Comparison of 1998 WHO/ISUP and 1973 WHO classifications for interobserver variability in grading of papillary urothelial neoplasms of the bladder: Pathological evaluation of 258 cases

Gonul I. I., Poyraz A., Unsal C., Acar C., Alkibay T.

Urologia Internationalis, vol.78, no.4, pp.338-344, 2007 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 78 Issue: 4
  • Publication Date: 2007
  • Doi Number: 10.1159/000100839
  • Journal Name: Urologia Internationalis
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.338-344
  • Keywords: Grading of urothelial tumors, Interobserver variability, Urothelial neoplasms
  • Gazi University Affiliated: Yes


Aim: Our aim was to compare the interobserver variability between the 1998 WHO/ISUP and 1973 WHO classifications. Methods: 258 consecutive papillary urothelial carcinomas were reviewed by two pathologists and assigned a tumor grade according to the 1973 WHO and 1998 WHO/ISUP without the knowledge of primary diagnosis and clinical follow-up. All cases were also histologically staged by the two pathologists separately as follows: pTa (noninvasive), pT1 (lamina propria invasion only), pT2 (muscularis propria invasion). Findings of both pathologists and degree of agreement were compared statistically by using Pearson's χ2 test and κ statistics respectively. A κ value of 0.21-0.40 is accepted as fair, 0.41-0.60 moderate and 0.61-0.80 substantial agreement. Results: Regardless of the pathologist, tumor grades of two classifications correlated to each other and the pathological stage (p < 0.05). Overall degree of agreement between pathologists was higher in the 1998 WHO/ISUP (κ 0.59) than the 1973 WHO (κ 0.41), but both were still moderate. Papillary urothelial neoplasia with low malignant potential was the group of 1998 WHO/ISUP that showed the lowest degree of agreement and if excluded, interobserver variability of the 1998 WHO/ISUP decreased significantly (κ 0.84). Conclusion: The diagnosis of papillary urothelial neoplasia with low malignant potential and the criteria that differentiates it from low-grade carcinomas needs improvement in order to compare the different studies and therapies and to provide more accurate information for management. Copyright © 2007 S. Karger AG.