Login to Access Video or Poster Abstract: MP10-10
Sources of Funding: None

Introduction

Assessment of urothelial carcinoma (UC) during cystoscopy or TURBT has a significant impact on the urologist's decision making: treatment with simple outpatient fulguration, the required depth of resection and the need of immediate post-surgical intravesical therapy all depend heavily on the urologist's ability to accurately assess pre-biopsy tumor stage and grade._x000D_ _x000D_

Methods

Photographs of 50 UC were taken at the beginning of TURBT and were presented to 7 senior urologists separately, all blind to the pathological report. Each urologist was asked to rate the tumor as low grade and noninvasive (Ta low grade), high grade and noninvasive (Ta high grade) or invasive (T1 or more). Results were compared with the final pathological findings.

Results

The single urologist correctly predicted the tumor stage and grade in 63.5% of cases (222 of 350, average of 32 out of 50 accurate assessments). Of the 128 incorrect assessments 54 underestimated the UC and 74 overestimated it. After achieving consensus in each case it turned out that the final majority assessment was correct in 40 of 50 cases (80%). Sensitivity and specificity of the final results for the diagnosis of T1 or higher were 80% and 88.6% respectively. Sensitivity and specificity for TaLG were 83.3% and 80% respectively. Inter-rater reliability was calculated and showed fair agreement (kappa=0.27).

Conclusions

To our knowledge this is the first documented evaluation of urologists' ability to assess UC stage and grade using endoscopic photographs. The single urologist can usually identify stage and grade of UC but accuracy increases when multiple senior urologists examine the photos and achieve consensus. When photos of UC exist, a team of senior urologists can make an excellent decision about the type and extent of surgical treatment and plan ahead post-surgical management of the patient.

Funding

None