PURPOSE: Malignant voided cytology with normal endoscopic evaluation represents a diagnostic and therapeutic challenge for many patients with a history of non-muscle-invasive bladder cancer (NMIBC).
Bladder biopsy is often advised but its efficacy is unclear. We seek to evaluate the usefulness of bladder biopsy for patients with unexplained positive cytology and to describe patterns of recurrence for this unique subset of patients.
MATERIALS AND METHODS: From an institutional database, we retrospectively identified patients with history of NMIBC and surveillance cystoscopy from 2008-2012 who had malignant voided urine cytology but normal cystoscopy. Patients underwent either systematic bladder biopsy or cystoscopic surveillance and were followed for recurrence and progression.
RESULTS: Of 444 patients, 343 were followed with surveillance only, and 101 underwent biopsy of normal-appearing bladder mucosa including 118 total biopsy procedures. Three (2.5%) biopsies showed carcinoma in situ; none revealed invasive carcinoma. With 32-month median follow-up, 194 (44%) patients experienced recurrence in the bladder, 24 (5%) in the upper tract, and 5 (1%) in prostatic urethra; 219 (49%) demonstrated no recurrence. Previous diagnosis of upper tract urothelial carcinoma and history of Bacille Calmette-Guerin treatment were associated with an increased recurrence risk on multivariable analysis. Recurrence rates/patterns were similar in the biopsy and surveillance groups.
CONCLUSIONS: Patients with malignant cytology despite normal cystoscopy have a high recurrence rate. Biopsy of normal-appearing bladder mucosa in this setting is rarely positive and does not alter recurrence patterns.
Written by:
Musser JE, O'Shaughnessy MJ, Kim PH, Herr HW. Are you the author?
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Reference: J Urol. 2014 Jun 21. pii: S0022-5347(14)03828-2.
doi: 10.1016/j.juro.2014.06.068
PubMed Abstract
PMID: 24960468
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