CIS Detection: Shared Responsibility in NMIBC Care

In this video, Ravi D. Chauhan, MD, FACS, and R. Jonathan Henderson, MD, explore how evolving practice patterns may have contributed to declining recognition of carcinoma in situ (CIS) in bladder cancer pathology reporting. The discussion focuses on the importance of multidisciplinary collaboration and the need for renewed attention to diagnostic techniques that historically played a larger role in NMIBC evaluation.

Chauhan reflects on how CIS was routinely emphasized during training but gradually became less prominent in routine reporting and management discussions over time. He notes that conversations with pathologists across community and academic settings frequently revealed a perception that CIS status no longer significantly affected treatment decisions. Chauhan highlights the value of professional collaboration through local meetings, scientific conferences, and peer discussions, emphasizing that shared experiences among urologists have helped bring greater awareness to the issue and encouraged more proactive engagement with pathology colleagues.

Henderson discusses how the issue of underreported CIS has emerged across a range of practice environments and describes varying levels of recognition among clinicians. He also addresses the role of surgical technique in accurate diagnosis, including the importance of bladder mapping and obtaining separate biopsy specimens to distinguish true CIS from adjacent “shoulder lesions” associated with papillary tumors. Both speakers emphasize that improving CIS detection requires shared accountability among urologists and pathologists, particularly as treatment selection increasingly depends on precise histopathologic characterization.

Editor’s Note: Ravi D. Chauhan, MD, FACS, reports relevant disclosures with Ferring Pharmaceuticals, UroGen Pharma, AstraZeneca Pharmaceuticals, and Merck. R. Jonathan Henderson, MD, reports relevant disclosures with Janssen, UroGen, AstraZeneca, and Pfizer.