Papillary urothelial neoplasm of low malignant potential: reliability of diagnosis and outcome
| Autor: | R.J. Conrad, P.A. Campbell, P. Mactaggart, David Nicol, C.M. Campbell |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Nephrology
medicine.medical_specialty Pathology Urology Urinary system Recurrence Internal medicine Medical Staff Hospital medicine Carcinoma Humans Papillary urothelial neoplasm of low malignant potential Retrospective Studies Observer Variation Carcinoma Transitional Cell business.industry Reproducibility of Results Cancer Retrospective cohort study medicine.disease Carcinoma Papillary Transitional cell carcinoma Urinary Bladder Neoplasms Clinical Competence Radiology business Kappa Follow-Up Studies |
| Zdroj: | BJU International. 93:1228-1231 |
| ISSN: | 1464-410X 1464-4096 |
| DOI: | 10.1111/j.1464-410x.2004.04848.x |
| Popis: | OBJECTIVE To determine the ability of pathologists to reproducibly diagnose a newly defined lesion, i.e. the papillary urothelial neoplasm of low malignant potential (PUNLMP) using the published criteria, defined by the 1998 World Health Organisation/International Society of Urological Pathology (WHO/ISUP) classification system; in addition, debate remains about the clinical behaviour of these lesions, thus the rates of recurrence and progression of PUNLMP lesions were assessed and compared with low-grade papillary urothelial carcinomas (LG-PUC) and high-grade (HG-PUC) over a 10-year follow-up. PATIENTS AND METHODS Forty-nine cases of superficial bladder cancer (G1-3 pTa) representing an initial diagnosis of transitional cell carcinoma made in 1990 were identified and re-graded using the 1998 WHO/ISUP classification by two pathologists. Inter-observer agreement was assessed using Cohen weighted kappa statistics. After reclassification the clinical follow-up was reviewed retrospectively, and episodes of recurrence and progression recorded. RESULTS The inter-observer agreement was moderate, regardless of whether one (kappa 0.45) or two (kappa 0.60) pathologists were used to grade these lesions. Re-classification identified 12 PUNLMP, 28 LG-PUC and nine HG-PUC. PUNLMP lesions recurred in 25% (3/12) of cases; no progression was documented. Recurrence rates were 75% (21/28) and 67% (6/9) for LG- and HG-PUC, respectively, and progression rates were 4% (1/28) and 22% (2/9). CONCLUSION The 1998 WHO/ISUP classification of urothelial neoplasms can be reproducibly applied by pathologists, with a moderate level of agreement. There is evidence that PUNLMP lesions have a more indolent clinical behaviour than urothelial carcinomas. However, the risk of recurrence and progression remains, and clinical monitoring of these patients is important. |
| Databáze: | OpenAIRE |
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