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Assessing Treatment Response After Intravesical Bacillus Calmette–Guerin Induction Cycle
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- The authors investigated the benefit of directed and random biopsies of trigon, right and left wall, dome, fundus, and prostatic urethra in patients with high-risk non–muscle invasive bladder cancer undergoing cystoscopy 4 to 6 weeks following bacillus Calmette–Guérin induction therapy. Suspicious areas were also biopsied and/or resected. Biopsies identified cancer in 20% overall, including 9% when cystoscopy and cytology were negative versus 38% when either was suspicious.
- Their findings suggest that routine bladder biopsies are less likely to be required in patients with negative cystoscopy and cytology; however, their omission may still miss cancer in 1 out of 10 patients in this scenario.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
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.
Additional Info
Disclosure statements are available on the authors' profiles:
Assessing Treatment Response After Intravesical Bacillus Calmette–Guerin Induction Cycle: Are Routine Bladder Biopsies Necessary?
World J Urol 2021 Apr 08;[EPub Ahead of Print], B Calò, F Sanguedolce, UG Falagario, M Chirico, F Fortunato, E Carvalho-Diaz, GM Busetto, C Bettocchi, G Carrieri, L CormioFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.