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Post-Bacille Calmette–Guerin surveillance for non-muscle invasive bladder cancer: do random biopsies offer an advantage? AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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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Iinuma K, Yuhara K, Kotaka H, Ozawa K, Kato D, Takai M, Nakane K, Mizutani K, Tsuchiya T, Koie T. 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. Cancer Rep (Hoboken) 2020; 4:e1321. [PMID: 33174397 PMCID: PMC8451375 DOI: 10.1002/cnr2.1321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although few studies evaluated the significance of random biopsies under white light cystoscopy (WLC) in patients with non-muscle-invasive bladder cancer (NMIBC), the findings are controversial. AIM This aim of this study was to evaluate what kind of preoperative covariates were useful as predictive factors in detecting carcinoma in situ (CIS) from normal-appearing mucosa using random bladder biopsies under WLC. METHODS AND RESULTS A total of 229 patients with NMIBC underwent initial TUR followed by random biopsies under WLC at Red Cross Takayama Hospital between 2007 and 2016. These patients underwent TUR with complete resection of intravesical visible tumors followed by random biopsies of normal-appearing mucosa. In this study, random bladder biopsies of normal-appearing urothelial mucosa, excluding abnormal mucosa, were carried out with a cold punch in the selected intravesical sites. The covariates included age, gender, the urine cytology result, presence of an abnormal mucosa, number of tumors, size of the largest tumors, configuration of the tumor, and tumor type. Abnormal mucosa was defined as reddish or mossy areas at the time of TUR under WLC. The primary endpoint was to determine what kind of preoperative covariates were useful as predictive factors in detecting CIS from normal-appearing mucosa using random bladder biopsies under WLC. Finally, 212 patients were evaluated, and 67 patients (31.6%) were diagnosed with CIS from normal-appearing mucosa. In univariate analysis, positive urine cytology, abnormal mucosa, and the number of tumors were significantly associated with concomitant CIS. On multivariate analysis, positive urine cytology and abnormal mucosa were significantly associated with CIS. CONCLUSION The patients who were diagnosed with positive urine cytology or abnormal mucosa by WLC are ideal candidates for TUR followed by random biopsy of normal-appearing mucosa.
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Affiliation(s)
- Koji Iinuma
- Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan
| | - Kazuya Yuhara
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama, Japan
| | - Hiroto Kotaka
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama, Japan
| | - Kaori Ozawa
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan
| | - Kosuke Mizutani
- Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan
| | - Tomohiro Tsuchiya
- Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan
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Subiela J, Palou J, Esquinas C, Fernández Gómez J, Rodríguez Faba O. Clinical usefulness of random biopsies in diagnosis and treatment of non-muscle invasive bladder cancer: Systematic review and meta-analysis. Actas Urol Esp 2018; 42:285-298. [PMID: 29169705 DOI: 10.1016/j.acuro.2017.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVE This systematic review of the literature has been focused on determining the clinical usefulness of random bladder biopsies (RB) in the diagnosis of carcinoma in situ. A meta-analysis was performed to establish the clinic and pathological factors associated to positive biopsies. EVIDENCE ACQUISITION A systematic review was performed using Pubmed/Medline database according to the PRISMA guidelines. Thirty-seven articles were included, recruiting a total of 12,657 patients, 10,975 were submitted to RB. EVIDENCE SYNTHESIS The overall incidence of positive RB was 21.91%. Significant differences were found in the incidence of positive RB when patients were stratified according to urine cytology result, tumor multiplicity, tumor appearance, stage and grade. The results of the meta-analysis revealed that the presence of positive cytology, tumor multiplicity, non-papillary appearance tumors, stage T1 and histological grades G2 and G3 represent the risk factors to predict abnormalities in RB. CONCLUSIONS The incidence of positive RB in patients with non-muscle invasive bladder cancer was 21.91%. The maximum usefulness of RB was observed when these are performed in a standardized way. The results of the meta-analysis showed that besides positive cytology and non-papillary appearance tumors, tumor multiplicity and histological grades G2 and G3 represent risk factors associated to positive RB, suggesting that the use of RB might be extensive to the intermediate risk group of the European Organization for Research and Treatment of Cancer (EORTC).
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Otsuka M, Taguchi S, Nakagawa T, Morikawa T, Maekawa S, Miyakawa J, Matsumoto A, Miyazaki H, Fujimura T, Fukuhara H, Kume H, Igawa Y, Homma Y. Clinical significance of random bladder biopsy in primary T1 bladder cancer. Mol Clin Oncol 2018; 8:665-670. [PMID: 29725532 DOI: 10.3892/mco.2018.1587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/27/2018] [Indexed: 11/06/2022] Open
Abstract
The clinical significance of random bladder biopsies in primary non-muscle-invasive bladder cancer is unclear. The present study investigated the significance of positive random bladder biopsies in primary T1 NMIBC. The present study retrospectively reviewed the records of 71 patients with primary pT1N0M0 bladder cancer who underwent transurethral resection of the bladder tumor (TURBT) and concomitant random bladder biopsy. A total of 12 patients who received cystectomy immediately following the TURBT were excluded, and the remaining 59 patients were included in the analysis. Random bladder biopsy was defined as a cold-cup biopsy of pre-specified normal-looking areas in the bladder. The association of clinicopathological factors, including random biopsy results, with intravesical recurrence were assessed by univariate and multivariate Cox proportional hazards analyses. Of the 59 patients, 15 (25%) demonstrated carcinoma in situ (CIS) lesions on random bladder biopsy: Five (33%) in biopsy specimens alone and the remaining 10 (67%) in biopsy and TUR specimens. Positive random biopsy was associated with preoperative positive urine cytology (P=0.011) and small size of the main tumor (P=0.008). Multivariate analysis demonstrated positive random biopsy as the sole independent poor prognostic factor for intravesical recurrence (hazard ratio: 4.69, P=0.014). The five patients who had CIS detected in biopsy specimens alone had worse, although non-significantly worse, recurrence-free survival compared with those with CIS detected in biopsy and TUR specimens (P=0.100). In conclusion, positive bladder random biopsy, equivalent to the presence of CIS, was an independent predictor of recurrence in primary T1 bladder cancer. Given that one-third of CIS lesions could not have been detected without biopsy, random bladder biopsy should be considered for patients with T1 tumors.
