Protocol for pathologic examination of bladder cancer according to the updates of the 5th edition of the WHO classification (2022): biopsy and transurethral resection specimens

Authors

DOI:

https://doi.org/10.14739/2310-1237.2024.3.313797

Keywords:

bladder cancer, urothelial carcinoma, standardized pathologic examination protocol, stage, grade, histologic subtype, biopsy, TURBT

Abstract

Bladder cancer (BC) is the ninth most common malignancy in the world, and BC morbidity and mortality prevail in industrialized countries and, in particular, in Central and Eastern Europe compared to global rates. The availability of a standardised structured protocol for pathological examination of primary biopsy and transurethral resection (TURBT) samples of the bladder, including the latest updates to the 5th edition of the WHO classification of urinary and male genital tumours (2022), will significantly improve the quality of diagnosis and influence the choice of the optimal trajectory for further treatment.

The aim of the study is to highlight the key updates of the latest WHO classification of BC (2022), to study the standards and protocols for pathological examination of BC specimens used in world practice, as well as to develop a Ukrainian version of the protocol for pathological examination of BC, which will include clinically relevant aspects.

Materials and methods. Analysis of literature in PubMed and Web of Science databases using the keywords: bladder cancer, pathology report, grade, stage, histological subtype, biopsy, TURBT, WHO 2022.

Results. The review highlights the latest updates of the WHO classification of BC cancer and proposes standardized pathology protocol for specimens after primary biopsy/TURBT, developed by adapting existing international recommendations of the College of American Pathologists and the International Collaboration on Cancer Reporting.

Conclusions. Adaptation and standardization of the pathological examination protocol for BC will significantly improve the quality of diagnosis, improve the choice of appropriate therapy and may pave the way for the future development of standardized pathological examination protocols for tumors of other localizations for their widespread use by pathologists in Ukraine.

Author Biographies

N. S. Bondarenko, Dnipro State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Pathological Anatomy, Forensic Medicine and Pathological Physiology

O. O. Bondarenko, Dnipro State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Pathological Anatomy, Forensic Medicine and Pathological Physiology

M. Yu. Polion, Dnipro State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Surgery No. 1 and Urology

P. O. Hrytsenko, Dnipro State Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Pathological Anatomy, Forensic Medicine and Pathological Physiology

I. S. Shponka, Dnipro State Medical University, Ukraine

MD, PhD, DSc, Professor of the Department of Pathological Anatomy, Forensic Medicine and Pathological Physiology

