Interobserver agreement and the role of smoothelin immunostain in the evaluation of Muscularis Propria (MP) invasion of Bladder Urothelial Carcinoma (BUC)

Ni Wayan Winarti; Ni Putu Sriwidyani; Luh Putu Iin Indrayani Maker; I Made Gotra; Ni Made Mahastuti; Tanaka; Silvia Kosashi; I Wayan Yudiana

doi:10.15562/bmj.v12i2.4541

Interobserver agreement and the role of smoothelin immunostain in the evaluation of Muscularis Propria (MP) invasion of Bladder Urothelial Carcinoma (BUC)

Ni Wayan Winarti ,

Ni Putu Sriwidyani ,

Luh Putu Iin Indrayani Maker ,

I Made Gotra ,

Ni Made Mahastuti ,

Tanaka ,

Silvia Kosashi ,

I Wayan Yudiana ,

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DOI: https://doi.org/10.15562/bmj.v12i2.4541 |
Published: 2023-07-10

Abstract

Link of Video Abstract: https://youtu.be/KymxBUAr9eI

Background: Bladder Urothelial Carcinoma (BUC) is common cancer in the genitourinary organs. One important determinant for its therapy modality is the presence of tumor invasion into Muscularis Propria (MP). Assessing MP invasion in routine Hematoxylin-Eosin (HE) slides of Transurethral Resection of Bladder (TUR-B) specimens is not always easy due to tissue fragmentation and morphological similarities of MP to muscularis mucosa (MM) and myofibroblasts. This study was done to determine the interobserver agreement in evaluating MP invasion and to find alternatives to overcome this diagnostic problem.

Methods: This cross-sectional observational analytic study was conducted in the Pathology Laboratory of the Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, in 2022. As many as 72 HE slides of TUR-B specimens of BUC patients were examined separately by five experienced pathologists. Smoothelin immunostaining, a marker to identify MP, was also examined as a comparison. Data were processed and statistically tested using the SPSS version 20.0 program for Windows.

Results: The interobserver agreement of those five pathologists was found to be low to moderate, with an average = 0.48, ranging between 0.18-0.69. One pathologist had a low agreement with four others (<0.4) and indicated diagnostic uncertainty in 41% of the samples examined. Among four other pathologists, the agreements were moderate, with = 0.40-0.69. The proportion of concordant examination results was only 45.8%. When the outcome of each HE slide was concluded by consensus, it was found that there was no statistically significant difference with smoothelin immunostaining results.

Conclusion: Evaluation of MP invasion of BUC in TUR-B specimens had low to moderate interobserver agreement, which indicated that this examination was subjective. However, the consensus of several pathologists seems to lead to better accuracy, close to the result of smoothelin immunostaining.

References

Moch H, Amin MB, Berney DM, Compérat EM, Gill AJ, Hartmann A, et al. The 2022 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2022;82(5):458-468.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249.
Winarti NW, Widayanti LA. Clinicopathological Profile of Patients with Bladder Lesions in Sanglah Hospital during the Period 2013-2017. Gaceta Medica de Caracas. 2022;130(Suppl 1):S73–S78.
DeGeorge KC, Holt HR, Hodges SC. Bladder Cancer: Diagnosis and Treatment. Am Fam Physician. 2017;96(8):507-514.
Poletajew S, Wilczek E, Wasiutyński A, Górnicka B. Antigenic profile of muscularis mucosae and muscularis propria of the urinary bladder. Iranian Journal of Immunology. 2015;12(1):50–63.
Elkady N, Abdou AG, Kandil M, Ghanem N. Diagnostic value of smoothelin and vimentin in differentiating muscularis propria from muscularis mucosa of bladder carcinoma. International Journal of Biological Markers. 2017;32(3):e305–e312.
Heabah NAG, Aref MF, Mokhtar MA, Shareef MM, El-Enain, AMA. Is Smoothelin Useful for Detection of Muscularis Propria Invasion in Urinary Bladder Carcinoma Cases? International Journal of Current Microbiology and Applied Sciences. 2019;8(7):350-358.
Kamoun A, de Reynie`s A, Allory Y, Sjo ̈dahl G, Robertson AG, Seiler R, et al. A Consensus Molecular Classification of Muscle-invasive Bladder Cancer. European Urology. 2020;77(4):420–433
Poletajew S, Fus L, Walędziak M, Pomada P, CiechańSka J, Wasiutyński A, et al. Comparison of Pathological Staging and Grading of Urothelial Bladder Carcinoma in Post-transurethral Resection and post-radical Cystectomy Specimens. Pol J Pathol. 2014;65(4):305-312.
Mazzucchelli R, Marzioni D, Tossetta G, Pepi L, Montironi R. Bladder Cancer Sample Handling and Reporting: Pathologist’s Point of View. Frontiers in Surgery. 2021;8:754741.
Mahde MM, Al Asadi AZ. Proper staging of bladder urothelial carcinoma using smoothelin and vimentinimmunohistochemical stains. Pakistan Journal of Medical and Health Sciences. 2021;15(1):412–416.
Mihai IM, Olteanu GE, Herman D, Anderco D, Iacob M, Nataras B, Cumpanas AA, et al. Analysis of Tumor Depth Invasion With Anti-Smoothelin Antibody in Equivocal Transurethral Resection of Urinary Bladder Tumor Surgical Specimens. International Journal of Surgical Pathology. 2021;29(1):54–63.
Kinra P, Malik A, Sivaramakrishna B, Dutta SV. Role of Immunohistochemistry in Differentiating Muscularis Mucosae from Muscularis Propria as An Aid to Accurate Staging of Invasive Urothelial Carcinoma : A Pilot Study. Advance Laboratory Medicine International. 2015;5(1):4–15.
Muhar AM, Siregar DR, Prabisma D. Relationship of gallbladder histopathology towards types of stones in cholelithiasis patients at Universitas Sumatera Utara Hospital, Medan, Indonesia. Bali Medical Journal. 2021;10(1):1-3.
Tafwid MI, Pratama ARH. Association between patient with muscle-invasive bladder cancer with the incidence of urinary tract infection in Karawang Regional Hospital: a single center study. Bali Medical Journal. 2022;11(3):1494-1497.
Santosa KB, Tirtayasa PMW, Oka AAG. Urological complications following obstetric-gynecologic procedures at Sanglah General Hospital, Bali-Indonesia. Bali Medical Journal. 2018;7(2):480-484.