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Affiliation(s)
- Masafumi Otsuka
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Shigekatsu Maekawa
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Jimpei Miyakawa
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Akihiko Matsumoto
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
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Abstract
Non-muscle-invasive bladder cancer (NMIBC) represents the vast majority of bladder cancer diagnoses, but this definition represents a spectrum of disease with a variable clinical course, notable for significant risk of recurrence and potential for progression. Management involves risk-adapted strategies of cystoscopic surveillance and intravesical therapy with the goal of bladder preservation when safe to do so. Multiple organizational guidelines exist to help practitioners manage this complicated disease process, but adherence to management principles among practising urologists is reportedly low. We review four major organizational guidelines on NMIBC: the American Urological Association (AUA)/Society of Urologic Oncology (SUO), European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN), and National Institute for Health and Care Excellence (NICE) guidelines.
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Affiliation(s)
- Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Management of non-muscle invasive bladder cancer: A comprehensive analysis of guidelines from the United States, Europe and Asia. Cancer Treat Rev 2016; 47:22-31. [PMID: 27231966 DOI: 10.1016/j.ctrv.2016.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/21/2022]
Abstract
Bladder cancer is the 8th most common cancer with 74,000 new cases in the United States in 2015. Non-muscle invasive bladder cancer (NMIBC) accounts for 75% of all bladder cancer cases. Transurethral resection and intravesical treatments remain the main treatment modality. Up to 31-78% of cases recur, hence the need for intensive treatment and surveillance protocols which makes bladder cancer one of the most expensive cancers to manage. The purpose of this review is to compare contemporary guidelines from Europe, (European Association of Urology), the United States (National Comprehensive Cancer Network), the United Kingdom (National Institute for Health and Care Excellence), Japan (Japanese Urological Association) and the International Consultation on Bladder Cancer (ICUD). We compare and contrast the different guidelines and the evidence on which their recommendations are based.
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Pagano MJ, Badalato G, McKiernan JM. Optimal treatment of non-muscle invasive urothelial carcinoma including perioperative management revisited. Curr Urol Rep 2015; 15:450. [PMID: 25234184 DOI: 10.1007/s11934-014-0450-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Non-muscle invasive urothelial carcinoma is a heterogeneous disease that requires the practicing urologist to implement a variety of surgical and non-surgical treatment strategies. The disease course can range from recurrent low grade papillary disease to aggressive disease concerning for progression from initial presentation. Depending on the particular patient and goals of care, treatments similarly span the range from minimally invasive fulgurations to immediate radical cystectomy. For most patients some form of intravesical therapy will bridge the gap between transurethral resections (TUR) and radical surgery. Recent advances in the field continue to emphasize the importance of quality TUR and its strong impact on outcomes. In addition, continued research to optimize intravesical therapies has provided more information about how, when, and in whom these agents should be utilized to enhance their efficacy. This review covers the current state of NMIBC and the standards of care for the management of this disease.
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Affiliation(s)
- Matthew J Pagano
- Department of Urology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave., 11th Floor, New York, NY, 10032, USA,
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8
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Casey RG, Catto JW, Cheng L, Cookson MS, Herr H, Shariat S, Witjes JA, Black PC. Diagnosis and Management of Urothelial Carcinoma In Situ of the Lower Urinary Tract: A Systematic Review. Eur Urol 2015; 67:876-88. [DOI: 10.1016/j.eururo.2014.10.040] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/24/2014] [Indexed: 12/28/2022]
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9
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Lopez-Beltran A. Bladder cancer: Normal cystoscopy, malignant cytology in NMIBC: why biopsy? Nat Rev Urol 2014; 11:550-1. [PMID: 25155791 DOI: 10.1038/nrurol.2014.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Antonio Lopez-Beltran
- Department of Pathology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon 300-873, Portugal
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10
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Musser JE, O'Shaughnessy MJ, Kim PH, Herr HW. Bladder biopsy of normal-appearing mucosa is not helpful in patients with unexplained positive cytology after nonmuscle invasive bladder cancer. J Urol 2014; 193:48-52. [PMID: 24960468 DOI: 10.1016/j.juro.2014.06.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Malignant voided cytology with normal endoscopic evaluation represents a diagnostic and therapeutic challenge in many patients with a history of nonmuscle invasive bladder cancer. Bladder biopsy is often advised but its efficacy is unclear. We evaluated the usefulness of bladder biopsy in patients with unexplained positive cytology and describe recurrence patterns in this unique patient subset. MATERIALS AND METHODS From an institutional database we retrospectively identified patients with a history of nonmuscle invasive bladder cancer and surveillance cystoscopy from 2008 to 2012 who had malignant voided urine cytology but normal cystoscopy. Patients underwent 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 a total of 118 biopsies of normal-appearing bladder mucosa. Three biopsies (2.5%) showed carcinoma in situ and none revealed invasive carcinoma. During the median 32-month followup recurrence developed in the bladder in 194 patients (44%), in the upper tract in 24 (5%) and in the prostatic urethra in 5 (1%) while 219 (49%) had no recurrence. A previous diagnosis of upper tract urothelial carcinoma and a history of bacillus Calmette-Guérin treatment were associated with an increased recurrence risk on multivariate analysis. Recurrence rates and 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 the recurrence pattern.
