The role and impact of pathology review on stage and grade assessment of stages Ta and T1 bladder tumors: A combined analysis of 5 European organization for research and treatment of cancer trials

Purpose: Pathological interpretations are largely subject to interpathologi st and intrapathologist variation. Differences in tumor stage and grade exi st in local and review pathological findings in patients with stage Ta-T1 b ladder tumors who are entered in randomized trials of adjuvant treatment af ter transurethral resection. Because they are diagnosed and treated based o n local pathological results, it is important to determine the reliability of local pathological evaluations and the extent to which pathology review may change the treatment decision process. Materials and Methods: We assessed local and review pathology results in 1, 400 patients treated in 5 European Organization for Research and Treatment of Cancer randomized phase III trials comparing various adjuvant prophylact ic treatment strategies for primary or recurrent stage Ta-T1 transitional c ell bladder cancer. Results: We noted large variations in T category and grade. Pathology revie w down staged T category to stage Ta in 53% of eases originally classified as stage TI. There was agreement in only 57% and 50% of stage Ta grade 1 an d stage T1 grade 3 cases, of which 10% were reclassified as muscle invasive disease greater than stage T1. While T category and grade have prognostic importance, differences in the prognosis based on local and review patholog ical studies were slight. Conclusions: Pathology review is not mandatory in low and intermediate risk cases since it has little impact on the prognosis and treatment decision m aking. In high risk cases of stage T1 grade 3 disease stage or grade is oft en changed, so that review remains essential in this subgroup.