A Histopathologic and Morphologic Study for Bladder Preservation in the Management of Invasive Bladder Tumors

Lee, Sang Eun; Kim, Yong Tae

Abstract

This study was designed to define the subgroup of patients with invasive bladder tumor who could be candidates for bladder preservation. Medical records of 50 patients with muscle invasive transitional cell carcinoma of bladder who underwent radical cystectomy in our hospital from March l983 to December l992 were reviewed. Tumor size, number, configuration, number of recurrence and grade at the time of TUR-B were compared to pathologic stage and lymph node status from radical cystectomy specimens. Pathologic stage such as P0, Pis, Pa, P1, P2 ( Group I) were defined to be superficially invasive tumor group in which bladder could possibly be preserved with TUR-B and P3a,P3b, P4(Group II) were defined to be deeply invasive tumor group in which bladder could not be preserved with TUR-B. The frequency of P0 and Group I of 50 cystectomy specimens were 8% and 46%. Among various factors evaluated, tumor configuration and size (less than 4cm) were the most significant ones discriminating superficially invasive from deeply invasive group(p<0.05). If bladder preservation modality using TUR-B is applied with this criteria, sensitivity, specificity. positive and negative predictive value were 57%, 74%, 65% and 67% respectively. In conclusion, papillary, small-sized tumors (less than 4cm) are likely to be superficially invasive and thus bladder preserving modality could be applied in this subgroup.