For a bladder tumor with mixed grades of high and low, what should be the clinical grade?

In cases of tumors with mixed grades, particularly when dealing with bladder tumors that demonstrate both high-grade and low-grade characteristics, the clinical grading typically leans towards the higher classification. High-grade tumors are characterized by more aggressive behavior, a higher likelihood of metastasis, and a worse overall prognosis compared to low-grade tumors.

When evaluating the clinical grade in a tumor that presents a mix of both high and low grades, the prevailing standard is to assign the high-grade designation to reflect the potential aggressiveness of the tumor. This approach is employed to ensure that treatment strategies are appropriately aggressive and that patient prognosis is appropriately assessed.

In this context, designating the clinical grade as high-grade accurately represents the worst characteristics of the tumor. Hence, the designation as high-grade (H: HG) is the most clinically relevant choice in informing treatment decisions and understanding the tumor's behavior.