Significance of Random Bladder Biopsies in Non-Muscle Invasive Bladder Cancer

Abstract

Background/Aims: To evaluate retrospectively the clinical outcome of random bladder biopsies in patients with non-muscle invasive bladder cancer (NMIBC) undergoing transurethral resection (TUR). Patients and Method: This study included 234 consecutive patients with NMIBC who underwent random biopsies from normal-appearing urothelium of the bladder, including the anterior wall, posterior wall, right wall, left wall, dome, trigone and/or prostatic urethra, during TUR. Result: Thirty-seven patients (15.8%) were diagnosed by random biopsies as having urothelial cancer. Among several factors available prior to TUR, preoperative urinary cytology appeared to be independently related to the detection of urothelial cancer in random biopsies on multivariate analysis. Urinary cytology prior to TUR gave 50.0% sensitivity, 91.7% specificity, 56.8% positive predictive value and 89.3% negative predictive value for predicting the findings of the random biopsies. Conclusion: Biopsies of normal-appearing urothelium resulted in the additional detection of urothelial cancer in a definite proportion of NMIBC patients, and it remains difficult to find a reliable alternative to random biopsies. Collectively, these findings suggest that it would be beneficial to perform random biopsies as part of the routine management of NMIBC.

Telocytes and ezrin expression in normal-appearing tissues adjacent to urothelial bladder carcinoma as predictors of invasiveness and recurrence

“…This group of patients appeared to have normal mucosa during cystoscopy 6 , 7 . Several reports have revealed that the normal-appearing mucosa in BC was not normal and may had concurrent dysplasia or CIS when examined with light microscopy 7 , 8 , 21 , 22 . Hence, there is a great need for additional tools and biomarkers to examine the normal-looking tissues in NMIBC to assess the likelihood of progression and recurrence, as well as, in MIBC patients who require proper staging for initiation of chemotherapy, radiotherapy, or immunotherapy.…”

Preoperative predictive factors of carcinoma in situ in the normal‐appearing mucosa in patients who underwent an initial transurethral resection for non‐muscle‐invasive bladder cancer under white light cystoscopy

“…In this study, 31.6% of the patients were diagnosed with CIS from the normal‐appearing mucosa. This changed the postoperative treatment and follow‐up schedule in such patients 17 . Furthermore, early diagnosis of CIS by random biopsies and optimal postoperative therapy such as intravesical instillation of Bacillus Calmette‐Guérin (BCG), may significantly improve the prognosis of the patients with concomitant CIS 17 .…”

“…This changed the postoperative treatment and follow‐up schedule in such patients 17 . Furthermore, early diagnosis of CIS by random biopsies and optimal postoperative therapy such as intravesical instillation of Bacillus Calmette‐Guérin (BCG), may significantly improve the prognosis of the patients with concomitant CIS 17 . It was reported that TUR with subsequent BCG instillation was more effective in preventing the recurrence of TaT1 tumors than TUR alone or TUR combined with chemotherapy 21 .…”

“…Although few studies have evaluated the significance of random biopsies in patients with NMIBC under WLC, these findings are controversial. 5 , 17 Hence, we retrospectively evaluated which preoperative covariates were useful as predictive factors in detecting CIS from normal‐appearing mucosa using random bladder biopsies under WLC and identified the candidates who benefited from this procedure.…”

Are we closer to seeing carcinoma in situ in the upper urinary tract?

“…UUT-CIS mirrors CIS of the bladder [ 22 ]. Standard white light ureterorenoscopy remains a poor diagnostic tool and akin to cystoscopy requires an invasive approach with increasing number of tissue samples taken to improve detection rate of CIS [ 23 ]. Sensitivity of multiple bladder biopsies is around 77% [ 24 ].…”