Department of Surgery - Urology
Visual prediction of urothelial cell carcinoma grade and stage: A prospective clinical trial
Heather Morris1, Ross Mason1, Gregory G. Bailly1, David G. Bell1, Ashley R. Cox1, Jon Duplisea1, Ricardo A. Rendon1, Thomas A. Skinner1, Peter Massaro1.
1Urology, Dalhousie University, Halifax, NS, Canada
Introduction: Urothelial cell carcinoma (UC) is most commonly diagnosed via cystoscopy, followed by transurethral resection (TURBT). At the time of TURBT, intravesical instillation of chemotherapy is a recommended treatment for patients felt to have solitary low grade lesions. This requires the urologist to make assumptions about the pathology results before histological confirmation. Few studies have examined the accuracy of urologists’ predictions on bladder tumor histology based on its endoscopic appearance. We sought out to study the accuracy of urologists’ predictions of grade, stage, and presence of CIS at the time of initial TURBT.
Methods: We performed a prospective clinical trial of patents with newly diagnosed bladder tumour(s) felt to be UC, who underwent TURBT. Urologists were asked to predict tumor stage, grade and presence of CIS based on white light cystoscopy. They were not blinded to any preoperative evaluations. Predictions were compared to pathologist assessments.
Results: Early results include predictions on 21 patients with a new diagnosis of a bladder tumor felt to be UC. Final pathology confirmed 1 lesion as solely CIS, 10 lesions as Ta, 5 lesions as T1, 3 lesions as T2, and 2 as benign lesions . The positive predictive value (PPV) and negative predictive value (NPV) for low grade tumors were 28.6% and 75.0% respectively. For high grade, the PPV and NPV were 85.7% and 57.1% respectively. For concurrent CIS, the PPV was 33.3% and the NPV was 100%. Table 1 displays the full results.
Conclusions: Herein, we present early results from our study evaluating the accuracy of urologists in predicting the stage of newly diagnosed bladder tumors. Urologists are better at predicting high grade tumors than they are at low grade, as suggested by our predictive values. These findings have implications when selecting patients for immediate post-operative instillations and when triaging the urgency of post-operative follow-up.
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