Has the 2004 WHO classification system facilitated changes in clinical management of papillary urothelial neoplasms?
In the past few decades, it has been and still is well understood by most practicing urologists and oncologists that noninvasive papillary urothelial tumors of all 1973 WHO grades require follow-up to detect recurrence or progression, despite the fact that grade 1 tumors are characteristically associated with an excellent prognosis. The length of clinical follow-up, the frequency of surveillance cystoscopy, and the adjunctive use of intravesical instillations of bacillus Calmette-Guérin (BCG) or a variety of chemotherapeutic agents are influenced by many factors, including histologic grade, tumor size, tumor multiplicity, depth of tumor invasion, recurrence history, and apparent grade migration with recurrence. Currently, both in North America and Europe, there is no uniformity in the clinical management of patients with noninvasive papillary urothelial tumors diagnosed according to the 2004 WHO grading system. Patients with PUNLMP and noninvasive low-grade carcinoma are typically trea
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