Browsing by Author "Mungan, U"

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    Histologic grading of urothelial papillary neoplasms: impact of combined grading (two-numbered grading system) on reproducibility
    Tuna, B; Yörükoglu, K; Düzcan, E; Sen, S; Nese, N; Sarsik, B; Akder, A; Sayhan, S; Mungan, U; Kirkali, Z
    The clinical management of tumor patients is often strongly infuenced by the tumor grade. The presence of heterogeneity is well recognized in a variety of tumors. Overall grade is based on highest grade area identified within a tumor. Urothelial carcinoma often contains different histological grades within the same tumor. This study investigates the impact of a combined grading system on the reproducibility of papillary urothelial neoplasms. A set prepared for an earlier study consisting of ten cases of each category (papillary urothelial neoplasm of low malignant potential (PUNLMP), LGPUC, and HGPUC) was used. Agreement between pairs of pathologists was evaluated using kappa statistics for the combined scoring system. Interobserver agreement was fair to substantial as reflected by kappa values ranging from 0.24 to 0.74 (mean kappa = 0.43). The combined scores of 2 and 3 which included PUNLMP showed the lowest degree of agreement and when this category was excluded from the analysis, interobserver agreement increased significantly (mean kappa = 0.65; ranging from 0.43 to 0.92) in terms of combined scores of 4, 5, and 6. PUNLMP has been shown to be the least reproducible component of a combined scoring system even among experienced observers. Exclusion of PUNLMP from grading scheme seems to improve interobserver variability.
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    Reproducibility of the 1998 World Health Organization/International Society of Urologic Pathology classification of papillary urothelial neoplasms of the urinary bladder
    Yorukoglu, K; Tuna, B; Dikicioglu, E; Duzcan, E; Isisag, A; Sen, S; Mungan, U; Kirkali, Z
    Objectives. This study assessed the diagnostic agreement and intra- and inter-observer reproducibility of the World Health Organization/International Society of Urologic Pathology Consensus Classification of Urothelial Neoplasms (1998 WHO/ISUP classification) and the 1973 WHO classification. Methods. A teaching set with 5 slides of each papillary neoplasm of low malignant potential, low-grade papillary carcinoma, high-grade papillary carcinoma, and a guideline, as well as a study set of 30 slides containing ten cases of each category, were sent to participants. Six pathologists expert in urological pathology reviewed the 30 slides of non-invasive papillary urothelial tumors in the study set. Diagnostic accuracy and reproducibility were evaluated using intra- and inter-rater techniques (kappa statistic). Results. A moderate to substantial intra- and inter-observer reproducibility was achieved for both the 1998 WHO/ISUP and 1973 WHO classification. The results of the two classification systems were not different statistically (P>0.05). Reproducibility was lower in low-grade tumors for both classifications. Conclusions. The new proposed classification system for non-invasive urothelial neoplasms does not increase the reproducibility. There is still a need for uniformity in grading in order to compare the different studies and therapies and to provide more accurate information for management.
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    A SURVEY OF PATIENT PREPARATION AND TECHNIQUE OF ULTRASOUND-GUIDED PROSTATE BIOPSY: A MULTICENTER STUDY OF UROONCOLOGICAL ASSOCIATION
    Bozlu, M; Akduman, B; Mungan, U; Özen, H; Baltaci, S; Türkeri, L; Kirkali, Z; Akdas, A; Adsan, O; Akdogan, B; Altinel, M; Ataus, S; Ayan, S; Bilen, CY; Çal, Ç; Cal, C; Dündar, M; Iseri, C; Kosan, M; Lekili, M; Müezzinoglu, T; Özer, G; Ozgok, Y; Perk, H; Soyupak, B; Soyupek, S; Soylu, A; Sözen, S; Sengör, F; Tansug, Z; Tekin, A; Yildirim, A
    Introduction: Ultrasound-guided prostate biopsy is the standard method for the diagnosis of prostate cancer. The aim of the present survey is to assess the variability in patient preparation and technique of ultrasound-guided prostate biopsy among Turkish Urologists. Materials and Methods: In July 2004, a questionnaire was sent out to e-mail addresses of the members of Urooncological Association, asking about the details of prostate biopsy protocol of the members. The survey consisted of multiple choice questions about the patient preparation and prostate biopsy technique. Responses were acquired via e-mail and analyzed in detail. Results: Thirty two urologists from 24 centers responded. The biopsy procedure was performed by the urologist only in 54.16% of the centers, both urologist and radiologist in 37.5%, and radiologist only in 8.33%. Transrectal route was the most common method for ultrasound-guided prostate biopsy. A half of the responders performed biopsy when PSA was greater than 4 ng/ml. All of the centers administered antibiotic and a half of them used enema before the procedure. Approximately 37% of responders did not administer any type of analgesia, but 29.1% of all responders administered a periprostatic nerve block for reducing pain during the procedure. Most urologists obtained 10 or 12 biopsy cores and only 20.8% of them obtained routine transitional zone biopsy during the initial biopsy session. Conclusion: This survey demonstrated that patient preparation and technique of ultrasound-guided prostate biopsy is not standardized among Turkish Urologists, and a guideline on prostate biopsy is needed.