Pathology report on grades

[joey]

Hi Jack,

As many of are aware, pathologists in Canada report the grade of BC based upon either 1973 WHO (grade 1,2,3) or WHO 2004 (low grade and high grade).   See the attached comparison chart.

I do understand that there were so much research done using WHO 1973 grade system and that it is too expensive to replicate the same research using WHO 2004 grade system.   The pathology of my bc was based upon WHO 1973 and I am aware that some other bc patients I know got their pathology report based upon WHO 2004 grade system.   Because of the internet, bc patients can access to many videos, research papers.    Yet, it is confusing as some studies are based upon WHO 1973 grade system and others are based on WHO 2004 grade system.

Proposal :  Is it possible to request, recommend, encourage, enforce (I know this is not an appropriate way)  pathologists, urologists, oncologists to report grades based upon both WHO 1973 and WHO 2004 grade system.   i.e. WHO 1973 grade 2 / WHO 2004  low grade, or WHO 1973 grade 2 / WHO 2004 high grade.   

Or are there any issues to report in both grade system?

[Jack Moon]

Hi Joey

Back in 2009 I was told by both a highly regarded Pathologist (also a bladder cancer survivor) and a world renowned Urologist that reporting in both systems could create problems for the Urologists in determining a proper treatment plan for Grade 2.
Here is a document the Pathologist sent me regarding why the system was changed in 2004.
• The primary G1 urothelial tumours are
defined as carcinomas, despite, as a rule,
not behaving as malignant tumours, not
metastasising, having a great capacity for
recurrence but a low potential for progression
and death.
• There was a tendency to classify as G1 only
the very well differentiated tumours, and
as G3 the very poorly differentiated ones,
combining into the G2 category all the
other cases (in some reported series the G2
tumours represent up to 65% of cases).
Therefore, tumours with varying degrees of
differentiation were classified as G2, so that a
subdivision of such cases into G2A and G2B
was suggested [9].
• There was some disagreement between the
reports by peripheral and referee pathologists
in multicentre international trials, indicating
that the assignment of grade was influenced,
to some degree, by subjective rather than by
objective criteria.
For these reasons attempts were made to
obtain greater reproducible and accuracy
for the grading of urothelial neoplasms.
Today recommended treatments for non-muscle invasive is based solely on the 2004 changes for low grade and high grade.
Wish I could be of more help.
Jack

[Author]

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