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Affiliation(s)
- John E Musser
- Urology Service, Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York.
| | - Matthew J O'Shaughnessy
- Urology Service, Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York
| | - Philip H Kim
- Urology Service, Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York
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Metwalli AR, Kamat AM. Controversial issues and optimal management of stage T1G3 bladder cancer. Expert Rev Anticancer Ther 2014; 6:1283-94. [PMID: 16925494 DOI: 10.1586/14737140.6.8.1283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of T1G3 bladder cancer is controversial. Diagnostic methods, such as bladder mapping or second-look transurethral resection are recommended to assess risk. Bacillus Calmette-Guérin intravesical therapy with a maintenance regimen is recommended for solitary T1G3 tumors. The timing of radical cystectomy for these patients is controversial, but early recurrence during intravesical therapy is an indication for radical cystectomy. Multifocal disease, concomitant carcinoma in situ and disease in the prostatic urethra and bladder neck also suggest aggressive disease and cystectomy should be considered in these patients.
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Affiliation(s)
- Adam R Metwalli
- The University of Texas MD Anderson Cancer Center, Department of Urology, Unit 1373, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Digesu GA, Sadeghi P, Sharma S, Puccini F, Tubaro A, Fernando R, Khullar V. The importance of cystoscopy and bladder biopsy in women with refractory overactive bladder: the urogynaecologist's point of view? Eur J Obstet Gynecol Reprod Biol 2013; 169:408-11. [PMID: 23820140 DOI: 10.1016/j.ejogrb.2013.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/22/2013] [Accepted: 05/31/2013] [Indexed: 11/17/2022]
Affiliation(s)
- G Alessandro Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom.
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13
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[Endoscopic resection. Aspects of technique and optimization of outcomes. Current indications to PDD-guided resection]. Urologia 2013; 80 Suppl 21:16-9. [PMID: 23559133 DOI: 10.5301/ru.2013.10859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trans-Urethral Resection (TUR) of bladder tumors is the gold standard to make the correct diagnosis and remove all visible lesions. The strategy of resection depends on the size of the lesion. Small tumors can be resected en bloc, while larger tumors should be resected separately in fractions to obtain a correct pathological diagnosis. Random biopsies from normal-looking mucosa should be performed in patients with positive urinary cytology and absence of visible tumor in the bladder. As a standard procedure, cystoscopy and TUR are performed using white light. Photodynamic diagnosis (PDD) is most useful for detecting CIS, and therefore should be restricted to those patients with a suspected high-grade tumor.
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Smith PJ, Lotan Y, Raj GV, Sagalowsky AI, Margulis V. Assessing treatment response after induction Bacillus Calmette-Guerin for carcinomain situof the urinary bladder: can post-induction random bladder biopsies be avoided? Cytopathology 2013; 25:108-11. [DOI: 10.1111/cyt.12064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Affiliation(s)
- P. J. Smith
- Department of Urology; UT Southwestern Medical School; Dallas TX USA
| | - Y. Lotan
- Department of Urology; UT Southwestern Medical School; Dallas TX USA
| | - G. V. Raj
- Department of Urology; UT Southwestern Medical School; Dallas TX USA
| | - A. I. Sagalowsky
- Department of Urology; UT Southwestern Medical School; Dallas TX USA
| | - V. Margulis
- Department of Urology; UT Southwestern Medical School; Dallas TX USA
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Gillespie JA, O'Donnell MA. New imaging techniques for non-muscle invasive bladder cancer: ready for primetime. Urol Clin North Am 2013; 40:271-9. [PMID: 23540784 DOI: 10.1016/j.ucl.2013.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Treatment of non-muscle invasive bladder cancer (NMBIC) requires direct visual appreciation of the tumor. Transurethral resection that is dependent solely on white light cystoscopy (WLC) often fails to accurately stage or completely resect NMIBC. These deficiencies of WLC are significant contributors to the high rates of recurrence and eventual progression to muscle invasive disease. This article looks at technologies that are being used in adjunct to WLC to augment the urologist's ability to identify, stage, and treat NMIBC.
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Affiliation(s)
- Joseph A Gillespie
- Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA
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16
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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. J Urol 2012; 188:748-53. [DOI: 10.1016/j.juro.2012.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Indexed: 11/24/2022]
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17
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Lightfoot AJ, Rosevear HM, Nepple KG, O'Donnell MA. Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high-grade non-muscle invasive bladder cancer. Int J Urol 2012; 19:988-93. [DOI: 10.1111/j.1442-2042.2012.03089.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Mostafid H, Brausi M. Measuring and improving the quality of transurethral resection for bladder tumour (TURBT). BJU Int 2011; 109:1579-82. [DOI: 10.1111/j.1464-410x.2011.10638.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Expression of cell cycle-associated proteins in non-muscle-invasive bladder cancer: Correlation with intravesical recurrence following transurethral resection. Urol Oncol 2011; 29:495-501. [DOI: 10.1016/j.urolonc.2009.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/30/2009] [Accepted: 08/03/2009] [Indexed: 11/21/2022]
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20
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Librenjak D, Novakovic ZS, Situm M, Milostic K, Duvnjak M. Biopsies of the normal-appearing urothelium in primary bladder cancer. Urol Ann 2011; 2:71-5. [PMID: 20882158 PMCID: PMC2943684 DOI: 10.4103/0974-7796.65115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/04/2010] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study was to determine the incidence of "positive" findings in biopsies of the normal-appearing urothelium near primary cancer and their influence on therapeutic decisions. Materials and Methods: Between January 2001 and October 2008, in 230 patients with primary bladder cancer during initial resection of tumor, we also performed random biopsy of surrounding normal-appearing urothelium. We analyzed retrospectively the number and type of positive biopsy findings and their impact on further treatment. Results: There were 40% of patients (92/230) whose normal-appearing urothelium biopsy revealed pathological findings such as tumor tissue, Tis, and dysplasia. In 24.4% of patients, the stage of the primary tumor was Ta (32/131), in 50% it was T1 stage (30/61), and in 79% T2 stage (30/38). When we assessed the grade of malignancy, we found 18% of biopsies with G1 tumors (16/88), 33% with G2 tumors (19/59), and 69% with G3 tumors (57/83). Tumor tissue that was found in the normal-appearing urothelium in biopsy specimens in 13% of patients was in stage Ta (17/131), in 16% it was T1 stage (10/61), and in 39% of patients, the tumor was in T2 stage (15/38). Pathological findings of random biopsies were crucial in changing therapeutical decisions in 4.6% (9/192) of patients. Conclusion: Biopsy of the normal-appearing urothelial tissue is easy to perform and may help in identifying patients with high risk of disease progression and recurrence. Based on our results and results from the literature we recommend this simple tool as part of the routine management during transurethral resection of primary bladder cancer.
