Papillary urothelial neoplasm of low malignant potential: reliability of diagnosis and outcome

Campbell, P. A., Conrad, R. J., Campbell, C. M., Nicol, D. L. and Mactaggart, P. (2004) Papillary urothelial neoplasm of low malignant potential: reliability of diagnosis and outcome. Bju International, 93 9: 1228-1231. doi:10.1111/j.1464-410X.2004.04848.x

Author Campbell, P. A.
Conrad, R. J.
Campbell, C. M.
Nicol, D. L.
Mactaggart, P.
Title Papillary urothelial neoplasm of low malignant potential: reliability of diagnosis and outcome
Journal name Bju International   Check publisher's open access policy
ISSN 1464-4096
Publication date 2004-06
Sub-type Article (original research)
DOI 10.1111/j.1464-410X.2004.04848.x
Volume 93
Issue 9
Start page 1228
End page 1231
Total pages 4
Place of publication Oxford, UK
Publisher Blackwell Publishing
Collection year 2004
Language eng
Subject C1
321012 Nephrology and Urology
730109 Surgical methods and procedures
1103 Clinical Sciences
Abstract OBJECTIVE To determine the ability of pathologists to reproducibly diagnose a newly defined lesion, i.e. the papillary urothelial neoplasm of low malignant potential (PUNLMP) using the published criteria, defined by the 1998 World Health Organisation/International Society of Urological Pathology (WHO/ISUP) classification system; in addition, debate remains about the clinical behaviour of these lesions, thus the rates of recurrence and progression of PUNLMP lesions were assessed and compared with low-grade papillary urothelial carcinomas (LG-PUC) and high-grade (HG-PUC) over a 10-year follow-up. PATIENTS AND METHODS Forty-nine cases of superficial bladder cancer (G1-3 pTa) representing an initial diagnosis of transitional cell carcinoma made in 1990 were identified and re-graded using the 1998 WHO/ISUP classification by two pathologists. Inter-observer agreement was assessed using Cohen weighted kappa statistics. After reclassification the clinical follow-up was reviewed retrospectively, and episodes of recurrence and progression recorded. RESULTS The inter-observer agreement was moderate, regardless of whether one (kappa 0.45) or two (kappa 0.60) pathologists were used to grade these lesions. Re-classification identified 12 PUNLMP, 28 LG-PUC and nine HG-PUC. PUNLMP lesions recurred in 25% (3/12) of cases; no progression was documented. Recurrence rates were 75% (21/28) and 67% (6/9) for LG- and HG-PUC, respectively, and progression rates were 4% (1/28) and 22% (2/9). CONCLUSION The 1998 WHO/ISUP classification of urothelial neoplasms can be reproducibly applied by pathologists, with a moderate level of agreement. There is evidence that PUNLMP lesions have a more indolent clinical behaviour than urothelial carcinomas. However, the risk of recurrence and progression remains, and clinical monitoring of these patients is important.
Keyword Urology & Nephrology
1998 Who/isup Classification
Papillary Urothelial Neoplasm Of Low Malignant Potential
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2005 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 25 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 15 Aug 2007, 03:33:37 EST