; Vol. 12, No. 1.
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title = "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",
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.",
author = "Kwon, {Ji Eun} and Namhoon Cho and Choi, {Yeong Jin} and Lim, {So Dug} and Cho, {Yong Mee} and Jun, {Sun Young} and Sanghui Park and Kim, {Young A.} and Kim, {Sung Sun} and Choe, {Mi Sun} and Lee, {Jung dong} and Kang, {Dae Yong} and Ro, {Jae Y.} and Kim, {Hyun Jung}",
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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. / Kwon, Ji Eun; Cho, Namhoon; Choi, Yeong Jin; Lim, So Dug; Cho, Yong Mee; Jun, Sun Young; Park, Sanghui; Kim, Young A.; Kim, Sung Sun; Choe, Mi Sun; Lee, Jung dong; Kang, Dae Yong; Ro, Jae Y.; Kim, Hyun Jung.

In: Diagnostic Pathology, Vol. 12, No. 1, 54, 24.07.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

T2 - A multi-center study in South Korea

AU - Kwon, Ji Eun

AU - Cho, Namhoon

AU - Choi, Yeong Jin

AU - Lim, So Dug

AU - Cho, Yong Mee

AU - Jun, Sun Young

AU - Park, Sanghui

AU - Kim, Young A.

AU - Kim, Sung Sun

AU - Choe, Mi Sun

AU - Lee, Jung dong

AU - Kang, Dae Yong

AU - Ro, Jae Y.

AU - Kim, Hyun Jung

PY - 2017/7/24

Y1 - 2017/7/24

N2 - 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.

AB - 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.

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U2 - 10.1186/s13000-017-0639-y

DO - 10.1186/s13000-017-0639-y

M3 - Article

VL - 12

JO - Diagnostic Pathology

JF - Diagnostic Pathology

SN - 1746-1596

IS - 1

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