Assessing treatment response after intravesical bacillus Calmette-Guerin induction cycle: are routine bladder biopsies necessary?
| Autor: | C Bettocchi, Luigi Cormio, Francesca Sanguedolce, Francesca Fortunato, Beppe Calò, Giuseppe Carrieri, Gian Maria Busetto, Ugo Falagario, Marco Chirico, Emanuel Carvalho-Diaz |
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| Rok vydání: | 2021 |
| Předmět: |
Nephrology
Male congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Treatment response Urology Biopsy Cytodiagnosis 030232 urology & nephrology 03 medical and health sciences 0302 clinical medicine Adjuvants Immunologic Predictive Value of Tests Internal medicine Cytology medicine Intravesical bacillus Calmette-Guerin Humans BCG response Neoplasm Invasiveness High-risk Bladder Cancer Urine cytology Aged Carcinoma Transitional Cell Bladder cancer medicine.diagnostic_test business.industry Carcinoma in situ Cystoscopy Middle Aged medicine.disease Administration Intravesical Treatment Outcome Bladder biopsy Urinary Bladder Neoplasms 030220 oncology & carcinogenesis NMIBC treatment BCG Vaccine Original Article Female business |
| Zdroj: | World Journal of Urology |
| ISSN: | 1433-8726 |
| Popis: | Purpose 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). Methods 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. Results 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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