Department of Urology and Renal Transplantation, University of Foggia-Ospedali Riuniti of Foggia, Foggia, Italy.
Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy.
World J Urol. 2021 Oct;39(10):3815-3821. doi: 10.1007/s00345-021-03690-w. Epub 2021 Apr 8.
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).
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.
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.
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.
确定在评估膀胱内卡介苗（BCG）诱导周期对高危非肌肉浸润性膀胱癌（NMIBC）的反应时是否需要常规进行膀胱活检（BBs）。
我们通过前瞻性维护的 NMIBC 数据库，确定了接受 BCG 诱导周期后进行 BBs 的高危疾病（原位癌、高级 Ta/T1）患者。评估了尿液细胞学、膀胱镜检查和 BBs 的结果。
共有 219 名患者符合纳入标准。20 名患者的尿液细胞学阳性，199 名患者的尿液细胞学阴性；35 名患者的膀胱镜检查阳性，32 名患者的膀胱镜检查可疑，152 名患者的膀胱镜检查正常。BBs 在 43 名（19.6%）患者中发现膀胱癌（BCa），细胞学和膀胱镜检查均为阴性的患者的 BCa 发生率为 9.3%，而其中一项或两项检查可疑/阳性的患者的 BCa 发生率为 38.0%。尿液细胞学、膀胱镜检查和联合检查的诊断准确性分别为 0.56、0.70 和 0.71。联合检查的阴性预测值为 90.7%。仅在细胞学和/或膀胱镜检查可疑/阳性的患者中进行 BBs 检查，可以避免 140 名（64%）患者接受该检查，但会在其中 13 名（9.3%）患者中漏诊 BCa，占所有 BCa 病例的 30%。
仅在细胞学阳性和可疑/阳性膀胱镜检查的患者中进行 BBs 检查可以避免 64%的不必要 BBs 检查，但会漏诊相当数量的 BCa。虽然目前尚无关于漏诊这些 BCa 的潜在后果的数据，但在为患者提供咨询时应考虑到这些信息。
