The association of urothelial abnormalities with neoplasia: a 10-year followup.

More than 10 years ago we reported on the histological appearance and clinical significance of random biopsies of the intervening urothelium in 100 patients with transitional cell carcinoma of the bladder. Although the biopsied mucosa appeared normal cystoscopically a surprisingly large number of abnormalities were found: only 5 per cent of the patients had normal urothelium, 40 per cent had established carcinoma in situ and the remaining 55 per cent had changes described variously as cystitis glandularis, atypia and metaplasia. In the intervening decade these patients have been followed carefully and have been reviewed to determine their fate. Of the original 100 cases 92 were sufficiently well documented to make a meaningful analysis. The outstanding finding was that patients with carcinoma in situ had a significantly worse outcome statistically than those with normal mucosa or nonmalignant aberrations regardless of the characteristics of the primary tumor and its grade or stage (p less than 0.001). A detailed analysis is presented in relation to the clinical and experimental findings, suggesting that patients with carcinoma in situ associated with the primary tumor may require treatment to supplement the initial tumor resection.