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Affiliation(s)
- Davor Librenjak
- Department of Urology, Clinical Hospital Center, School of Medicine, Soltanska 1, 21000 Split, Croatia
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21
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Sexton WJ, Wiegand LR, Correa JJ, Politis C, Dickinson SI, Kang LC. Bladder cancer: a review of non-muscle invasive disease. Cancer Control 2011; 17:256-68. [PMID: 20861813 DOI: 10.1177/107327481001700406] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Bladder cancer is one of the most common cancers affecting men and women and thus has a profound impact on health care. The majority of patients (75%) with newly diagnosed urothelial tumors have non-muscle invasive disease confined to the bladder mucosa or the lamina propria. METHODS The authors review the literature as well as recently published clinical guidelines regarding the bladder cancer risk and causative factors, diagnostic and pathologic evaluation, prognostic variables, and management strategies for patients with non-muscle invasive bladder cancer. RESULTS Recurrence and progression remain problematic for many patients and are dependent on multiple clinical and pathological features, the most important of which are tumor stage, grade, multifocality, size, recurrence patterns, and the association with carcinoma in situ. Accurate assessment of clinical stage and tumor grade is critical in determining management and surveillance strategies. Intravesical therapies positively influence tumor recurrence rates. Disease progression rates may be impacted in high-risk patients who receive both induction bacille Calmette-Guérin (BCG) and a maintenance BCG regimen. Cystectomy still plays a pivotal role in patients with high-risk tumors and in patients who fail more conservative attempts to eradicate non-muscle invasive disease. CONCLUSIONS Non-muscle invasive bladder cancers represent a broad group of tumors with varying biologic potential. Successful treatment depends on the careful integration of diagnostic and surveillance tests, macroablation through transurethral resection, accurate assessment of clinical stage, and the timely and appropriate delivery of intravesical chemotherapeutic and immunomodulatory agents.
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Affiliation(s)
- Wade J Sexton
- Genitourinary Oncology Program, Tampa, FL 33612, USA.
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Han J, Lin T, Xu K, Jiang C, Huang H, Yin X, Xie W, Yao Y, Zhang C, Huang J. Improved detection of nonmuscle invasive urothelial carcinoma of the bladder using pirarubicin endoscopy: a prospective, single-center preliminary study. J Endourol 2010; 24:1801-6. [PMID: 20932082 DOI: 10.1089/end.2009.0680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Fluorescence cystoscopy (FC) with intravesical instillation of a photosensitizing agent has emerged as an adjunctive and safe diagnostic tool with high sensitivity and reasonable specificity; however, it has not been widely accepted, because it is time-consuming and expensive. The aim of the present study was to determine whether the use of the fluorescent dye pirarubicin [(2"R)-4'-O-tetrahydropyranyl doxorubicin] (THP) in endoscopy can improve detection of nonmuscle invasive urothelial carcinoma of the bladder. PATIENTS AND METHODS Forty-eight patients with known or suspected bladder urothelial carcinoma were enrolled in this prospective study between January 2008 and April 2009. The Storz D-light system was used to detect fluorescence 15 minutes after intravesical instillation with 30 mg THP. Endoscopic findings, histopathologic evaluation of biopsy lesions, and adverse effects of THP were recorded. RESULTS After THP uptake, the lesions appear bright orange under white light, and produce bright red fluorescence under blue light. Among 238 biopsies evaluated (84 malignant, 20 dysplasia, and 134 benign), sensitivity of overall tumors, carcinoma in situ (CIS), and dysplasia detection using FC was 96% (81/84), 100% (6/6), and 90% (18/20), respectively. The specificity of FC was 74.7% (115/154), and its false-positive rate was 32.5% (39/120). No significant systemic side effects or allergic reactions were observed other than a few cases of mild cystitis. CONCLUSION THP endoscopy may improve the detection of nonmuscle invasive urothelial carcinoma of the bladder, especially CIS and flat lesions. Results indicate that THP is a promising fluorescent dye for diagnosis and follow-up of nonmuscle invasive bladder carcinoma. Moreover, it is inexpensive, easily available, simple to administer, and is associated with few side effects.
