While surveillance biopsies play a critical role in management of patients with muscle invasive bladder cancer (MIBC) treated with trimodal therapy (TMT), their assessment is often confounded by pronounced post-treatment changes. The aim of this study was to characterize these morphologic alterations and their clinical implications. A single-center retrospective analysis of surveillance transurethral resection of bladder tumor (TURBT) samples was undertaken, assessing for post-treatment morphologic changes in non-neoplastic and neoplastic tissue, as well as the correlation between these changes and cancer recurrence and cancer-specific survival. The cohort consisted of 73 patients with 56 males (76.7%), median age of 72, stage cT2 in 84.9%. The median follow-up was 28 months (4-207 months) with 34 patients (46.6%) dead during follow-up. A wide spectrum of morphologic characteristics was documented in all post-TMT TURBTs with most common features including fibrosis (63.0%), inflammation (56.2%) and epithelial denudation (45.2%). Presence of fibrosis inversely correlated with cancer-specific death, X2 (1, n=68)=4.921, p=0.027. Among the 18 cases with residual MIBC, 12 cases (66.7%) showed morphologic changes in the neoplastic cells that deviated from usual morphology of urothelial carcinoma. Presence of these changes was enriched in patients with subsequent disease recurrence (n=18, Fisher's Exact Test p=0.05). Secondary pathology review identified two cases (2.7%) with diagnostic discrepancy, both due to omission of in-situ component. Post-treatment changes in post-TMT TURBTs must be recognized to avoid diagnostic misinterpretation and accurately guide patient management. Also, poor cellular preservation and severe cytologic changes in the residual carcinoma are not associated with a better prognosis.
Human pathology. 2022 Apr 28 [Epub ahead of print]
Gertruda Evaristo, Baharak Khadang, Ronald Kool, Gautier Marcq, Mina S Farag, Wassim Kassouf, Fadi Brimo
Department of Pathology, McGill University Health Centre, McGill University Health Centre. 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada., Experimental Surgery, Research Institute of the McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada; Department of Urology, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada., Department of Urology, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada., Department of Pathology, McGill University Health Centre, McGill University Health Centre. 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada. Electronic address: .