GRADING IN SUPERFICIAL PAPILLARY BLADDER-CARCINOMA, WITH AN EMPHASIS ON NUCLEAR ORIENTATION

OBJECTIVE: To develop it computerized analysis method that could refle ct not only cellular anaplasia but also the orientation (PV) of neopla stic elements and could allo ru the separation of low (grade G 1 and G 2a) and high (G 2b) grades of superficial papillary bladder tumors (S PBTs). STUDY DESIGN: Cellular anaplasia is based on classic morphometr ic parameters, such as mean and standard deviation of area, perimeter, roundness and aspect ratio (length/width ratio) of 50 papillary bladd er tumors (16 G 1, 10 G 2a and 24 G 2b according to Pauwels),Orientati on of the major axis of each nucleus with respect to the true basal me mbrane was calculated using the SD of value distribution. RESULTS: No statistically significant differences were found between cases showing contiguous grades (G 1 versus G 2a or G 2a versus G 2b). PV, SD of th e area and SD of the perimeter were the parameters that could signific antly distinguish between G1 and G 2b and between G 1 plus G 2a and G 2b (P <.05). When comparing G 1 with G 2a plus G 2b, only PV and SD of the area were statistically significant. CONCLUSION: Quantification o f the irregularities in the orientation of nuclei with respect to the basal membrane may improve morphometric classification of low grade SP BTs.