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Affiliation(s)
- Jinli Han
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Matsushima M, Kikuchi E, Hasegawa M, Matsumoto K, Miyajima A, Oya M. Clinical impact of bladder biopsies with TUR-BT according to cytology results in patients with bladder cancer: a case control study. BMC Urol 2010; 10:12. [PMID: 20591189 PMCID: PMC2912875 DOI: 10.1186/1471-2490-10-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 06/30/2010] [Indexed: 11/29/2022] Open
Abstract
Background There seems to be no consensus concerning taking bladder biopsies during transurethral resection of bladder tumor (TUR-BT). We investigate the clinical significance of bladder biopsy with TUR-BT and the relationship between urinary cytology and the biopsy results. Methods We reviewed a total of 424 patients with non-muscle invasive bladder cancer treated with TUR-BT between 1998 and 2005. Of the total, 293 patients also underwent a bladder biopsy. Biopsies from suspicious-appearing urothelium (N = 59) and those from normal-appearing urothelium (N = 234) were evaluated separately. Results Bladder cancer was observed in 23 cases (39.0%) who underwent a biopsy of suspicious-appearing urothelium. Among these 23 cases, 9 cases with visible tumor resection had carcinoma in situ (CIS) only in the biopsies from suspicious-appearing urothelium. Urinary cytology was negative in 3 of the 9 cases. Bladder cancer was observed in 26 cases (11.1%) who underwent a biopsy of normal-appearing urothelium. Of them, 5 cases with visible tumors had CIS only in the multiple biopsies from normal-appearing urothelium. Urinary cytology was positive in all of the 5 cases. No upstaging or upgrading cases were found in these patients by the addition of these two types of biopsy. Furthermore, therapy was not altered in these patients. With or without bladder biopsy was not a significant factor for tumor recurrence in either the univariate or multivariate analysis. Conclusions Based on the results, it is concluded the multiple biopsies from normal-appearing urothelium are not necessary in patients with negative cytology results because of the low detection rate and lack of influence on therapeutic decisions. Meanwhile, biopsy of suspicious-appearing urothelium is needed in patients with negative cytology results in order to detect CIS due to staging properties. This result supports a recent EAU guideline.
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Thorstenson A, Schumacher MC, Wiklund NP, Jonsson MN, Larsson P, Wijkström H, Onelöv E, Steineck G, De Verdier PJ. Diagnostic random bladder biopsies: reflections from a population-based cohort of 538 patients. ACTA ACUST UNITED AC 2010; 44:11-9. [PMID: 19958071 DOI: 10.3109/00365590903419020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess whether diagnostic random bladder biopsies and the detection of concomitant carcinoma in situ (CIS) have an impact on the frequency of intravesical bacille Calmette-Guérin (BCG) instillations or radical cystectomy; and whether this affects the cancer-specific survival in patients with pTaG3 or pT1G1-G3 transitional cell carcinoma of the urinary bladder. MATERIAL AND METHODS A population-based cohort of 538 patients with newly diagnosed bladder cancer was prospectively registered in the Stockholm County during 1995 and 1996 and followed for more than 5 years. RESULTS Random biopsies were recommended in all patients but the decision to take biopsies was made by the treating urologist and hence performed in 326 out of 538 patients (61%), which revealed concomitant CIS in 47 patients(14%). Sixty out of 103 (58%) patients with pTaG3 or pT1G1-G3 tumours, in whom random biopsies were performed, received intravesical BCG compared with five out of 22 patients (23%) where random biopsies were not taken (p = 0.004). Moreover, 23 out of 103 patients (22%) with pTaG3 or pT1G1-G3 tumours in whom random biopsies were performed underwent radical cystectomy compared with none out of 22 patients (0%) without random biopsies (p = 0.013). The Cox proportional hazard ratio for death due to bladder cancer in patients with pTaG3 or pT1G1-G3 tumours among patients not having versus having undergone random biopsies was 2.5 (95% confidence interval 1.1-5.6). CONCLUSION Patients diagnosed in Stockholm in 1995 or 1996 with pTaG3 or pT1G1-G3 bladder tumours having undergone random bladder biopsies more frequently underwent BCG treatment and radical cystectomy and had higher cancer-specific survival than patients who did not undergo random biopsies.
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Affiliation(s)
- Andreas Thorstenson
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska University Hospital, Stockholm, Sweden
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Bryan RT, Collins SI, Daykin MC, Zeegers MP, Cheng KK, Wallace DMA, Sole GM. Mechanisms of recurrence of Ta/T1 bladder cancer. Ann R Coll Surg Engl 2010; 92:519-24. [PMID: 20522307 DOI: 10.1308/003588410x12664192076935] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Bladder cancer recurrence occurs via four mechanisms - incomplete resection, tumour cell re-implantation, growth of microscopic tumours, and new tumour formation. The first two mechanisms are influenced by clinicians before and immediately after resection; the remaining mechanisms have the potential to be influenced by chemopreventive agents. However, the relative importance and timing of these mechanisms is currently unknown. Our objective was to postulate the incidence and timing of these mechanisms by investigating the location of bladder cancer recurrences over time. PATIENTS AND METHODS The topographical locations of tumours and their recurrences were analysed retrospectively for 169 patients newly-diagnosed with Ta/T1 bladder cancer, with median follow-up of 33.8 months. Tumours were assigned to one or more of six bladder sectors, and time to recurrence and location of recurrences were recorded. RESULTS Median time to first tumour recurrence was 40 months. Median times between subsequent recurrences were 6.6, 7.9, 8.0 and 6.6 months for recurrences 1 to 2, 2 to 3, 3 to 4, and 4 to 5, respectively. The risk of first tumour recurrence in any given bladder sector increased by nearly 4-fold if the primary tumour was resected from that sector (P < 0.001); this association was not significant for subsequent recurrences. The proportion of tumour recurrences in multiple bladder sectors increased from 13% for the first recurrence to 100% for recurrence seven onwards. CONCLUSIONS First tumour recurrence appears different to subsequent recurrences; incomplete resection and tumour cell reimplantation may dominate at this time-point. Only later does genuine new tumour formation appear to increase in importance. This has important implications for clinical trials, especially those involving chemopreventive agents.
