1
|
Gupta R, Selinger CI, Ashford B, Chua MST, Clark JR, Damian DL, Jackett LA, James C, Johnson S, Ladwa R, Lambie D, McKenzie C, Tan ST, Scolyer RA. Implementing structured pathology reporting protocol for non-melanocytic skin cancers: practical considerations. Pathology 2023; 55:743-759. [PMID: 37573165 DOI: 10.1016/j.pathol.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
Non-melanocytic skin cancers (NMSCs) account for five times the incidence of all other cancers combined and cost US $6 billion annually. These are the most frequent specimens encountered in community pathology practice in many Western countries. Lack of standardised structured pathology reporting protocols (SPRPs) can result in omission of critical information or miscommunication leading to suboptimal patient management. The lack of standardised data has significant downstream public health implications, including insufficient data for reliable development of prognostic tools and health-economy planning. The Royal College of Pathologists of Australasia has developed an NMSC SPRP. A multidisciplinary expert committee including pathologists, surgeons, dermatologists, and radiation and medical oncologists from high volume cancer centres was convened. A systematic literature review was performed to identify evidence for including elements as mandatory standards or best practice guidelines. The SPRP and accompanying commentary of evidence, definitions and criteria was peer reviewed by external stakeholders. Finally, the protocol was revised following feedback and trialled in multiple centres prior to implementation. Some parameters utilised clinically for determining management and prognosis including tumour depth, lymphovascular invasion or distance to the margins lack high level evidence in NMSC. Dermatologists, surgeons, and radiation oncologists welcomed the SPRP. Pathologists indicated that the variety of NMSC specimens ranging from curettes to radical resections as well as significant differences in the biological behaviour of different tumours covered by the NMSC umbrella made use of a single protocol difficult. The feedback included that using a SPRP for low risk NMSC was neither clinically justified nor compensated adequately by the Australian Medicare Reimbursement Schedule. Following stakeholder feedback, the SPRP implementation was restricted to excision specimens of head and neck NMSC; and low-risk NMSC, such as superficial basal cell carcinoma, were excluded. Implementing NMSC SPRP fulfils an unmet clinical need. Unlike other cancers, NMSCs generate a range of specimen types and are reported in a wide range of pathology practices. Limiting use of SPRP to NMSC at higher risk of progression and providing formatted templates for easy incorporation into laboratory information systems were essential to successful deployment. In the future, further consideration should be given to implementing the SPRP to include all relevant specimens, including non-head and neck and low-risk NMSC specimens.
Collapse
Affiliation(s)
- Ruta Gupta
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
| | | | - Bruce Ashford
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Margaret S T Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Diona L Damian
- Discipline of Dermatology, Bosch Institute, University of Sydney, and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Jackett
- Department of Pathology, Austin Health, Melbourne, Vic, Australia
| | | | | | - Rahul Ladwa
- Department of Cancer Care Services, Princess Alexandra Hospital, Woolloongabba, Qld, Australia; Faculty of Medicine, University of Queensland, Herston, Qld, Australia
| | - Duncan Lambie
- Princess Alexandra Hospital, Pathology Queensland, Brisbane, Qld, Australia; Frazer Institute, University of Queensland, Brisbane, Qld, Australia
| | - Catriona McKenzie
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand; Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Richard A Scolyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
2
|
Aron M, Zhou M. Urothelial Carcinoma: Update on Staging and Reporting, and Pathologic Changes Following Neoadjuvant Chemotherapies. Surg Pathol Clin 2022; 15:661-679. [PMID: 36344182 DOI: 10.1016/j.path.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Staging and reporting of cancers of the urinary tract have undergone major changes in the past decade to meet the needs for improved patient management. Substantial progress has been made. There, however, remain issues that require further clarity, including the substaging of pT1 tumors, grading and reporting of tumors with grade heterogeneity, and following NAC. Multi-institutional collaborative studies with prospective data will further inform the accurate diagnosis, staging, and reporting of these tumors, and in conjunction with genomic data will ultimately contribute to precision and personalized patient management.
Collapse
Affiliation(s)
- Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California; Department of Urology, Keck School of Medicine, University of Southern California.
| | - Ming Zhou
- Department of Anatomic and Clinical Pathology, Tufts University School of Medicine and Tufts Medical Center, 800 Washington St., Box 802, Boston, MA 02111
| |
Collapse
|
3
|
Mazzucchelli R, Marzioni D, Tossetta G, Pepi L, Montironi R. Bladder Cancer Sample Handling and Reporting: Pathologist's Point of View. Front Surg 2021; 8:754741. [PMID: 34926567 PMCID: PMC8674620 DOI: 10.3389/fsurg.2021.754741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this narrative review is to provide adequate information on handling and reporting of the bladder cancer samples to improve the closely collaboration between pathologists and urologists. The main (but not exclusive) research tool used was PubMed and 87 references were selected and quoted in the text. We have considered handling of biopsies, transurethral resection (TUR), and cystectomy specimens to summarize the different methods of sampling and the related issues. Moreover, we considered and discussed the main prognostic factors, such as histological tumor type, grade, and stage of bladder cancer, that should be described in the pathological report. In addition, critical issues encountered in the interpretation of histological samples were discussed.
