Transurethral resection of bladder tumors (PG039)

Pathomorphological examination after transurethral resection (TUR) — is a detailed study of fragments of the tumor and adjacent tissues of the bladder obtained using an endoscopic instrument through the urethra. Code PG039 provides for the analysis of the entire volume of the removed material, which is the main diagnostic method and at the same time the first stage of treatment of bladder neoplasms.

Research objective: The main task of the pathologist is to determine the exact type of tumor and the degree of its penetration into the wall of the organ. Since the result depends on whether the patient can save the bladder, the study focuses on finding muscle invasion (growth of the tumor into the muscle layer), which is a critical criterion for choosing further surgical tactics.

What does the pathologist evaluate:

• Histological type of neoplasm: confirmation of urothelial carcinoma or detection of rare forms (squamous cell carcinoma, adenocarcinoma).

• Malignancy grade (Grade): WHO classification (Low grade - low degree, High grade - high degree of aggressiveness).

• Depth of invasion (stage T): whether the tumor is limited to the mucosa ($Ta,T1$) or has it already begun to grow into the muscle wall ($T2$).

• Presence of muscle layer in the sample: confirmation that the surgeon took a deep enough biopsy to adequately assess the stage.

• Lymphovascular invasion: detection of tumor cells in small vessels, which increases the risk of metastasis.

Clinical significance: The conclusion according to the code PG039 is the foundation for the treatment strategy. For superficial tumors ($Ta,T1$) the patient is usually prescribed intravesical therapy. Detection of invasion into the muscular layer ($T2$) radically changes the approach and most often requires radical surgery (cystectomy).

When is it prescribed:

• after primary endoscopic removal of a bladder tumor;

• when performing a re-resection (Re-TUR) to clarify the stage of the disease;

• monitoring of the condition in case of tumor recurrence after previously performed treatment;

• diagnostics when detecting large or multiple neoplasms on the mucous membrane.