Diagnosis of urothelial carcinoma in situ using blue light cystoscopy and the utility of immunohistochemistry in blue light-positive lesions diagnosed as atypical.
Aged
Aged, 80 and over
Biomarkers, Tumor
/ metabolism
Carcinoma in Situ
/ diagnosis
Carcinoma, Transitional Cell
/ diagnosis
Cystoscopy
/ methods
Fluorescence
Humans
Immunohistochemistry
Keratin-20
/ metabolism
Male
Middle Aged
Retrospective Studies
Urinary Bladder Neoplasms
/ diagnosis
Urothelium
/ metabolism
Blue light cystoscopy
Photosensitizing agents
Urothelial carcinoma in situ
Journal
Human pathology
ISSN: 1532-8392
Titre abrégé: Hum Pathol
Pays: United States
ID NLM: 9421547
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
17
02
2019
revised:
22
04
2019
accepted:
28
04
2019
pubmed:
10
5
2019
medline:
19
5
2020
entrez:
10
5
2019
Statut:
ppublish
Résumé
Carcinoma in situ (CIS) is difficult to visualize with white light cystoscopy (WLC), whereas blue light cystoscopy (BLC) using photosensitizing agents improves detection rates. We retrospectively reviewed transurethral biopsies of bladder tumors in which both WLC and BLC evaluations were performed (n = 135 samples from 79 patients). Biopsies were classified based on the presence/absence of fluorescence under BLC and the final pathological report (CIS/benign/atypical). Forty-one (30%) cases were diagnosed as CIS; of those, 38 (93%) were BLC(+), including 23 that were WLC(-). Conversely, 51 (38%) lesions were BLC(+) but classified as non-CIS. Eleven BLC(+) cases were diagnosed as "atypical." These cases were anonymized and reviewed by 7 pathologists for concordance and then immunostained for CK20, p53, and Ki-67. Immunohistochemistry results were interpreted as consistent with CIS if there was full-thickness staining of CK20, more than 50% p53-positive cells, and more than 50% Ki-67-positive cells. Review of BLC(+)/atypical cases showed a mean agreement of 79%, and none of the cases showed staining pattern consistent with CIS. Therefore, all 11 cases of BLC(+)/atypical were considered non-CIS for the final analysis. All patients with BLC(+)/atypical lesions had a history of intravesical Bacillus Calmette-Guerin and/or mitomycin. Using final pathology as the reference, sensitivity, specificity, and negative predictive value of BLC were 93% (confidence interval [CI], 80.1%-98.5%), 46% (CI, 35.4%-56.3%), and 94% (CI, 82.5%-97.8%), respectively. The low specificity of BLC leads to BLC(+) lesions with atypical diagnosis. Morphological classification of these lesions is fairly consistent among different pathologists. Immunohistochemistry for p53/CK20/Ki-67 in this setting is only helpful to potentially avoid overcalling CIS.
Identifiants
pubmed: 31071342
pii: S0046-8177(19)30083-8
doi: 10.1016/j.humpath.2019.04.018
pmc: PMC6696917
mid: NIHMS1044339
pii:
doi:
Substances chimiques
Biomarkers, Tumor
0
KRT20 protein, human
0
Keratin-20
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-7Subventions
Organisme : NCI NIH HHS
ID : T32 CA193145
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
Cancer. 1999 Jun 1;85(11):2469-74
pubmed: 10357420
Am J Surg Pathol. 2001 Aug;25(8):1074-8
pubmed: 11474293
Appl Immunohistochem Mol Morphol. 2002 Dec;10(4):327-31
pubmed: 12607601
Mod Pathol. 2003 Mar;16(3):187-91
pubmed: 12640096
BJU Int. 2004 Sep;94(4):492-6
pubmed: 15329099
J Urol. 2005 Sep;174(3):862-6; discussion 866
pubmed: 16093971
Appl Immunohistochem Mol Morphol. 2006 Sep;14(3):260-5
pubmed: 16932015
J Urol. 2007 Jul;178(1):62-7
pubmed: 17499283
J Urol. 2007 Jul;178(1):68-73; discussion 73
pubmed: 17499291
BJU Int. 2008 Nov;102(9 Pt B):1228-33
pubmed: 19035886
Eur Urol. 2010 Apr;57(4):655-60
pubmed: 19819064
BJU Int. 2010 Mar;105(6):789-94
pubmed: 19832725
J Urol. 2010 Nov;184(5):1907-13
pubmed: 20850152
Int J Technol Assess Health Care. 2011 Jan;27(1):3-10
pubmed: 21262078
BJU Int. 2011 Oct;108(8 Pt 2):E297-303
pubmed: 21414125
Surg Endosc. 2012 Dec;26(12):3634-41
pubmed: 22729704
Hum Pathol. 2013 May;44(5):860-6
pubmed: 23199526
Am J Surg Pathol. 2013 Dec;37(12):1815-23
pubmed: 24225842
Am J Surg Pathol. 2014 Aug;38(8):e20-34
pubmed: 25029121
Eur Urol. 2016 Jul;70(1):93-105
pubmed: 26935559
Cent European J Urol. 2016;69(2):150-6
pubmed: 27551551
J Urol. 2017 Mar;197(3 Pt 1):548-558
pubmed: 27780784
Photomed Laser Surg. 2017 Sep;35(9):459-464
pubmed: 28537820
Urol Oncol. 2018 Jan;36(1):8.e17-8.e24
pubmed: 28947304
Arch Pathol Lab Med. 2018 Jan;142(1):64-69
pubmed: 28967804
Urol Oncol. 2018 Aug;36(8):361.e1-361.e6
pubmed: 29859728
BJU Int. 2019 Jan;123(1):35-41
pubmed: 29979488