References

  1. Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Observatory: Cancer Today [Internet].. Lyon, France: International Agency for Research on Cancer; 2024 [cited 2024 Jul 27]. Available from: https://gco.iarc.who.int/today
  2. Fedorenko ZP, Hulak LO, Mykhailovych YY, Horokh YL, Ryzhov AU, Sumkina OV, et al. [Cancer in Ukraine, 2022-2023. Morbidity, mortality, performance indicators of the oncology service] [Internet]. Bulletin of the National Cancer Registry of Ukraine. 2024;22. Ukrainian. Available from: http://ncru.inf.ua/publications/BULL_25/index.htm#rubriki
  3. Gontero P, Birtle A, Compérat E, Dominguez Escrig JL, Liedberg F, Mariappan P, et al. EAU Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and CIS) [Internet]. Cloudfront.net. [cited 2024 Jun 27]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Non-muscle-Invasive-Bladder-Cancer-2024.pdf
  4. Witjes JA, Bruins HM, Carrión A, Cathomas R, Compérat EM, Efstathiou JA, et al. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer [Internet]. Cloudfront.net. [cited 2024 Jun 27]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Muscle-Invasive-and-Metastatic-Bladder-Cancer-2024.pdf
  5. Kamoun A, de Reyniès A, Allory Y, Sjödahl G, Robertson AG, Seiler R, et al. A Consensus Molecular Classification of Muscle-invasive Bladder Cancer. Eur Urol. 2020;77(4):420-33. doi: https://doi.org/10.1016/j.eururo.2019.09.006
  6. Choi W, Porten S, Kim S, Willis D, Plimack ER, Hoffman-Censits J, et al. Identification of distinct basal and luminal subtypes of muscle-invasive bladder cancer with different sensitivities to frontline chemotherapy. Cancer Cell. 2014;25(2):152-65. doi: https://doi.org/10.1016/j.ccr.2014.01.009
  7. Robertson AG, Kim J, Al-Ahmadie H, Bellmunt J, Guo G, Cherniack AD, et al. Comprehensive Molecular Characterization of Muscle-Invasive Bladder Cancer. Cell. 2017;171(3):540-556.e25. doi: https://doi.org/10.1016/j.cell.2017.09.007
  8. Damrauer JS, Hoadley KA, Chism DD, Fan C, Tiganelli CJ, Wobker SE, et al. Intrinsic subtypes of high-grade bladder cancer reflect the hallmarks of breast cancer biology. Proc Natl Acad Sci U S A. 2014;111(8):3110-5. doi: https://doi.org/10.1073/pnas.1318376111
  9. Cancer Genome Atlas Research Network. Comprehensive molecular characterization of urothelial bladder carcinoma. Nature. 2014;507(7492):315-22. doi: https://doi.org/10.1038/nature12965
  10. WHO classification of tumours: urinary and male genital tumours. 5th ed. Vol. 8. Lyon, France: IARC; 2022.
  11. Varma M, Srigley JR, Brimo F, Compérat E, Delahunt B, Koch M, et al. Dataset for the reporting of urinary tract carcinoma-biopsy and transurethral resection specimen: recommendations from the International Collaboration on Cancer Reporting (ICCR). Mod Pathol. 2020;33(4):700-12. doi: https://doi.org/10.1038/s41379-019-0403-9
  12. The Royal College of Pathologists. Cancer datasets and tissue pathways [Internet]. Rcpath.org. [cited 2024 Jun 27]. Available from: https://www.rcpath.org/profession/guidelines/cancer-datasets-and-tissue-pathways.html
  13. Cancer Protocol Templates [Internet]. College of American Pathologists. 2017 [cited 2024 Jun 27]. Available from: https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates
  14. Royal College of Pathologists of Australia. Cancer protocols [Internet]. Royal College of Pathologists of Australia. Available from: https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Cancer-Protocols-Pre