Collapse
Affiliation(s)
- Roberta Mazzucchelli
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Daniela Marzioni
- Departement of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Tossetta
- Departement of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Laura Pepi
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|
4
|
Carlsen B, Klingen TA, Andreassen BK, Haug ES. Tumor cell invasion in blood vessels assessed by immunohistochemistry is related to decreased survival in patients with bladder cancer treated with radical cystectomy. Diagn Pathol 2021; 16:109. [PMID: 34809660 PMCID: PMC8609845 DOI: 10.1186/s13000-021-01171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Lymphovascular invasion (VI) is an established prognostic marker for many cancers including bladder cancer. There is a paucity of data regarding whether the prognostic significance of lymphatic invasion (LVI) differs from blood vessel invasion (BVI). The aim was to examine LVI and BVI separately using immunohistochemistry (IHC), and investigate their associations with clinicopathological characteristics and prognosis. A secondary aim was to compare the use of IHC with assessing VI on standard HAS (hematoxylin-azophloxine-saffron) sections without IHC. Methods A retrospective, population –based series of 292 invasive bladder cancers treated with radical cystectomy (RC) with curative intent at Vestfold Hospital Trust, Norway were reviewed. Traditional histopathological markers and VI based on HAS sections were recorded. Dual staining using D2–40/CD31 antibodies was performed on one selected tumor block for each case. Results The frequency of LVI and BVI was 32 and 28%, respectively. BVI was associated with features such as higher pathological stages, positive regional lymph nodes, bladder neck involvement and metastatic disease whereas LVI showed weaker or no associations. Both BVI and LVI independently predicted regional lymph node metastases, LVI being the slightly stronger factor. BVI, not LVI predicted higher pathological stages. BVI showed reduced recurrence free (RFS) and disease specific (DSS) survival in uni-and multivariable analyses, whereas LVI did not. On HAS sections, VI was found in 31% of the cases. By IHC, 51% were positive, corresponding to a 64% increased sensitivity in detecting VI. VI assessed without IHC was significantly associated with RFS and DSS in univariable but not multivariable analysis. Conclusions Our findings indicate that BVI is strongly associated with more aggressive tumor features. BVI was an independent prognostic factor in contrast to LVI. Furthermore, IHC increases VI sensitivity compared to HAS. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-021-01171-7.
Collapse
Affiliation(s)
- Birgitte Carlsen
- Department of Pathology, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, N-3103, Tonsberg, Norway.
| | - Tor Audun Klingen
- Department of Pathology, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, N-3103, Tonsberg, Norway
| | | | - Erik Skaaheim Haug
- Department of Urology, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, N-3103, Tonsberg, Norway
| |
Collapse
|
5
|
Updated pathology reporting standards for bladder cancer: biopsies, transurethral resections and radical cystectomies. World J Urol 2021; 40:915-927. [PMID: 34554298 PMCID: PMC8994708 DOI: 10.1007/s00345-021-03831-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
Aim Optimal management of bladder cancer requires an accurate, standardised and timely pathological diagnosis, and close communication between surgeons and pathologists. Here, we provide an update on pathology reporting standards of transurethral resections of the bladder and cystectomies. Methods We reviewed recent literature, focusing on developments between 2013 and 2021. Results Published reporting standards developed by pathology organizations have improved diagnosis and treatment. Tumor sub-staging and subtyping has gained increased attention. Lymph nodes continue to be an area of debate, and their staging has seen minor modifications. Several tasks, particularly regarding specimen preparation (“grossing”), are not yet standardized and offer opportunity for improvement. Molecular classification is rapidly evolving, but currently has only limited impact on management. Conclusion Pathological reporting of bladder cancer is continuously evolving and remains challenging in some areas. This review provides an overview of recent major developments, with a particular focus on published reporting standards.
Collapse
|
6
|
Kim J, Randhawa H, Sands D, Lambe S, Puglia M, Serrano PE, Pinthus JH. Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations. Bladder Cancer 2021. [DOI: 10.3233/blc-211536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harbouring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into account to optimize outcomes in these patients. Unfortunately, the current literature specifically related to the treatment of cirrhotic bladder cancer patients remains sparse. We aim to review the literature on treatment considerations for this patient population with respect to perioperative, surgical, and adjuvant management.
