Grading and staging of bladder carcinoma in transurethral resection specimens - Correlation with 105 matched cystectomy specimens

We compared the grading and staging of transurethral resection of the bladd er (TURB) and cystectomy specimens for 105 patients who underwent radical c ystectomy for urothelial carcinoma between 1980 and 1984. Of 105 patients, 96% underwent cystectomy within 100 days of TURB (median interval, 10 days) . Grading was performed according to the 1998 World Health Organization/lnt ernational Society of Urologic Pathology grading system and staging accordi ng to the 1997 TNM classification. Histologic grade was low-grade, 13; high -grade, 92 in TURB specimens; low-grade, 17; high-grade, 88 in cystectomy s pecimens. Pathologic stage was Ta, 15; T1, 55; and T2, 35 in TURB specimens ; Ta, 5; T1, 19; T2, 19; T3, 46; and T4, 16 in cystectomy specimens. Histol ogic grade at TURB was associated with pathologic stage at cystectomy (P < .001). When all advanced-stage (muscle-invasive) carcinomas (pT2 or more) w ere considered together; 55 patients were understaged by TURB, 4 had higher stage in TURB than in cystectomy, and 46 were the same stage as by cystect omy. Forty-three of 55 patients with stage TI carcinoma at TURB had advance d-stage carcinoma at cystectomy, including 34 who had extravesicular extens ion (pT3 or more). We found pathologic understaging by TURB occurs in a sig nificant number of patients with bladder cancer; the newly proposed grading system predicted final pathologic stage.