Urothelial carcinoma (UC) provides a unique challenge in the practice of genitourinary pathology. In contrast, for example, to renal cell carcinoma, where preoperative evaluation and staging are clinical and imaging based, or prostatic adenocarcinoma, where biopsy grading (but not usually staging) dictates therapeutic approach, in UC a hybrid approach is undertaken: pathologic findings based on endoscopic samples, in a context of physical examination, endoscopic, and imaging findings, guide clinical staging for treatment planning. For many invasive UCs, particularly those involving the muscularis propria of the urinary bladder, ureter, or pelvicalyceal system, these findings may be correlated with definitive pathologic staging at the time of primary resection. Herein, we review the current understanding of and diagnostic approach to UC invasion and staging, with awareness of the unique considerations for the upper and lower urinary tracts, and cover several recent developments salient to routine clinical practice.
From the *Department of Pathology, University of Michigan Health System, Ann Arbor, MI; and †Department of Pathology and ‡Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA.
Reprints: Steven Christopher Smith, MD, PhD, Department of Pathology, Virginia Commonwealth University Health System, PO Box 980662, 1200 E. Marshall St, Richmond, VA 23298. E-mail: firstname.lastname@example.org.
The authors have no funding or conflicts to declare.