Pathological diagnosis dictates treatment options for patients with bladder cancer. Pathological diagnosis is the cellular specificity of a biopsy specimen including the cell type, growth rate, aggressiveness and other biological characteristics of the cancer. Thus, correct initial diagnosis is imperative in order to correctly determine optimal treatment regimens for patients. However, results from a recent study published in the journal Cancer indicate that pathologic diagnosis may be incorrect in a significant number of bladder cancer specimens and second pathology opinions may be warranted.
The bladder is a hollow organ in the lower abdomen that stores urine. Transitional cell carcinoma refers to bladder cancer involving the cells that line the inside of the bladder. Treatment of bladder cancer depends on the stage, or extent of disease, and may consist of the surgical removal of the bladder (radical cystectomy), surgical removal of the cancer tissue (transurethral resection) with preservation of the bladder, chemotherapy, radiation and/or biological therapy (treatment utilizing the immune system to fight cancer). A radical cystectomy is associated with high medical costs and a significant decrease in the quality of life for patients. Therefore, this surgical procedure is utilized only when considered necessary.
Previous clinical studies have indicated a significant rate of discrepancy between initial pathological diagnosing of bladder tissue specimens and follow-up evaluations of the same specimens 1,2,3 . In an effort to further evaluate these pathological discrepancies, pathologists from the University of Virginia re-analyzed specimens from 97 patients initially diagnosed with transitional cell bladder cancer at 30 community hospitals and 4 academic institutions between 1996 and 1999. Differences between initial diagnoses and follow-up analyses were noted. If the diagnostic discrepancy was such that treatment would have been different for the patient, an experienced genitourinary pathologist further analyzed the specimen.
Approximately 20% of specimens had a significant discrepancy between initial and follow-up pathology evaluation with regard to diagnosis, stage, cellular aggressiveness and cellular type. As a result of the pathology review, five radical cystectomies were avoided in this patient group. Two patients underwent an immediate radical cystectomy due to initial understaging.
With discrepancies reaching near 20%, a second opinion on pathological evaluation may be warranted for patients with bladder cancer. Pathologists specializing in the genitourinary field may provide the most appropriate reference for these cases. Patients diagnosed with bladder cancer may wish to speak with their physician about the possibility of getting a second opinion regarding the pathology of their biopsy specimen and/or the risks and benefits of participating in a clinical trial further evaluating diagnostic procedures. Sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov).
- Ooms et al. Human Pathology, Vol 14, pp 140-143, 1983
- Sharkey, et al. Journal of Urology, Vol 157, pp 68-70, 1997
- Oosterlinck, et al. Journal of Urology , Vol 149, pp 749-752, 1993