  15. Grignon D, Brimo F, Comperat E, Delahunt B, Koch M, Lopez-Beltran A, et al. Urinary Tract Carcinoma Histopathology Reporting Guide – Biopsy and Transurethral Resection Specimen. 1st edition. International Collaboration on Cancer Reporting; Sydney, Australia: International Collaboration on Cancer Reporting; 2018.
  16. Grignon D, Brimo F, Comperat E, Delahunt B, Koch M, Lopez-Beltran A, et al. Carcinoma of the Bladder, Histopathology Reporting Guide. 1st edition. Sydney, Australia: International Collaboration on Cancer Reporting; 2018.
  17. College of American Pathologists. Protocol for the Examination of Biopsy and Transurethral Resection of Bladder Tumor (TURBT) Specimens From Patients With Carcinoma of the Urinary Bladder [Internet]. 2023 [cited 2024 Jun 24]. Available from: https://documents.cap.org/protocols/Bladder.Bx.TURBT_4.2.0.0.REL_CAPCP.pdf?_gl=1*19x7b0f*_ga*NTE3OTU2MjcyLjE3MTk0ODM4OTY.*_ga_97ZFJSQQ0X*MTcxOTQ4Mzg5NS4xLjEuMTcxOTQ4NDQxNS4wLjAuMA
  18. Amin MB, Smith SC, Reuter VE, Epstein JI, Grignon DJ, Hansel DE, et al. Update for the practicing pathologist: The International Consultation On Urologic Disease-European association of urology consultation on bladder cancer. Mod Pathol. 2015;28(5):612-30. doi: https://doi.org/10.1038/modpathol.2014.158
  19. Hansel DE, Amin MB, Comperat E, Cote RJ, Knüchel R, Montironi R, et al. A contemporary update on pathology standards for bladder cancer: transurethral resection and radical cystectomy specimens. Eur Urol. 2013;63(2):321-32. doi: https://doi.org/10.1016/j.eururo.2012.10.008
  20. Chandra A, Griffiths D, McWilliam LJ. Best practice: gross examination and sampling of surgical specimens from the urinary bladder. J Clin Pathol. 2010;63(6):475-9. doi: https://doi.org/10.1136/jcp.2009.071191
  21. Lopez-Beltran A, Luque RJ, Mazzucchelli R, Scarpelli M, Montironi R. Changes produced in the urothelium by traditional and newer therapeutic procedures for bladder cancer. J Clin Pathol. 2002;55(9):641-7. doi: https://doi.org/10.1136/jcp.55.9.641
  22. Oxley JD, Cottrell AM, Adams S, Gillatt D. Ketamine cystitis as a mimic of carcinoma in situ. Histopathology. 2009;55(6):705-8. doi: https://doi.org/10.1111/j.1365-2559.2009.03437.x
  23. Manini C, Angulo JC, López JI. Mimickers of Urothelial Carcinoma and the Approach to Differential Diagnosis. Clin Pract. 2021;11(1):110-23. doi: https://doi.org/10.3390/clinpract11010017
  24. Chan TY, Epstein JI. Radiation or chemotherapy cystitis with "pseudocarcinomatous" features. Am J Surg Pathol. 2004;28(7):909-13. doi: https://doi.org/10.1097/00000478-200407000-00010
  25. Teoh JY, MacLennan S, Chan VW, Miki J, Lee HY, Chiong E, et al. An International Collaborative Consensus Statement on En Bloc Resection of Bladder Tumour Incorporating Two Systematic Reviews, a Two-round Delphi Survey, and a Consensus Meeting. Eur Urol. 2020;78(4):546-69. doi: https://doi.org/10.1016/j.eururo.2020.04.059
  26. Brausi M, Collette L, Kurth K, van der Meijden AP, Oosterlinck W, Witjes JA, et al. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol. 2002;41(5):523-31. doi: https://doi.org/https://doi.org/10.1016/s0302-2838(02)00068-4
  27. Teoh JY, Mayor N, Li KM, Lo KL, Ng CF, Mostafid H. En-bloc resection of bladder tumour as primary treatment for patients with non-muscle-invasive bladder cancer: routine implementation in a multi-centre setting. World J Urol. 2021;39(9):3353-8. doi: https://doi.org/10.1007/s00345-021-03675-9
  28. Richterstetter M, Wullich B, Amann K, Haeberle L, Engehausen DG, Goebell PJ, et al. The value of extended transurethral resection of bladder tumour (TURBT) in the treatment of bladder cancer. BJU Int. 2012;110(2 Pt 2):E76-9. doi: https://doi.org/10.1111/j.1464-410X.2011.10904.x
