The Value of Transurethral Bladder Biopsy after Intravesical Bacillus Calmette-Guérin Instillation Therapy for Nonmuscle Invasive Bladder Cancer: A Retrospective, Single Center Study and Cumulative Analysis of the Literature

Swietek, Natalia; Waldert, Matthias; Rom, Maximilian; Schatzl, Georg; Wiener, H.; Susani, Martin; Klatte, Tobias

doi:10.1016/j.juro.2012.05.015

Cited by 18 publications

(16 citation statements)

References 26 publications

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“…While May et al found that bladder biopsies had a positive impact on therapeutic decisions of all NMIBC patients, Highshaw et al found that bladder biopsies are unnecessary in case of negative findings on cystoscopy [17,19]. Similarly, biopsies were found to be unwarranted when cytology and flexible cystoscopy are combined for surveillance [20,21]. To the authors' knowledge, this study is the first to assess the time to recurrence when comparing bladder biopsies to flexible cystoscopy.…”

Section: Discussionmentioning

confidence: 84%

Post-Bacille Calmette–Guerin surveillance for non-muscle invasive bladder cancer: do random biopsies offer an advantage?

et al. 2021

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Background The optimal surveillance method for recurrence of non-muscle invasive bladder cancer (NMIBC) after intravesical BCG treatment is unknown. The aim of this study is to assess the difference between two surveillance methods: cystoscopy with bladder biopsies and office-based flexible cystoscopy in detecting NMIBC recurrence and time to recurrence. Methods Charts of patients who underwent transurethral resection of bladder tumor with subsequent intravesical Bacillus Calmette–Guerin (BCG) treatment were reviewed between January 2015 and December 2018. Baseline demographics and oncological parameters were compared between the two methods of surveillance. Then, the role of the surveillance method for NMIBC recurrence and time to recurrence were evaluated in backward logistic regression and hazard ratios estimated in Cox regression models, respectively. Results Fifty-one patients (50.5%) underwent office-based flexible cystoscopy and 50 patients (49.5%) had bladder biopsies. The patients undergoing either surveillance methods were comparable for baseline demographic and oncological parameter. The predictors of recurrence and earlier BCG relapse were increased body mass index, the presence of multifocal tumors, the presence of concurrent carcinoma in situ, and tumor size at presentation. Bladder cancer recurrence was mostly affected by multifocality of the disease [OR 3.61 95%CI (1.17–11.15)] and the presence of concomitant carcinoma in situ [4.35 (1.29–14.68)]. Yet, the surveillance method neither predicted a higher recurrence yield nor earlier diagnosis. Conclusion In our cohort, there is neither difference in recurrence yield nor earlier diagnosis of recurrence between office-based flexible cystoscopy and bladder biopsies. Larger prospective studies are needed to assess the generalizability of these findings.

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Section: Discussionmentioning

confidence: 84%

Post-Bacille Calmette–Guerin surveillance for non-muscle invasive bladder cancer: do random biopsies offer an advantage?

et al. 2021

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“…It has been established that erythematous lesions are benign in nature in the presence of negative cytology at the time of 3–6 months from the first instillation of BCG. A retrospective study and cumulative analysis by Swietek et al estimated the predictive value of individual lesion type in cystoscopy performed after an induction course of BCG. The authors found that the PPV of erythema with positive cytology was 56% and 9% with negative cytology present.…”

Section: Discussionmentioning

confidence: 99%

“…Given the controversy regarding the diagnostic significance of urine cytology, the management of erythematous lesions of BCG‐treated bladder is heterogeneous. During BCG instillations, erythematous lesions probably signify bladder irritation and in the presence of negative cytology biopsy is not needed ; however, occurrence of erythema and other bladder lesions is common during later follow‐up after a BCG regimen. The objectives of the present study were to classify the cystoscopic appearance of BCG‐induced bladder mucosal lesions during post‐BCG surveillance and to correlate cystoscopy findings with urine cytology and subsequent histological assessment.…”

Section: Introductionmentioning

confidence: 99%

Urine cytology is a feasible tool for assessing erythematous bladder lesions after bacille Calmette‐Guérin (BCG) treatment

et al. 2018

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Bladder lesions after BCG instillations pose a challenge during follow-up and the appropriate management strategy is not clear. Lesions should not be overlooked as being BCG-induced irritation because they may harbour significant malignancies. The presence of papillary or flat tumour always warrants a biopsy or resection. In the case of erythematous lesions, our results suggest that biopsy may be avoided if voided urine cytology is negative.

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“…Indeed, the guidelines provide a weak recommendation for patients with high-risk disease having cystoscopy and cytology at 3 months after TURBT and a strong recommendation for such patients having BBs in case of positive cytology and/or positive/suspicious cystoscopy. Available literature provides conflicting data, since some studies suggest that cystoscopy and urinary cytology may be sufficient to assess the efficacy of BCG induction course, thus reserving BBs only to cases whereby such exams yield suspicious/positive findings [5,6], while others recommend routine BBs [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Assessing treatment response after intravesical bacillus Calmette–Guerin induction cycle: are routine bladder biopsies necessary?

et al. 2021

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Purpose To determine the need for routine bladder biopsies (BBs) in assessing response to the induction cycle of intravesical bacillus Calmette–Guérin (BCG) for high-risk non-muscle-invasive bladder cancer (NMIBC). Methods Our prospectively maintained NMIBC database was queried to identify patients with high-risk disease (carcinoma in situ, high-grade Ta/T1) who underwent BBs after BCG induction cycle. Urine cytology, cystoscopy, and BBs findings were evaluated. Results A total of 219 patients met the inclusion criteria. Urine cytology was positive in 20 patients and negative in 199; cystoscopy was positive in 35 patients, suspicious in 32 and normal in 152 patients. BBs yielded bladder cancer (BCa) in 43 (19.6%) patients, with a BCa rate of 9.3% in patients with negative cytology and cystoscopy as opposed to 38.0% in patients whereby one or both exams were suspicious/positive. The diagnostic accuracy of urine cytology, cystoscopy, and combined tests was 0.56, 0.70, and 0.71, respectively. The negative predictive value of combined tests was 90.7%. Performing BBs only in patients with positive cytology and/or positive/suspicious cystoscopy would have spared 140 (64%) patients to undergo this procedure while missing BCa in 13 (9.3%) of them, representing 30% of all BCa cases. Conclusion Performing BBs only in patients with positive cytology and suspicious/positive cystoscopy would spare 64% of un-necessary BBs but miss a non-negligible number of BCas. While no data are available regarding the potential consequences of missing such BCas, such information should be taken into account in patient’s counselling.

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The Value of Transurethral Bladder Biopsy after Intravesical Bacillus Calmette-Guérin Instillation Therapy for Nonmuscle Invasive Bladder Cancer: A Retrospective, Single Center Study and Cumulative Analysis of the Literature

Abstract: Routine transurethral bladder biopsies after a bacillus Calmette-Guérin induction course are not necessary. An individually approach is recommended, tailored from cystoscopic findings and cytology.

Cited by 18 publications

References 26 publications

Post-Bacille Calmette–Guerin surveillance for non-muscle invasive bladder cancer: do random biopsies offer an advantage?

Post-Bacille Calmette–Guerin surveillance for non-muscle invasive bladder cancer: do random biopsies offer an advantage?

Urine cytology is a feasible tool for assessing erythematous bladder lesions after bacille Calmette‐Guérin (BCG) treatment

Assessing treatment response after intravesical bacillus Calmette–Guerin induction cycle: are routine bladder biopsies necessary?

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