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67th Annual Meeting Abstracts
Does the Yield of Random Bladder Biopsies Justify Their Use in the Assessment of Patients Following Intravesical BCG Therapy??
*Matthew J Resnick, *Daniel J Canter, *Thomas J Guzzo, *Laurie Magerfleisch, S Bruce Malkowicz
University of Pennsylvania School of Medicine, Philadelphia, PA
Introduction: In this study we assessed the utility of random bladder biopsies in the evaluation of treatment failure following BCG therapy for non muscle-invasive (NMI) TCC.
Methods: We reviewed our database of patients with NMI bladder cancer and isolated 253 patients with TCC who underwent a 6-week course of BCG. Patients underwent cystoscopy and directed or random bladder biopsies based upon the presence or absence of suspicious findings on cystoscopy. The results were analyzed to assess the yield of random biopsies in the detection of treatment failure.
Results: A total of 253 patients were treated with 6-weeks of BCG for NMI TCC. Of the 84 patients who underwent directed biopsies, 13 (15.5%) were found to have TCC on pathologic evaluation as compared to 10 of 169 (5.9%) patients with a normal cystoscopic examination who underwent random bladder biopsies. The relative risk of cancer diagnosis was found to be 2.6 (95% CI 1.19-5.71, p<0.01). Positive urine cytology did not improve the yield of random biopsies. The overall sensitivity and specificity of cystoscopy for the identification of TCC were 56.5% and 69.1%, respectively. The positive predictive value of suspicious findings on cystoscopy was found to be 15.4% and the negative predictive value of a normal cystoscopy 94.1%.
Conclusions: While the use of directed biopsies is required to evaluate for the presence of persistent disease, the yield of random bladder biopsies is limited. Accordingly, careful consideration of the utility of such a practice is necessary in the evaluation of patients following BCG therapy.
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