Pathological assessment of morcellated tissue after ERBT: insights from a two-round Delphi survey

PURPOSE: To evaluate the pathological adequacy of morcellated ERBT specimens using a two-round Delphi methodology and to establish expert consensus among leading pathologists worldwide. METHODS: Core pathological parameters relevant for ERBT specimens were predefined, and representative high-quality digital slides of morcellated ERBT specimens were selected. These images were reviewed by an international panel of expert uropathologists with extensive experience in bladder cancer. A two-round Delphi survey was conducted, in which panelists rated the importance of predefined pathological parameters on a 5-point Likert scale. The items on which a consensus was not reached during the first round, were reviewed and rephrased for the second round involving the same responders. Consensus was defined as > 75% agreement among participants. RESULTS: 10 responders took part in the survey. During the initial Delphi round, agreement was achieved on six points, covering aspects such as tumor grading and staging (including lympho-vascular invasion, perineural invasion, detrusor muscle presence, grading adequacy, and histological classification). A broader statement also reached consensus, indicating that morcellation following ERBT provides specimen of appropriate quality. After revising the statements, the second round resulted in consensus on three more items: morcellated specimens allow for precise staging, evaluation of detrusor muscle invasion, and identification of carcinoma in situ. CONCLUSION: Tissue acquired after ERBT through morcellation permits dependable pathological evaluation, encompassing grading, staging, and identification of critical prognostic indicators such as carcinoma in situ, detrusor muscle, lymph vascular and perineural invasion. Morcellation is not perceived to compromise pathological evaluation based on expert consensus.