Khadhouri Sinan, Gallagher Kevin, MacKenzie Kenneth R, Shah Taimur T, Gao Chuanyu, Zimmermann Eleanor, Mannas Miles, Lee Taeweon, Marra Giancarlo, Gomez Rivas Juan, Marcq Gautier, Assmus Mark A, Ucar Taha, Claps Francesco, Boltri Matteo, Pizzuto Giuseppe, Burnhope Tara, Nkwam Nkwam, Tanasescu George, Boxall Nicholas E, Downey Alison P, Sukhu Troy A, Antón-Juanilla Marta, Rai Sonpreet, Moore Madeline, Bandeira de Mello Kathryn, Parsons Sian, McGrath John S, Kasivisvanathan Veeru
University of St Andrews St Andrews United Kingdom.
Western General Hospital Edinburgh United Kingdom.
BJUI Compass. 2025 Jan 6;6(1):e475. doi: 10.1002/bco2.475. eCollection 2025 Jan.
To assess the contemporary malignancy rate in isolated de novo red patches in the bladder and associated risk factors for better selection of red patch biopsy.
Patients from the IDENTIFY dataset; Patients referred to secondary care with suspected urinary tract cancer and found to have isolated de novo red patches on cystoscopy.
We reported the unadjusted cancer prevalence in isolated de novo red patches that were biopsied; multivariable logistic regression was used to explore cancer-associated risk factors including age, sex, smoking, type of haematuria, LUTS, UTIs and a suspicious-looking red patch (as reported by the cystoscopist). Sub-analysis of these by clinical role and experience was performed.
A total of 1110 patients with isolated de novo red patches were included. 41.5% (n = 461) were biopsied, with a malignancy rate of 12.8% (59/461), which was significantly higher in suspicious versus non-suspicious red patches (19.1% vs. 2.81%, p < 0.01). There was a significant association between bladder cancer and age (OR 1.04, 95% CI 1.01-1.07, p = 0.01), smoking history (OR 2.62, 95% CI 1.09-6.27, p = 0.03) and suspicious-looking patch (OR 6.50, 95% CI 2.47-17.1, p < 0.01). The majority of malignancies were in over 60-year-olds. Malignancy rates in suspicious versus non-suspicious red patches did not differ significantly between clinical roles or experiences.Limitations included subjectivity in classifying a suspicious patch and selection bias as not all patches were biopsied.
Many patients still undergo unnecessary biopsies under general anaesthetic for isolated de novo red patches. Clinicians should consider the patient's age, smoking status and how suspicious-looking the patch is, before deciding on surveillance versus biopsy to improve cancer diagnostic yield.
评估孤立性原发性膀胱红色斑块的当代恶性肿瘤发生率及相关危险因素，以更好地选择红色斑块活检。
来自IDENTIFY数据集的患者；因疑似尿路癌转诊至二级医疗机构且膀胱镜检查发现有孤立性原发性红色斑块的患者。
我们报告了接受活检的孤立性原发性红色斑块的未调整癌症患病率；采用多变量逻辑回归分析来探究癌症相关危险因素，包括年龄、性别、吸烟、血尿类型、下尿路症状、尿路感染以及膀胱镜检查医生报告的可疑红色斑块。按临床角色和经验进行了亚组分析。
共纳入1110例有孤立性原发性红色斑块的患者。41.5%（n = 461）接受了活检，恶性肿瘤发生率为12.8%（59/461），可疑红色斑块的恶性肿瘤发生率显著高于非可疑红色斑块（19.1%对2.81%，p < 0.01）。膀胱癌与年龄（OR 1.04，95%CI 1.01 - 1.07，p = 0.01）、吸烟史（OR 2.62，95%CI 1.09 - 6.27，p = 0.03）和可疑斑块（OR 6.50，95%CI 2.47 - 17.1，p < 0.01）之间存在显著关联。大多数恶性肿瘤发生在60岁以上人群。可疑与非可疑红色斑块的恶性肿瘤发生率在临床角色或经验方面无显著差异。局限性包括可疑斑块分类的主观性以及选择偏倚，因为并非所有斑块都进行了活检。
许多患者仍因孤立性原发性红色斑块在全身麻醉下接受不必要的活检。临床医生在决定进行监测还是活检以提高癌症诊断率之前，应考虑患者的年龄、吸烟状况以及斑块的可疑程度。