  29. D'Andrea D, Soria F, Hurle R, Enikeev D, Kotov S, Régnier S, et al. En Bloc Versus Conventional Resection of Primary Bladder Tumor (eBLOC): A Prospective, Multicenter, Open-label, Phase 3 Randomized Controlled Trial. Eur Urol Oncol. 2023;6(5):508-15. doi: https://doi.org/10.1016/j.euo.2023.07.010
  30. Holzbeierlein J, Bixler BR, Buckley DI, Chang SS, Holmes RS, James AC, et al. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/SUO Guideline (2017; Amended 2020, 2024). J Urol. 2024;212(1):3-10. doi: https://doi.org/10.1097/JU.0000000000003981
  31. Lenis AT, Lec PM, Chamie K, Mshs MD. Bladder Cancer: A Review. JAMA. 2020;324(19):1980-91. doi: https://doi.org/10.1001/jama.2020.17598
  32. Paner GP, Kamat A, Netto GJ, Samaratunga H, Varma M, Bubendorf L, et al. International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 2: Grading of Mixed Grade, Invasive Urothelial Carcinoma Including Histologic Subtypes and Divergent Differentiations, and Non-Urothelial Carcinomas. Am J Surg Pathol. 2024 Jan 1;48(1):e11-e23. doi: https://doi.org/10.1097/PAS.0000000000002077
  33. Veskimäe E, Espinos EL, Bruins HM, Yuan Y, Sylvester R, Kamat AM, et al. What Is the Prognostic and Clinical Importance of Urothelial and Nonurothelial Histological Variants of Bladder Cancer in Predicting Oncological Outcomes in Patients with Muscle-invasive and Metastatic Bladder Cancer? A European Association of Urology Muscle Invasive and Metastatic Bladder Cancer Guidelines Panel Systematic Review. Eur Urol Oncol. 2019;2(6):625-42. doi: https://doi.org/10.1016/j.euo.2019.09.003
  34. Wasco MJ, Daignault S, Zhang Y, Kunju LP, Kinnaman M, Braun T, et al. Urothelial carcinoma with divergent histologic differentiation (mixed histologic features) predicts the presence of locally advanced bladder cancer when detected at transurethral resection. Urology. 2007;70(1):69-74. doi: https://doi.org/10.1016/j.urology.2007.03.033
  35. Linder BJ, Boorjian SA, Cheville JC, Sukov WR, Thapa P, Tarrell RF, et al. The impact of histological reclassification during pathology re-review--evidence of a Will Rogers effect in bladder cancer? J Urol. 2013;190(5):1692-6. doi: https://doi.org/10.1016/j.juro.2013.05.040
  36. Gaisa NT, Braunschweig T, Reimer N, Bornemann J, Eltze E, Siegert S, et al. Different immunohistochemical and ultrastructural phenotypes of squamous differentiation in bladder cancer. Virchows Arch. 2011;458(3):301-12. doi: https://doi.org/10.1007/s00428-010-1017-2
  37. Zhao G, Wang C, Tang Y, Liu X, Liu Z, Li G, et al. Glandular differentiation in pT1 urothelial carcinoma of bladder predicts poor prognosis. Sci Rep. 2019;9(1):5323. doi: https://doi.org/10.1038/s41598-019-41844-4
  38. Kim SP, Frank I, Cheville JC, Thompson RH, Weight CJ, Thapa P, et al. The impact of squamous and glandular differentiation on survival after radical cystectomy for urothelial carcinoma. J Urol. 2012;188(2):405-9. doi: https://doi.org/10.1016/j.juro.2012.04.020
  39. Przybycin CG, McKenney JK, Nguyen JK, Shah RB, Umar SA, Harik L, et al. Urothelial Carcinomas With Trophoblastic Differentiation, Including Choriocarcinoma: Clinicopathologic Series of 16 Cases. Am J Surg Pathol. 2020;44(10):1322-30. doi: https://doi.org/10.1097/PAS.0000000000001532
  40. Lopez-Beltran A, Henriques V, Montironi R, Cimadamore A, Raspollini MR, Cheng L. Variants and new entities of bladder cancer. Histopathology. 2019;74(1):77-96. doi: https://doi.org/10.1111/his.13752