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Affiliation(s)
- Richard T Bryan
- Department of Public Health, Epidemiology and Biostatistics, School of Population Sciences, University of Birmingham, Birmingham, UK.
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Hexaminolevulinate-Guided Fluorescence Cystoscopy in the Diagnosis and Follow-Up of Patients with Non–Muscle-Invasive Bladder Cancer: Review of the Evidence and Recommendations. Eur Urol 2010; 57:607-14. [DOI: 10.1016/j.eururo.2010.01.025] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 01/13/2010] [Indexed: 11/21/2022]
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Herr HW, Al-Ahmadie H, Dalbagni G, Reuter VE. Bladder cancer in cystoscopically normal-appearing mucosa: a case of mistaken identity? BJU Int 2010; 106:1499-501. [DOI: 10.1111/j.1464-410x.2010.09332.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sonn GA, Mach KE, Jensen K, Hsiung PL, Jones SN, Contag CH, Wang TD, Liao JC. Fibered confocal microscopy of bladder tumors: an ex vivo study. J Endourol 2009; 23:197-201. [PMID: 19196063 DOI: 10.1089/end.2008.0524] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The inadequacy of white-light cystoscopy to detect flat bladder tumors is well recognized. Great interest exists in developing other imaging technologies to augment or supplant conventional cystoscopy. Fibered confocal microscopy offers the promise of providing in vivo histopathologic information to help distinguish malignant from benign bladder lesions. We report the initial use of this technology to visualize tumors in the human bladder. MATERIALS AND METHODS We performed ex vivo fibered confocal imaging of fresh radical cystectomy specimens using the Mauna Kea Technologies Cellvizio system. The findings were compared with results from standard histopathology. RESULTS The bladders of four patients were imaged using the fibered confocal microscope. Normal and neoplastic urothelium manifested differences in cellular and vascular density. CONCLUSION This study demonstrates the feasibility of using fibered confocal microscopy to detect histologic differences between normal and neoplastic urothelium, and establishes a foundation for the use of fiber-based confocal microscopy in clinical studies.
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Affiliation(s)
- Geoffrey A Sonn
- Department of Urology, Stanford University School of Medicine, Stanford, California 94305-5118, USA
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30
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Fujimoto K. Corrigenda. Int J Urol 2009. [DOI: 10.1111/j.1442-2042.2009.02257.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karl A, Tritschler S, Stanislaus P, Gratzke C, Tilki D, Strittmatter F, Knüchel R, Stief CG, Zaak D. Positive urine cytology but negative white-light cystoscopy: an indication for fluorescence cystoscopy? BJU Int 2009; 103:484-7. [DOI: 10.1111/j.1464-410x.2008.08032.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Approaches to Carcinoma In Situ (CIS). Bladder Cancer 2009. [DOI: 10.1007/978-1-59745-417-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mitropoulos D, Adamakis I, Perimenis P. Contemporary diagnosis of bladder cancer. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2008; 2:713-720. [PMID: 23495780 DOI: 10.1517/17530059.2.6.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Early diagnosis of bladder cancer is mandatory, as a delay in treatment has been shown to affect prognosis. The current diagnostic standard of cystoscopy and cytology is costly, invasive and inconvenient, whereas advances in molecular biology have resulted in the evolvement of several markers. OBJECTIVE To review diagnostic considerations in the use of old and new technical modalities and tests for the detection of bladder cancer. METHODS A PubMed search of the literature concerning bladder cancer diagnosis was performed. Reviews are included on certain topics to avoid extensive reference to separate studies. CONCLUSION Recent technical advances have an impact on the management of patients with suspected bladder cancer. Cytology is still an important adjunct in the diagnostic work-up, whereas urine-bound tests may have a role in screening and surveillance. However, cystoscopy is the standard of care for the detection of bladder cancer. Fluorescence cystoscopy is an adjunctive tool, especially for the prompt identification of carcinoma in situ.
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Affiliation(s)
- Dionisios Mitropoulos
- Associate Professor of Urology University of Athens, Medical School, 1st Department of Urology, Mikras Asias 17, 115 27 Athens, Greece +30 210 7701141 ; +30 210 7701141 ;
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Schmidbauer J, Marberger M. Recent developments in fluorescence cystoscopy: do novel agents bring a benefit? Curr Opin Urol 2007; 17:347-51. [PMID: 17762629 DOI: 10.1097/mou.0b013e3282c8c73f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In flat bladder cancer and carcinoma in situ, and in multifocal papillary cancer, some smaller lesions may be overlooked at cystoscopy. For 10 years fluorescence cystoscopy has been promoted to solve these problems without wider acceptance. New fluorophobes now promise better clinical applicability. RECENT FINDINGS In prospective multicenter studies fluorescence cystoscopy shows significant improvement in the detection of flat bladder cancer and carcinoma in situ. It also permits more reliable identification of all neoplastic lesions with multifocal tumors, hence more precise removal and as a consequence lower recurrence rates. SUMMARY New agents bring a significant benefit. Hexyl-aminolevulinate offers more rapid urothelial accumulation, better fluorescence contrast and less photobleaching than previously used fluorophobes. It is simple to use in everyday practice and has a favorable toxicity profile.
