ArticleWorld journal of urology2026
Development and multi-observer validation of a histopathological scoring system for interstitial cystitis/bladder pain syndrome diagnosis.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo develop and validate a pragmatic histopathological scoring system for interstitial cystitis/bladder pain syndrome (IC/BPS) that distinguishes Hunner-type interstitial cystitis (HIC) from bladder pain syndrome (BPS) and inflammatory non-HIC chronic cystitis mimicking Hunner lesions ("other cystitis").
methodsBladder biopsies from 96 patients were analyzed: HIC (n = 32), BPS (n = 42), and other cystitis (n = 22; bacillus Calmette-Guérin-related, follicular, and chronic bacterial cystitis). Four pathologists (A-D; A as index/model observer) independently scored hematoxylin-eosin sections using five histopathological features (inflammation, plasma cell infiltration, eosinophil infiltration, tertiary lymphoid structures, urothelial denudation; total 0-8). ROC curves were generated for HIC vs. BPS and HIC vs. other cystitis. Youden index-derived thresholds were compared across observers to select simple integer cutoffs and define an operational three-tier classification (0-2: BPS, 3-4: indeterminate, 5-8: HIC). Diagnostic performance was assessed using AUC and contingency-table metrics. Inter-observer agreement for the three-tier classification was evaluated using Fleiss' kappa.
resultsHIC vs. BPS discrimination was excellent across pathologists (AUC 0.966-0.991; pooled AUC 0.983). HIC vs. other cystitis discrimination was moderate-to-good (AUC 0.723-0.808; pooled AUC 0.738). Overall agreement for the three-tier classification was 60.4% with Fleiss' κ = 0.657; agreement was highest for BPS and modest for other cystitis.
conclusionsThis hematoxylin-eosin-based scoring system enables standardized IC/BPS phenotyping, robustly separating HIC from BPS and providing a structured framework for inflammatory overlap cases, with reproducible performance across international pathologists.
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