Why CIS Reporting Matters in Bladder Cancer Care

Advances in the treatment landscape for non–muscle-invasive bladder cancer (NMIBC) have renewed attention on the importance of accurately identifying carcinoma in situ (CIS), particularly among patients with BCG-unresponsive disease. In this video, Ravi D. Chauhan, MD, FACS, and R. Jonathan Henderson, MD, discuss how evolving FDA labeling and NCCN recommendations have made CIS documentation increasingly relevant to treatment selection and reimbursement.

Chauhan describes how he began noticing that pathology reports frequently categorized tumors only as high grade or low grade, without specifically identifying papillary disease or CIS. Although this distinction previously had limited impact on management, the introduction of newer therapies for BCG-unresponsive disease with CIS prompted renewed attention to pathology reporting practices. After discussing the issue directly with pathologists, Chauhan found that many were unaware that CIS status had become clinically actionable. He explains that specifically requesting evaluation for CIS on pathology requisitions appeared to increase detection rates, highlighting the potential influence of clinician-pathologist communication on diagnostic reporting.

Henderson shares similar observations from his own practice and describes retrospective data suggesting that concomitant CIS may be substantially underreported in patients with high-grade Ta and T1 disease.¹ He notes that reporting limitations may stem not only from clinical assumptions but also from pathology software workflows that do not routinely prompt for CIS documentation. Henderson explains that his pathology group implemented mandatory CIS reporting fields for bladder cancer cases and emphasizes that the issue appears to extend beyond individual practices, with similar experiences reported across academic centers and international institutions.

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.

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