[1] Moch H, Amin MB, Berney DM, Compérat EM, Gill AJ, Hartmann A, et al. The 2022 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. Eur Urol. 2022;82(5):458-468.

[2] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249.

[3] Winarti NW, Widayanti LA. Clinicopathological Profile of Patients with Bladder Lesions in Sanglah Hospital during the Period 2013-2017. Gaceta Medica de Caracas. 2022;130(Suppl 1):S73–S78.

[4] DeGeorge KC, Holt HR, Hodges SC. Bladder Cancer: Diagnosis and Treatment. Am Fam Physician. 2017;96(8):507-514.

[5] Poletajew S, Wilczek E, Wasiutyński A, Górnicka B. Antigenic profile of muscularis mucosae and muscularis propria of the urinary bladder. Iranian Journal of Immunology. 2015;12(1):50–63.

[6] Elkady N, Abdou AG, Kandil M, Ghanem N. Diagnostic value of smoothelin and vimentin in differentiating muscularis propria from muscularis mucosa of bladder carcinoma. International Journal of Biological Markers. 2017;32(3):e305–e312.

[7] Heabah NAG, Aref MF, Mokhtar MA, Shareef MM, El-Enain, AMA. Is Smoothelin Useful for Detection of Muscularis Propria Invasion in Urinary Bladder Carcinoma Cases? International Journal of Current Microbiology and Applied Sciences. 2019;8(7):350-358.

[8] Kamoun A, de Reynie`s A, Allory Y, Sjo ̈dahl G, Robertson AG, Seiler R, et al. A Consensus Molecular Classification of Muscle-invasive Bladder Cancer. European Urology. 2020;77(4):420–433

[9] Poletajew S, Fus L, Walędziak M, Pomada P, CiechańSka J, Wasiutyński A, et al. Comparison of Pathological Staging and Grading of Urothelial Bladder Carcinoma in Post-transurethral Resection and post-radical Cystectomy Specimens. Pol J Pathol. 2014;65(4):305-312.

[10] Mazzucchelli R, Marzioni D, Tossetta G, Pepi L, Montironi R. Bladder Cancer Sample Handling and Reporting: Pathologist’s Point of View. Frontiers in Surgery. 2021;8:754741.

[11] Mahde MM, Al Asadi AZ. Proper staging of bladder urothelial carcinoma using smoothelin and vimentinimmunohistochemical stains. Pakistan Journal of Medical and Health Sciences. 2021;15(1):412–416.

[12] Mihai IM, Olteanu GE, Herman D, Anderco D, Iacob M, Nataras B, Cumpanas AA, et al. Analysis of Tumor Depth Invasion With Anti-Smoothelin Antibody in Equivocal Transurethral Resection of Urinary Bladder Tumor Surgical Specimens. International Journal of Surgical Pathology. 2021;29(1):54–63.

[13] Kinra P, Malik A, Sivaramakrishna B, Dutta SV. Role of Immunohistochemistry in Differentiating Muscularis Mucosae from Muscularis Propria as An Aid to Accurate Staging of Invasive Urothelial Carcinoma : A Pilot Study. Advance Laboratory Medicine International. 2015;5(1):4–15.

[14] Muhar AM, Siregar DR, Prabisma D. Relationship of gallbladder histopathology towards types of stones in cholelithiasis patients at Universitas Sumatera Utara Hospital, Medan, Indonesia. Bali Medical Journal. 2021;10(1):1-3.

[15] Tafwid MI, Pratama ARH. Association between patient with muscle-invasive bladder cancer with the incidence of urinary tract infection in Karawang Regional Hospital: a single center study. Bali Medical Journal. 2022;11(3):1494-1497.

[16] Santosa KB, Tirtayasa PMW, Oka AAG. Urological complications following obstetric-gynecologic procedures at Sanglah General Hospital, Bali-Indonesia. Bali Medical Journal. 2018;7(2):480-484.

Interobserver agreement and the role of smoothelin immunostain in the evaluation of Muscularis Propria (MP) invasion of Bladder Urothelial Carcinoma (BUC)

Abstract

References

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