International Opinions on Grading of Urothelial Carcinoma: A Survey Among European Association of Urology and International Society of Urological Pathology Members

Beijert IJ, Cheng L, Liedberg F, Plass K, Williamson SR, Gontero P, Ribal MJ, Babjuk M, Black PC, Kamat AM, Algaba F, Berman DM, Hartmann A, Masson-Lecomte A, Rouprêt M, Lopez-Beltran A, Samaratunga H, Shariat SF, Mostafid AH, Varma M, Shen S, Burger M, Tsuzuki T, Palou J, Compérat EM, Sylvester RJ, van der Kwast TH, van Rhijn BW, Downes MR (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 52

Pages Range: 154-165

DOI: 10.1016/j.euros.2023.03.019

Abstract

Background: Grade of non–muscle-invasive bladder cancer (NMIBC) is an important prognostic factor for progression. Currently, two World Health Organization (WHO) classification systems (WHO1973, categories: grade 1–3, and WHO2004 categories: papillary urothelial neoplasm of low malignant potential [PUNLMP], low-grade [LG], high-grade [HG] carcinoma) are used. Objective: To ask the European Association of Urology (EAU) and International Society of Urological Pathology (ISUP) members regarding their current practice and preferences of grading systems. Design, setting, and participants: A web-based, anonymous questionnaire with ten questions on grading of NMIBC was created. The members of EAU and ISUP were invited to complete an online survey by the end of 2021. Thirteen experts had previously answered the same questions. Outcome measurements and statistical analysis: The submitted answers from 214 ISUP members, 191 EAU members, and 13 experts were analyzed. Results and limitations: Currently, 53% use only the WHO2004 system and 40% use both systems. According to most respondents, PUNLMP is a rare diagnosis with management similar to Ta-LG carcinoma. The majority (72%) would consider reverting back to WHO1973 if grading criteria were more detailed. Separate reporting of WHO1973-G3 within WHO2004-HG would influence clinical decisions for Ta and/or T1 tumors according the majority (55%). Most respondents preferred a two-tier (41%) or a three-tier (41%) grading system. The current WHO2004 grading system is supported by a minority (20%), whereas nearly half (48%) supported a hybrid three- or four-tier grading system composed of both WHO1973 and WHO2004. The survey results of the experts were comparable with ISUP and EAU respondents. Conclusions: Both the WHO1973 and the WHO2004 grading system are still widely used. Even though opinions on the future of bladder cancer grading were strongly divided, there was limited support for WHO1973 and WHO2004 in their current formats, while the hybrid (three-tier) grading system with LG, HG-G2, and HG-G3 as categories could be considered the most promising alternative. Patient summary: Grading of non–muscle-invasive bladder cancer (NMIBC) is a matter of ongoing debate and lacks international consensus. We surveyed urologists and pathologists of European Association of Urology and International Society of Urological Pathology on their preferences regarding NMIBC grading to generate a multidisciplinary dialogue. Both the “old” World Health Organization (WHO) 1973 and the “new” WHO2004 grading schemes are still used widely. However, continuation of both the WHO1973 and the WHO2004 system showed limited support, while a hybrid grading system composed of both the WHO1973 and the WHO2004 classification system may be considered a promising alternative.

Authors with CRIS profile

Involved external institutions

Antoni van Leeuwenhoek Netherlands (NL) Brown University United States (USA) (US) Lund University / Lunds universitet Sweden (SE) European Association of Urology Netherlands (NL) Cleveland Clinic United States (USA) (US) University of British Columbia Canada (CA) University of Texas Health Science Center at Houston (UTHealth) United States (USA) (US) Autonomous University of Barcelona (UAB) / Universitat Autònoma de Barcelona Spain (ES) Queen's University Canada (CA) University of Cordoba / Universidad de Córdoba (UCO) Spain (ES) University of Queensland Australia (AU) University Hospital of Wales (UHW) United Kingdom (GB) Houston Methodist United States (USA) (US) Universität Regensburg Germany (DE) Vienna General Hospital / Allgemeines Krankenhaus der Stadt Wien (AKH) Austria (AT) Sunnybrook Health Sciences Centre Canada (CA)

How to cite

APA:

Beijert, I.J., Cheng, L., Liedberg, F., Plass, K., Williamson, S.R., Gontero, P.,... Downes, M.R. (2023). International Opinions on Grading of Urothelial Carcinoma: A Survey Among European Association of Urology and International Society of Urological Pathology Members. European Urology Open Science, 52, 154-165. https://dx.doi.org/10.1016/j.euros.2023.03.019

MLA:

Beijert, Irene J., et al. "International Opinions on Grading of Urothelial Carcinoma: A Survey Among European Association of Urology and International Society of Urological Pathology Members." European Urology Open Science 52 (2023): 154-165.

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