Collapse
Affiliation(s)
- John Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David Sands
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Shahid Lambe
- Division of Urology, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, ON, Canada
| | - Marco Puglia
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | | | - Jehonathan H. Pinthus
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| |
Collapse
|
7
|
Komina S, Petrusevska G, Janevska V, Jovanovic R, Zdravkovski P, Saidi S, Zafirovska BI, Topuzovska S. Effect of bladder cancer variant histology on survival outcome in patients treated with radical cystectomy: A single-centre experience. Urol Ann 2021; 13:288-295. [PMID: 34421267 PMCID: PMC8343292 DOI: 10.4103/ua.ua_95_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/27/2020] [Indexed: 12/24/2022] Open
Abstract
Context Bladder cancer (BC) is the sixth most common malignant neoplasm in men. Recently, great effort has been devoted to the study of BC variant histology (VH). Yet, the results from these studies have shown conflicting data and remain unclear whether their presence alters recurrence and survival rates after radical cystectomy (RC). Aims We undertook this study aiming to test the effect on VH on recurrence-free survival (RFS) and overall survival (OS) in single-center RC patients. Settings and Design We have retrospectively analyzed medical records and pathology reports from 331 patients who underwent RC with or without pelvic lymphadenectomy at University Urology Clinic-Skopje, North Macedonia, in the period between 2010 and 2018. Subjects and Methods Microscopic analysis of the specimens involved the evaluation of histological tumor type, tumor grade, pathological tumor node metastasis stage, presence of lymphovascular invasion, and resection margin status. Statistical Analysis Used Univariable and multivariable Cox regression models were applied to test the effect of VH on RFS and OS. Results We found 185 patients who matched our inclusion criteria. At multivariable analyses, lymphovascular invasion and positive resection margins were associated with shorter RFS. Similarly, patients diagnosed with lymphovascular invasion, positive resection margins, and a pelvic lymph node metastasis had poorer OS. VH was not found to be an independent predictor of both RFS and OS (P > 0.05). Conclusions The present study did not reveal prognostic effect of VH on RFS and OS. In our series, histomorphologic parameters including lymphovascular invasion, resection margins, and pelvic lymph node metastasis were the most relevant predictors on survival outcome after RC.
Collapse
Affiliation(s)
- Selim Komina
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Gordana Petrusevska
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Vesna Janevska
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Rubens Jovanovic
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Pance Zdravkovski
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Skender Saidi
- Faculty of Medicine, University Clinic of Urology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Beti Ivanovska Zafirovska
- Institute of Epidemiology and Biostatistics with Medical Informatics, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Sonja Topuzovska
- Faculty of Medicine, Institute of Medical and Experimental Biochemistry, Ss. Cyril and Methodius University, Skopje, North Macedonia
| |
Collapse
|
8
|
Oszwald A, Wasinger G, Larnaudie L, Varinot J, Sebe P, Cussenot O, Compérat E. Pathological reporting of cystectomy lymph nodes: a retrospective analysis of experience in Paris. World J Urol 2021; 39:4029-4035. [PMID: 33743060 PMCID: PMC8571145 DOI: 10.1007/s00345-021-03630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Pathological evaluation of pelvic lymph node (LN) dissection (PLND) is important for management of cystectomy patients. However, challenges such as unclear interobserver variability of LN counting remain. Here, we assess interobserver variability of LN measures and their clinical utility, with a focus on variant histology. Methods We retrieved radical cystectomy cases with PLND between 2010 and 2016 and reevaluated pathological parameters; number of total and metastatic LN, LN density (LND), length of metastatic LN and metastases, extranodal extension (ENE). Results We report 96 patients: median age of 71a, 34 cases pN+, 36 cases with any extent of variant histology, median follow-up 10 months. Perivesical LN were only rarely identified, but frequently metastatic (4/9). Variant histology (34 cases) frequently exhibited LN metastasis (53% of pN+ cases). Interobserver variance was poor for total LN (kappa = 0.167), excellent for positive LN (0.85) and pN staging (0.96), and mediocre for LND (0.53). ROC analysis suggests that both LND and the sum of LN metastasis length may predict outcome (AUC 0.83 and 0.75, respectively). Conclusion Our study confirms the notion of LND as a prognostic measure, but cautions due to strong interobserver variance of LN counts. The sum length of LN metastases could be a measure that is independent of LN counts. We find that microscopically identified perivesical LN merit particular attention. In summary, our study highlights current challenges in pathological reporting of PLND, confirms previous observations and forms a basis for further studies.
Collapse
Affiliation(s)
- André Oszwald
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Wasinger
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Laura Larnaudie
- Department of Pathology, GRC n°5 Predictive Onco-Urology, AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Justine Varinot
- Department of Pathology, GRC n°5 Predictive Onco-Urology, AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Philippe Sebe
- Department of Urology, La Croix Saint-Simon, Paris, France
| | - Olivier Cussenot
- CeRePP, 75020, Paris, France.,Department of Urology, GRC n°5 Predictive Onco-Urology, AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria. .,Department of Pathology, GRC n°5 Predictive Onco-Urology, AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France. .,CeRePP, 75020, Paris, France.
| |
Collapse
|
9
|
Paner GP, Montironi R. Re: J. Alfred Witjes, Harman Max Bruins, Richard Cathomas, et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines. Eur Urol 2021;79:82-104: Importance of Standardized Pathology Reporting for Urological Cancers in the Implementation of Urology Guidelines. Eur Urol 2020; 79:e30-e32. [PMID: 32873442 DOI: 10.1016/j.eururo.2020.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Gladell P Paner
- Departments of Pathology and Surgery, Section of Urology, University of Chicago, Chicago, IL, USA.
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, Ancona, Italy
| |
Collapse
|