1. Size: <0.5 cm vs >3 cm
2. Pedicle: thin stalk vs stout vs sessile
3. Fronds: solid vs coalescent vs thin
4. Cytology: negative vs high-grade
This is important as a good endoscopy carries a wealth of information regarding T-stage.
There are several important points for achieving an en bloc resection of a bladder tumor as noted by Dr. Malavaud:
- The plane of dissection
- The prograde dissection
- Intermittent bursts of plasma kinetic energy
- Sharp and blunt dissection
- Innovative handling of the loop – used to “lift” and “push” the tumor
Dr. Malavaud says that it is often difficult for pathologists to accurately assess bladder cancer T-stage. As noted in a classic paper from the 1990s, among 90 specimens assessed by 11 histopathologists, there was poor (kappa statistic 0.41) agreement of disease stage1. Indeed, a pathologist’s confidence in the specimen is related to the quality of the resection (ie. en bloc), the presence of detrusor muscle, lack of cautery artifact, and ease of analysis.
Dr. Malvaud concluded with the following take-home message slide advocating for en bloc resection of NMIBC tumors:
Presented by: Bernard Malavaud, MD, Ph.D., FEBU, professor of Urology, Toulouse Medical School
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Twitter: @zklaassen_md, at the 16th Meeting of the European Section of Oncological Urology, #ESOU19, January 18-20, 2019, Prague, Czech Republic
References:
1. Robertson AJ, Beck JS, Burnett RA, et al. Observer variability in histopathological reporting of transitional cell carcinoma and epithelial dysplasia in bladders. J Clin Pathol 1990 Jan;43(1):17-21.