  41. Amin MB. Histological variants of urothelial carcinoma: diagnostic, therapeutic and prognostic implications. Mod Pathol. 2009;22 Suppl 2:S96-S118. doi: https://doi.org/10.1038/modpathol.2009.26
  42. Weyerer V, Eckstein M, Compérat E, Juette H, Gaisa NT, Allory Y, et al. Pure Large Nested Variant of Urothelial Carcinoma (LNUC) Is the Prototype of an FGFR3 Mutated Aggressive Urothelial Carcinoma with Luminal-Papillary Phenotype. Cancers (Basel). 2020;12(3):763. doi: https://doi.org/10.3390/cancers12030763
  43. Compérat E, Roupret M, Yaxley J, Reynolds J, Varinot J, Ouzaïd I, et al. Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. Pathology. 2010;42(7):650-4. doi: https://doi.org/10.3109/00313025.2010.522173
  44. Meeks JJ, Taylor JM, Matsushita K, Herr HW, Donat SM, Bochner BH, et al. Pathological response to neoadjuvant chemotherapy for muscle-invasive micropapillary bladder cancer. BJU Int. 2013;111(8):E325-30. doi: https://doi.org/10.1111/j.1464-410X.2012.11751.x
  45. Sui W, Matulay JT, James MB, Onyeji IC, Theofanides MC, RoyChoudhury A, et al. Micropapillary Bladder Cancer: Insights from the National Cancer Database. Bladder Cancer. 2016 Oct 27;2(4):415-423. doi: https://doi.org/10.3233/BLC-160066
  46. Ching CB, Amin MB, Tubbs RR, Elson P, Platt E, Dreicer R, et al. HER2 gene amplification occurs frequently in the micropapillary variant of urothelial carcinoma: analysis by dual-color in situ hybridization. Mod Pathol. 2011;24(8):1111-9. doi: https://doi.org/10.1038/modpathol.2011.69
  47. Guo CC, Dadhania V, Zhang L, Majewski T, Bondaruk J, Sykulski M, et al. Gene Expression Profile of the Clinically Aggressive Micropapillary Variant of Bladder Cancer. Eur Urol. 2016;70(4):611-20. doi: https://doi.org/10.1016/j.eururo.2016.02.056
  48. Al-Ahmadie HA, Iyer G, Lee BH, Scott SN, Mehra R, Bagrodia A, et al. Frequent somatic CDH1 loss-of-function mutations in plasmacytoid variant bladder cancer. Nat Genet. 2016;48(4):356-8. doi: https://doi.org/10.1038/ng.3503
  49. Dayyani F, Czerniak BA, Sircar K, Munsell MF, Millikan RE, Dinney CP, et al. Plasmacytoid urothelial carcinoma, a chemosensitive cancer with poor prognosis, and peritoneal carcinomatosis. J Urol. 2013;189(5):1656-61. doi: https://doi.org/10.1016/j.juro.2012.11.084
  50. Li Q, Assel M, Benfante NE, Pietzak EJ, Herr HW, Donat M, et al. The Impact of Plasmacytoid Variant Histology on the Survival of Patients with Urothelial Carcinoma of Bladder after Radical Cystectomy. Eur Urol Focus. 2019;5(1):104-8. doi: https://doi.org/10.1016/j.euf.2017.06.013
  51. Compérat E, Oszwald A, Wasinger G, Hansel DE, Montironi R, van der Kwast T, et al. Updated pathology reporting standards for bladder cancer: biopsies, transurethral resections and radical cystectomies. World J Urol. 2022;40(4):915-27. doi: https://doi.org/10.1007/s00345-021-03831-1
  52. Yang G, Bondaruk J, Cogdell D, Wang Z, Lee S, Lee JG, et al. Urothelial-to-Neural Plasticity Drives Progression to Small Cell Bladder Cancer. iScience. 2020;23(6):101201. doi: https://doi.org/10.1016/j.isci.2020.101201
  53. Guo CC, Majewski T, Zhang L, Yao H, Bondaruk J, Wang Y, et al. Dysregulation of EMT Drives the Progression to Clinically Aggressive Sarcomatoid Bladder Cancer. Cell Rep. 2019;27(6):1781-1793.e4. doi: https://doi.org/10.1016/j.celrep.2019.04.048
  54. Meeks JJ, Al-Ahmadie H, Faltas BM, Taylor JA 3rd, Flaig TW, DeGraff DJ, et al. Genomic heterogeneity in bladder cancer: challenges and possible solutions to improve outcomes. Nat Rev Urol. 2020;17(5):259-70. doi: https://doi.org/10.1038/s41585-020-0304-1
