Clinical Significance of Focal High-Grade Component in an otherwise Noninvasive Low-Grade Papillary Urothelial Carcinoma

Document Type

Conference Proceeding

Publication Date

3-19-2022

Publication Title

Mod Pathol

Abstract

Background: Introduction: The clinical significance of focal high-grade component in an otherwise noninvasive low grade papillary urothelial carcinoma (LGTCC) is not well understood. We looked at follow-up findings in patients diagnosed with focal noninvasive high-grade papillary urothelial carcinoma (fHG). Design: All consecutive cases with the diagnosis of fHG in a transurethral resection of a bladder tumor (TURBT) performed at our institution between 2010-2018 were included. All cases with a previous diagnosis of noninvasive high-grade papillary urothelial carcinoma (HGTCC) or invasive urothelial carcinoma (INTCC) were excluded. All slides were reviewed by two pathologists (OH and KS) including one urologic pathologist (OH). Selected cases were reviewed by a second urologic pathologist (NSG). We divided the cohort based on the percentage of high-grade component (HG) into (5% or less HG, 10% or less HG, 15% or less HG). Anything with more than 15% HG was considered as HGTCC. Follow-up data was collected from our medical records. Statistical analysis was performed using the Chi square test. Results: 56 patients were included. Median age was 70 (39-96). 44 patients were male and 12 were female. Follow-up period ranged between 2 and 84 months with a range between 1 and 7 follow-ups. 8 patients (14.3%) had no follow-up in our system and were excluded. Of the remaining 48 patient's follow-up showed INTCC in 2 (4.2%) patients, HGTCC in 23 (47.9%) patients, LGTCC in 8 (16.7%) patients, atypical cells in urine cytology in 5 (10.4%) patients and follow-up was negative in the remaining 10 (20.8%) patients. There was no statistically significant relationship between the percentage of HG and follow-up. (table 1) Conclusions: Previous studies have shown that the rate of progression of LGTCC into HGTCC or INTCC range between 4-10%. In our cohort of noninvasive papillary urothelial carcinoma with focal high-grade component, 52.1% of patients showed progression into INTCC or HGTCC. The percentage of HG was not related to progression rate. These findings suggest that noninvasive papillary urothelial carcinoma with focal high-grade component and noninvasive low-grade papillary urothelial carcinoma have different clinical course and noninvasive papillary urothelial carcinoma with focal high-grade component should be managed as noninvasive high-grade papillary urothelial carcinoma regardless of the percentage of HG.

PubMed ID

Not assigned.

Volume

35

Issue

SUPPL 2

First Page

660

Last Page

661

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