Bladder Cancer: Specimen Handling and Reporting

Abstract

Meticulous examination of bladder cancer specimens and precise reporting of pathological findings provide pivotal information to clinicians for the management of patients with bladder cancers and risk assessment for tumor recurrence, progression, and response to treatment. This important diagnostic information can be obtained from bladder specimens and should be included in the pathology report. This chapter describes the key steps required for accurate diagnosis of bladder cancer. Before the diagnosis of bladder cancer, clinical features that need to be checked are described: patient’s history, previous pathological examination history, imaging, and cystoscopic findings. This chapter provides a detailed explanation on gross and microscopic examination of various bladder specimens such as cystoscopic biopsy, transurethral resections, and partial or radical surgery. In addition, diagnostic and prognostic information that should be stated on the pathology report were clarified: histologic tumor type, grade, stage, marginal status, lymphovascular invasion, carcinoma in situ, lymph node and distant organ metastases, etc. There has been active research on how to successfully predict clinical response of chemotherapy and immunotherapy in bladder cancer patients. FDA-approved or potential predictive tissue markers are provided in this chapter and include PD-L1 immunohistochemistry, mismatch repair deficiency, tumor mutation burden, gene expression signature, and genetic mutation.