  55. Compérat E, Amin MB, Epstein JI, Hansel DE, Paner G, Al-Ahmadie H, et al. The Genitourinary Pathology Society Update on Classification of Variant Histologies, T1 Substaging, Molecular Taxonomy, and Immunotherapy and PD-L1 Testing Implications of Urothelial Cancers. Adv Anat Pathol. 2021;28(4):196-208. doi: https://doi.org/10.1097/PAP.0000000000000309
  56. Paner GP, Montironi R, Amin MB. Challenges in Pathologic Staging of Bladder Cancer: Proposals for Fresh Approaches of Assessing Pathologic Stage in Light of Recent Studies and Observations Pertaining to Bladder Histoanatomic Variances. Adv Anat Pathol. 2017;24(3):113-27. doi: https://doi.org/10.1097/PAP.0000000000000152
  57. Amin MB, Edge S, Greene FL, Schilsky RL, Byrd DR, Gaspar LE, et al., editors. AJCC Cancer Staging Manual. 8th ed. Cham, Switzerland: Springer International Publishing; 2016.
  58. Lemos MB, Okoye E. Atlas of Surgical Pathology grossing. Cham: Springer; 2019.
  59. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Compérat E, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol. 2013;64(4):639-53. doi: https://doi.org/10.1016/j.eururo.2013.06.003
  60. Lopez-Beltran A, Bassi PF, Pavone-Macaluso M, Montironi R; European Society of Uropathology; Uropathology Working Group. Handling and pathology reporting of specimens with carcinoma of the urinary bladder, ureter, and renal pelvis. A joint proposal of the European Society of Uropathology and the Uropathology Working Group. Virchows Arch. 2004;445(2):103-10. doi: https://doi.org/10.1007/s00428-004-1039-8
  61. Mariappan P, Finney SM, Head E, Somani BK, Zachou A, Smith G, et al. Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: validation across time and place and recommendation for benchmarking. BJU Int. 2012;109(11):1666-73. doi: https://doi.org/10.1111/j.1464-410X.2011.10571.x
  62. Mariappan P, Finney SM, Head E, Somani BK, Zachou A, Smith G, et al. Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: validation across time and place and recommendation for benchmarking. BJU Int. 2012;109(11):1666-73. doi: https://doi.org/10.1111/j.1464-410X.2011.10571.x
  63. Werntz RP, Smith ZL, Packiam VT, Smith N, Steinberg GD. The Impact of Lymphovascular Invasion on Risk of Upstaging and Lymph Node Metastasis at the Time of Radical Cystectomy. Eur Urol Focus. 2020;6(2):292-7. doi: https://doi.org/10.1016/j.euf.2018.09.019
  64. Mari A, Kimura S, Foerster B, Abufaraj M, D'Andrea D, Gust KM, et al. A systematic review and meta-analysis of lymphovascular invasion in patients treated with radical cystectomy for bladder cancer. Urol Oncol. 2018;36(6):293-305. doi: https://doi.org/10.1016/j.urolonc.2018.03.018
  65. Lotan Y, Gupta A, Shariat SF, Palapattu GS, Vazina A, Karakiewicz PI, et al. Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. J Clin Oncol. 2005;23(27):6533-9. doi: https://doi.org/10.1200/JCO.2005.05.516

Downloads

Additional Files

Published

2024-12-27

How to Cite

1.
Bondarenko NS, Bondarenko OO, Polion MY, Hrytsenko PO, Shponka IS. Protocol for pathologic examination of bladder cancer according to the updates of the 5th edition of the WHO classification (2022): biopsy and transurethral resection specimens. Pathologia [Internet]. 2024Dec.27 [cited 2026May25];21(3):259-70. Available from: https://pat.zsmu.edu.ua/article/view/313797

Issue

Vol. 21 No. 3 (2024)

Section

Review

License

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Лицензия Creative Commons