(UroToday.com) The 2025 South Central AUA annual meeting included a session on bladder cancer, featuring a presentation from Dr. R. Jonathan Henderson discussing underreporting of CIS in patients with high-grade papillary non muscle invasive bladder cancer. Patients with high-grade Ta/T1 non muscle invasive bladder cancer often have concomitant CIS. However, the rate is variable, and pathologists may not examine every bladder biopsy once a high-grade papillary lesion is identified.
Newer drugs for patients with BCG–unresponsive non muscle invasive bladder cancer, such as nadofaragene firadenovec, have a label indication for those with CIS ± papillary tumors. Therefore, failure to report CIS may impact access to therapy. This study assessed the incidence of CIS in a cohort of patients with high-grade Ta/T1 non muscle invasive bladder cancer in a private practice setting.
Pathology specimens from transurethral resections in 2024 from patients at Arkansas Urology with a diagnosis of high-grade papillary non muscle invasive bladder cancer without CIS were initially reviewed by 8 different pathologists, and re-reviewed by one pathologist, with review of all bladder biopsies and incidence of CIS reported. Because these samples were sent from a diverse set of practices, detailed clinical information was not available; information collected included age, sex, number of samples, original diagnosis stage, ICD-10 code, and the name of the reading pathologist.
There were 328 patient samples reviewed, but additional review identified 12 cases to have T2 disease (these cases were excluded), leaving 326 total cases for analysis (254 Ta and 62 T1). The mean age of all patients was 73 years (range: 47-93 years) and 81% were male:
The rate of CIS found on pathology re-review ranged from 15.9% to 66.7% among the 8 pathologists who conducted initial reviews. The difference in the rate of CIS positivity between pathologists was statistically significant (p < 0.05). Overall, there were 80 cases (25.3%) of CIS identified on re-review, which were numerically higher in T1 disease (19/62, 30.6%) than in Ta disease (61/254, 24.0%):
Dr. Henderson concluded his presentation discussing underreporting of CIS in patients with high-grade papillary non muscle invasive bladder cancer with the following take-home points:
- Based on this single-center study, approximately one-quarter of high-grade Ta/T1 specimens may have initially unreported CIS
- Good communication between the urologist and pathologist is essential to request a specific ruling out of CIS in all bladder fragments, as a diagnosis of CIS in addition to high-grade papillary disease may impact therapeutic options for the patient, according to FDA labels and NCCN guidelines
Presented by: R. Jonathan Henderson, MD, Arkansas Urology, Little Rock, AR
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 South Central American Urological Association (AUA) Annual Meeting, Orlando, FL, Wed, Sept 10 – Sat, Sept 13, 2025.