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Affiliation(s)
- Jörg Schmidbauer
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Sedelaar JM, Witjes JA. Technique of TUR of Bladder Tumours: Value of Repeat TUR and Random Biopsies. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.eeus.2007.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pavone-Macaluso M, Lopez-Beltran A, Aragona F, Bassi P, Fitzpatrick JM. The pathology of bladder cancer: an update on selected issues. BJU Int 2006; 98:1161-5. [PMID: 16879435 DOI: 10.1111/j.1464-410x.2006.06445.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To achieve a closer relationship between urologists and pathologists and to use a common language and identical objectives in the pathology of bladder cancer. METHODS AND RESULTS Special emphasis was given to an analysis of the new World Health Organization (WHO) grading system, to the interpretation of the last Tumour-Nodes-Metastasis staging rules, and to identifying new markers of prognostic significance in clinical practice. A consensus was achieved on the main points. CONCLUSIONS The 2004 WHO grading system must become acceptable to clinicians, perhaps by a minimal modification of the present terminology. Simple transurethral resection-biopsy should be expressed in terms of clinical rather than pathological staging. Although there are substantial improvements, no new markers can be recommended for routine use in histopathology at present.
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Sengupta S, Blute ML. The management of superficial transitional cell carcinoma of the bladder. Urology 2006; 67:48-54; discussion 54-5. [PMID: 16530076 DOI: 10.1016/j.urology.2006.01.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 01/11/2006] [Indexed: 11/20/2022]
Abstract
Superficial transitional cell carcinomas (TCC) of the urinary bladder, defined as those that are restricted to the mucosa or the lamina propria, represent a common condition with a wide spectrum of biologic significance. High-grade superficial TCC, particularly in the presence of lamina propria invasion, has a significant risk of occult or subsequent progression to muscle-invasive or metastatic disease. Such high-risk lesions merit aggressive therapy with repeat resection followed by intravesical therapy, usually in the form of bacille Calmette-Guérin. Criteria for failure of intravesical therapy are not well defined, but persistent cytologic or cystoscopic abnormalities at 6 months are worrisome. Salvage intravesical therapy may sometimes be successful, but early cystectomy should be strongly considered, especially in younger patients. Close surveillance of patients with high-risk superficial TCC is essential.
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Affiliation(s)
- Shomik Sengupta
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Oosterlinck W, Solsona E, Akaza H, Busch C, Goebell PJ, Malmström PU, Ozen H, Sved P. Low-grade Ta (noninvasive) urothelial carcinoma of the bladder. Urology 2006; 66:75-89. [PMID: 16399417 DOI: 10.1016/j.urology.2005.07.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
This article discusses the development of international guidelines for the diagnosis, treatment, follow-up, and prevention of low-grade Ta urothelial carcinoma of the bladder. The authors, who are experts in this field from 3 continents and 7 countries, reviewed the English language literature through September 2004. The results of the authors' deliberations are presented here as a consensus document. The objective of this study was to determine the optimal diagnostic workup, treatment, follow-up, and prevention of low-grade, Ta urothelial carcinoma of the bladder. A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) met to critically review the literature on the diagnosis and treatment of low-grade Ta urothelial carcinoma of the bladder. Research was conducted using Medline; this search engine also was used to identify additional works not detected at the initial search. Evidence-based recommendations for diagnosis and management of the disease were made with reference to a 4-point scale. Low-grade Ta urothelial carcinoma of the bladder is a well-studied subject with many level 1 and 2 evidence references that support clinical practice. Findings from 135 reviewed citations are summarized. Many grade A and B recommendations on the diagnostic workup and management of this disease can be given with level 1 and 2 evidence based on prospective randomized clinical trials of sufficient statistical power. This should improve the quality of the treatment of this disease.
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Nieder AM, Brausi M, Lamm D, O'Donnell M, Tomita K, Woo H, Jewett MAS. Management of stage T1 tumors of the bladder: International Consensus Panel. Urology 2006; 66:108-25. [PMID: 16399419 DOI: 10.1016/j.urology.2005.08.066] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 08/12/2005] [Indexed: 11/25/2022]
Abstract
The International Consensus Panel on T1 bladder tumors markers reviewed the subject from a clinical perspective. From diagnosis to treatment decisions, what are the important issues in the management of a new patient? The assessment of prognostic factors for progression requires optimal resection and documentation. The role of immediate adjuvant intravesical chemotherapy after resection remains controversial. How often should the upper tract be assessed for tumor recurrence? The decision on whether to attempt bladder conservation with intravesical therapy or to perform a cystectomy is the most difficult issue in the management of superficial bladder cancer today. Finally, what therapies exist if initial intravesical bacille Calmette-Guérin fails to eradicate the disease or prevent recurrence? The panel thoroughly explored all these subjects and has made recommendations with supporting evidence.
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Affiliation(s)
- Alan M Nieder
- Department of Urology, State University New York, Stony Brook, New York, USA
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Eduardo Matheus W, Nardi Pedro R, Maia Oliveira RR, Ferreira U, Rodrigues Netto N. [Is there a place for randomized biopsies in the follow up of superficial transitional cell carcinoma of the urinary bladder?]. Actas Urol Esp 2005; 29:842-5. [PMID: 16353770 DOI: 10.1016/s0210-4806(05)73355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Transitional cell carcinoma of the bladder represents a disease of entire urothelial tract. The follow up is very important to detect any lesion that might represent a progression or a local recurrence. Some authors recommend randomized biopsies as a routine workup, others recommend cystoscopies and urinary cytology as the main part of superficial bladder cancer follow up. PATIENTS AND METHODS Forty nine patients with superficial bladder cancer were followed up during a ten-year period. Randomized biopsies and urinary cytology were harvested according to the international cancer protocol on bladder cancer. RESULTS 15 (1%) out of 1.489 randomized biopsies found to be positive to transitional cell carcinoma. Four out (10.5%) of 35 biopsies targeted to suspicious areas were positive to transitional cell carcinoma. 50 (17.4%) out of 288 cystoscopies with urinary cytology found to be positive to transitional cell carcinoma. Sensitivity and Specificity of biopsies (including randomized and targeted) were 31% and 85.2% respectively. Sensitivity and specificity of cystoscopies with urinary cytology were 48% and 86.5% respectively. CONCLUSION Randomized biopsies did not show to detect more local recurrence or progression when compared to the urinary cytology. Cystoscopies with urinary cytology have good sensitivity and specificity for detection of tumor recurrence during follow up of transitional cell carcinoma.
