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Abstract：
BACKGROUND: The World Health Organization Classification (WHO) of Urinary and Male Genital Tumors has recently been updated to its 5th edition. The new edition presents a comprehensive approach to the classification of urinary and male genital tumors with an incorporation of morphologic, clinical, and genomic data.
OBJECTIVE: This review aims to update the new classification of bladder cancer in the 5th edition and to highlight important changes in nomenclatures, diagnostic criteria, and molecular characterization, as compared to the 4th edition.
METHODS: The pathologic classification of bladder cancer in the 5th edition of WHO Classification of Urinary and Male Genital Tumours was compared to that in the 4th edition. PubMed was searched using key words, including bladder cancer, WHO 1973, WHO 1998, WHO 2004, WHO 2016, histology, pathology, genomics, and molecular classification in the time frame from 1973 to August of 2022. Other relevant papers were also consulted, resulting in the selection of 81 papers as references.
RESULTS: The binary grading of papillary urothelial carcinoma (UC) is practical, but it may be oversimplified and contribute to \"grade migration\" in recent years. An arbitrary cutoff (5%) has been proposed for bladder cancers with mixed grades. The diagnosis of papillary urothelial neoplasm with low malignant potential has been dramatically reduced in recent years because of overlapping morphology and treatment with low-grade papillary UC. An inverted growth pattern should be distinguished from true (or destructive) stromal invasion in papillary UC. Several methods have been proposed for pT1 tumor substaging, but it is often challenging to substage pT1 tumors in small biopsy specimens. Bladder UC shows a high tendency for divergent differentiation, leading to several distinct histologic subtypes associated with an aggressive clinical behavior. Molecular classification based on the genomic analysis may be a useful tool in the stratification of patients for optimal treatment.
CONCLUSIONS: The 5th edition of WHO Classification of Urinary and Male Genital Tumours has made several significant changes in the classification of bladder cancer. It is important to be aware of these changes and to incorporate them into routine clinical practice.
OBJECTIVE: This review aims to update the new classification of bladder cancer in the 5th edition and to highlight important changes in nomenclatures, diagnostic criteria, and molecular characterization, as compared to the 4th edition.
METHODS: The pathologic classification of bladder cancer in the 5th edition of WHO Classification of Urinary and Male Genital Tumours was compared to that in the 4th edition. PubMed was searched using key words, including bladder cancer, WHO 1973, WHO 1998, WHO 2004, WHO 2016, histology, pathology, genomics, and molecular classification in the time frame from 1973 to August of 2022. Other relevant papers were also consulted, resulting in the selection of 81 papers as references.
RESULTS: The binary grading of papillary urothelial carcinoma (UC) is practical, but it may be oversimplified and contribute to \"grade migration\" in recent years. An arbitrary cutoff (5%) has been proposed for bladder cancers with mixed grades. The diagnosis of papillary urothelial neoplasm with low malignant potential has been dramatically reduced in recent years because of overlapping morphology and treatment with low-grade papillary UC. An inverted growth pattern should be distinguished from true (or destructive) stromal invasion in papillary UC. Several methods have been proposed for pT1 tumor substaging, but it is often challenging to substage pT1 tumors in small biopsy specimens. Bladder UC shows a high tendency for divergent differentiation, leading to several distinct histologic subtypes associated with an aggressive clinical behavior. Molecular classification based on the genomic analysis may be a useful tool in the stratification of patients for optimal treatment.
CONCLUSIONS: The 5th edition of WHO Classification of Urinary and Male Genital Tumours has made several significant changes in the classification of bladder cancer. It is important to be aware of these changes and to incorporate them into routine clinical practice.
摘要：
背景：世界卫生组织（WHO）对泌尿系和男性生殖器肿瘤的分类最近已更新为第5版。新版本提出了一种全面的方法来分类泌尿和男性生殖器肿瘤，并结合了形态学，临床,和基因组数据。
目的：这篇综述旨在更新第5版膀胱癌的新分类，并强调命名法的重要变化，诊断标准,和分子表征，与第四版相比。
方法：将第5版《WHO泌尿和男性生殖器肿瘤分类》中膀胱癌的病理分类与第4版进行了比较。PubMed是用关键词搜索的,包括膀胱癌,WHO1973,WHO1998,WHO2004,WHO2016,组织学,病理学,基因组学，以及1973年至2022年8月的分子分类。还查阅了其他相关文件，结果选择了81篇论文作为参考文献。
结果：乳头状尿路上皮癌（UC）的二元分级是实用的，但它可能过于简化，并有助于近年来的“等级迁移”。对于混合等级的膀胱癌，已提出了任意截止值（5％）。近年来，由于重叠的形态学和低度乳头状UC的治疗，具有低恶性潜能的乳头状尿路上皮肿瘤的诊断已大大减少。倒置的生长模式应与乳头状UC的真实（或破坏性）基质侵袭区分开。已经提出了几种方法用于pT1肿瘤子状态分析，但在小活检标本中对pT1肿瘤进行亚组治疗通常是具有挑战性的。膀胱UC显示出较高的分化倾向，导致与侵袭性临床行为相关的几种不同的组织学亚型。基于基因组分析的分子分类可能是对患者进行分层以进行最佳治疗的有用工具。
结论：第5版《WHO泌尿系和男性生殖器肿瘤分类》在膀胱癌的分类中做出了一些重大改变。重要的是要意识到这些变化并将其纳入常规临床实践。
目的：这篇综述旨在更新第5版膀胱癌的新分类，并强调命名法的重要变化，诊断标准,和分子表征，与第四版相比。
方法：将第5版《WHO泌尿和男性生殖器肿瘤分类》中膀胱癌的病理分类与第4版进行了比较。PubMed是用关键词搜索的,包括膀胱癌,WHO1973,WHO1998,WHO2004,WHO2016,组织学,病理学,基因组学，以及1973年至2022年8月的分子分类。还查阅了其他相关文件，结果选择了81篇论文作为参考文献。
结果：乳头状尿路上皮癌（UC）的二元分级是实用的，但它可能过于简化，并有助于近年来的“等级迁移”。对于混合等级的膀胱癌，已提出了任意截止值（5％）。近年来，由于重叠的形态学和低度乳头状UC的治疗，具有低恶性潜能的乳头状尿路上皮肿瘤的诊断已大大减少。倒置的生长模式应与乳头状UC的真实（或破坏性）基质侵袭区分开。已经提出了几种方法用于pT1肿瘤子状态分析，但在小活检标本中对pT1肿瘤进行亚组治疗通常是具有挑战性的。膀胱UC显示出较高的分化倾向，导致与侵袭性临床行为相关的几种不同的组织学亚型。基于基因组分析的分子分类可能是对患者进行分层以进行最佳治疗的有用工具。
结论：第5版《WHO泌尿系和男性生殖器肿瘤分类》在膀胱癌的分类中做出了一些重大改变。重要的是要意识到这些变化并将其纳入常规临床实践。
