The Significance of Repeat Bladder Biopsy after Intravesical Bacillus Calmette-Guerin Therapy for High Risk Superficial Transitional Cell Carcinoma of Bladder

Kim, Byung Hoon; Park, Choal Hee; Kim, Chun Il

Abstract

PURPOSE: The routine follow-up study protocol after Bacillus Calmette-Guerin (BCG) therapy for high risk superficial transitional cell cancer (TCC) of the bladder is voided urine cytology and cystoscopy every 3 months for the first 2 years. If abnormal findings are shown at those tests, then bladder biopsy is needed. We evaluated the value and necessity of routine biopsy with cytology and cystoscopy as screening tools for the purpose of determining which patients should undergo biopsy.
MATERIALS AND METHODS
The routine biopsy records of 67 patients with superficial TCC of the bladder who received BCG therapy were reviewed. The pathology findings before BCG therapy, along with the follow-up cystoscopy, cytology and biopsy results after BCG therapy, were noted.
RESULTS
The cystoscopic and/or cytologic findings were abnormal in 51 (76.1%) cases. TCC of bladder was found on biopsy after BCG therapy in 25 (37.3%) of all 67 cases. All of the 16 cases with normal cystoscopy and cytology findings represent negative biopsy results. Overall, the positive biopsy rates were 17.6% (3 of 17) after treatment for multiple Ta lesions, 41.9% (13 of 31) after treatment for multiple T1 lesions, and 47.4% (9 of 19) after treatment for carcinoma in situ (CIS).
CONCLUSIONS
Patients with superficial TCC of the bladder who have negative cystoscopy and urine cytology results can safely be spared routine transurethral bladder biopsy with its associated morbidity. However, patients with T1 and CIS are very likely to have persistent abnormal cytologic or abnormal cystoscopic findings, and this warrants investigation with biopsy and these patients may benefit from routine scheduled biopsy.