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Grading and Staging of Bladder Carcinoma in Transurethral Resection Specimens
Correlation With 105 Matched Cystectomy Specimens

Liang Cheng MD, Roxann M. Neumann RN, Amy L. Weaver MS, John C. Cheville MD, Bradley C. Leibovich MD, Dharamdas M. Ramnani MD, Beth G. Scherer MS, Ajay Nehra MD, Horst Zincke MD, PhD, David G. Bostwick MD
DOI: http://dx.doi.org/10.1309/94B6-8VFB-MN9J-1NF5 275-279 First published online: 1 February 2000


We compared the grading and staging of transurethral resection of the bladder (TURB) and cystectomy specimens for 105 patients who underwent radical cystectomy for urothelial carcinoma between1980 and 1984. Of 105 patients, 96% underwent cystectomy within 100 days of TURB (median interval, 10 days). Grading was performed according to the 1998 World Health Organization/International Society of Urologic Pathology grading system and staging according to the 1997 TNM classification. Histologic grade was low-grade, 13; high-grade, 92 in TURB specimens; low-grade, 17; high-grade, 88 in cystectomy specimens. Pathologic stage was Ta, 15; T1, 55; and T2, 35 in TURB specimens; Ta, 5; T1, 19; T2, 19; T3, 46; and T4, 16 in cystectomy specimens. Histologic grade at TURB was associated with pathologic stage at cystectomy (P < .001). When all advanced-stage (muscle-invasive) carcinomas (pT2 or more) were considered together, 55 patients were understaged by TURB, 4 had higher stage in TURB than in cystectomy, and 46 were the same stage as by cystectomy. Forty-three of 55 patients with stage T1 carcinoma at TURB had advanced-stage carcinoma at cystectomy, including 34 who had extravesicular extension (pT3 or more). We found pathologic understaging by TURB occurs in a significant number of patients with bladder cancer; the newly proposed grading system predicted final pathologic stage.

Key Words:
  • Bladder
  • Carcinoma
  • Staging
  • Muscle invasion
  • Cystectomy
  • Grading
  • Transurethral resection