Diagnostic algorithm for papillary urothelial tumors in the urinary bladder

• Published in: Virchows Archiv : an international journal of pathology 2008-04, Vol.452 (4), p.353-362
• Main Authors: Shim, Jung-Weon, Cho, Kang Su, Choi, Young-Deuk, Park, Yong-Wook, Lee, Dong-Wha, Han, Woon-Sup, Shim, Sang-In, Kim, Hyun-Jung, Cho, Nam Hoon
• Format: Article
• Language: English
• Subjects: Algorithms; Biological and medical sciences; Biomarkers, Tumor - metabolism; Carcinoma, Papillary - classification; Carcinoma, Papillary - diagnosis; Carcinoma, Papillary - pathology; Carcinoma, Transitional Cell - classification; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - pathology; Cytology; Disease Progression; Humans; Investigative techniques, diagnostic techniques (general aspects); Ion Channels; Keratin-20 - metabolism; Medical sciences; Medicine; Medicine & Public Health; Membrane Proteins - metabolism; Mitotic Index; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Original; Original Article; Pathology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Tumor Suppressor Protein p53 - metabolism; Urinary bladder; Urinary Bladder Neoplasms - classification; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - pathology; Urothelium - metabolism; Urothelium - pathology
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-008-0585-x

Papillary urothelial neoplasms with deceptively bland cytology cannot be easily classified. We aimed to design a new algorithm that could differentiate between these neoplasms based on a scoring system. We proposed a new scoring system that enables to reproducibly diagnose non-invasive papillary urothelial tumors. In this system, each lesion was given individual scores from 0 to 3 for mitosis and cellular thickness, from 0 to 2 for cellular atypia, and an additional score for papillary fusion. These scores were combined to form a summed score allowing the tumors to be ranked as follows: 0–1 = UP, 2–4 = low malignant potential (LMP), 5–7 = low-grade transitional cell carcinoma (TCC), and 8–9 = high-grade TCC. In addition to the scoring system, ancillary studies of MIB and p53 indexes with CK20 expression pattern analyses were compared together with clinical parameters. The MIB index was strongly correlated with disease progression. Four of the 22 LMP patients (18.2%) had late recurrences, two of these four (9.1%) had progression to low-grade carcinoma. The MIB index for LMP patients was strongly associated with recurrence (recurrence vs. non-recurrence, 16.5 vs. 8.1, p