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Bassi P, Serretta V, Pinto F, Calpista A, Galuffo A, Dispensa N. Superficial Bladder Cancer Therapy: A Review. Urologia 2005. [DOI: 10.1177/039156030507200302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most bladder cancers present as a superficial disease, confined to the bladder mucosa or submucosal layer, without muscle invasion. Most superficial tumors have a propensity for recurrence after transurethral resection; some have a high risk for progression to muscle invasion. The treatment aim in superficial bladder cancer with intravesical therapy is three-fold: (1) eradicate existing disease, (2) prevention of recurrence, (3) prevention of tumor progression. The prognostic factors (tumor stage, grade, size, number and recurrence pattern) allow the stratification of tumors in different risk groups to plan treatment. Studies on pharmacokinetics have proved the efficacy of optimized drug delivery. Comparing resection with and without intravesical chemotherapy, a short-term reduction, approximately 15%, in tumor recurrence with chemotherapy can be obtained, but no effect on progression was proven. No agent has proved to be more effective than the others. A single instillation of chemotherapy immediately after transurethral resection has proven to be effective, but the role of maintenance therapy is controversial. Immunotherapy, in the form of Bacillus Calmette-Guerin, is generally shown to be more effective than chemotherapy, even if the results in comparison to mitomycin C do not result conclusive. Several new approaches are being explored to improve the efficacy of this therapy.
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Affiliation(s)
- P.F. Bassi
- Dipartimento di Scienze Oncologiche e Chirurgiche, Sezione di Clinica Urologia, Università degli Studi di Padova
| | - V. Serretta
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Sezione di Clinica Urologica Università degli Studi di Palermo
| | - F. Pinto
- Dipartimento di Scienze Oncologiche e Chirurgiche, Sezione di Clinica Urologia, Università degli Studi di Padova
| | - A. Calpista
- Dipartimento di Scienze Oncologiche e Chirurgiche, Sezione di Clinica Urologia, Università degli Studi di Padova
| | - A. Galuffo
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Sezione di Clinica Urologica Università degli Studi di Palermo
| | - N. Dispensa
- Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, Sezione di Clinica Urologica Università degli Studi di Palermo
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Abstract
TIG3 transitional cell carcinoma of the bladder represents a highly malignant tumor with a variable and unpredictable biologic potential. The most critical aspect of management requires a detailed discussion with the patient regarding the treatment options. Both the physician and the patient should be willing to reconsider the treatment options as the disease continues to evolve. In most cases initial management involves complete resection of the tumor, accurate staging of the disease, and intravesical immunotherapy or chemotherapy. Rigorous surveillance with long-term follow-up is crucial for managing these cases. In selected cases with adverse prognostic factors immediate cystectomy should be considered. The choice and timing of the decision to abandon bladder preservation and proceed with cystectomy should be continuously reconsidered on an individual patient basis, in concordance with the evolution of the disease (Fig. 1). The goal is to spare the bladder when possible but not at the risk of death from metastatic disease. Radical cystectomy in high-grade stage T1 transitional cell carcinoma offers excellent results in regard to the prevention of recurrence and progression and survival. Improvements in urinary diversion and nerve-sparing techniques have decreased the magnitude of social implications related to cystectomy in most patients regardless of gender. The discovery of reliable markers may contribute to better selection of patients for bladder sparing. Until then, the optimal treatment for the T1G3 tumor remains controversial.
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Affiliation(s)
- Murugesan Manoharan
- Department of Urology, University of Miami School of Medicine, 1400 NW 10th Avenue, # 506, Miami, FL 33136, USA
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Affiliation(s)
- Federico A Corica
- Department of Urology, Medical University of South Carolina,, Charleston, 29425, USA
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Lopez-Beltran A, Bassi P, Pavone-Macaluso M, Montironi R. Handling and pathology reporting of specimens with carcinoma of the urinary bladder, ureter, and renal pelvis. Eur Urol 2004; 45:257-66. [PMID: 15036668 DOI: 10.1016/j.eururo.2003.09.018] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2003] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Pathologists play a pivotal role in the diagnosis and in the report of the pathological features related to prognosis. METHODS To meet these endpoints, the following issues must be accomplished: adequate information about the patient history, proper handling of the specimens, identification of the reliable histopathological techniques necessary to reach the more detailed diagnostic information and evaluate the prognostic variables, and a standardized pathological report. RESULTS Recent efforts to standardize the histopathological evaluation have generated significant confusion among the urological and pathological communities as well. No consensus has been achieved about the optimal pathological grading of urothelial tumors, to date. CONCLUSION A proposal for standardization of sampling and reporting of the urothelial tissues achieved within Uropathology follows. The urologists have a great role in assisting pathologists in the proper examination by providing them with clinical information.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Pathology, Unit of Anatomic Pathology, Faculty of medicine, Cordoba University Medical School, Avda. Menendez-Pidal S/N, 14004 Cordoba, Spain.
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