The Role of Pathology Review of Transurethral Bladder Tumor Resection Specimens in the Modern Era

PURPOSE: The value of pathological reinterpretation of tissue slides has long been questioned. At the Cleveland Clinic subspecialization in genitourinary pathology began in 2003 and has been maintained. We evaluate the role of second review on transurethral bladder tumor resection pathology slides before and after subspecialization and potential impact on treatment. MATERIALS AND METHODS: Transurethral bladder tumor resection specimens from 78 and 116 patients with bladder cancer in 2002 and 2004, respectively, were reviewed. Initial surgical pathology reports from institutions outside the Cleveland Clinic were compared with review report by a pathologist with genitourinary pathology specialization (HSL). Those cases with differences in diagnosis or staging were then evaluated by a urologist (JSJ) considering current standards of care. RESULTS: The reinterpretation differed substantially from the initial report in 26 of 78 cases (33.3%) in 2002 and in 31 of 116 (26.7%) in 2004 (p = 0.3), resulting in a possible impact on management in 28.2% (22 of 78) in 2002 and 23.3% (27 of 116) in 2004 (p = 0.54). In each year 4 cases diagnosed with bladder cancer elsewhere were determined to have no malignancy. The majority of discrepancies related to the presence of carcinoma in situ in 2002 and to the presence or absence of muscularis propria and/or muscle involvement by carcinoma in 2004. CONCLUSIONS: Second review of transurethral bladder tumor resection specimens shows differences of interpretation in 26.7% to 33.3% of cases, which is sufficient to alter management. There was no significant difference in the rate of discrepancies before and after genitourinary pathology subspecialization. Referral centers must assume responsibility for establishing the diagnosis before consultation and/or therapy.