Login to Access Video or Poster Abstract: MP10-06
Sources of Funding: None.

Introduction

Red patches in the bladder are often seen during endoscopic surveillance of bladder cancer at cystoscopy, particularly in patients who have had intravesical BCG treatment. However, it is difficult to distinguish BCG artefact from malignancy, namely carcinoma in-situ (CIS) in the absence of narrow band imaging or photodynamic diagnostics. Therefore, can we safely assume that histologically benign persistent red patches biopsied previously within a certain timeframe will remain benign entities? Our objectives are to establish whether the regular biopsy of red patches seen during endoscopic surveillance for bladder cancer is worthwhile and determine a suitable time frame for repeat biopsy of prior histologically benign persistent red patches in patients on endoscopic surveillance for bladder cancer.

Methods

4,805 flexible cystoscopy (FC) reports over a 12-month period (January - December 2015) were retrospectively reviewed at a UK tertiary teaching hospital and those undergoing cystoscopic surveillance for bladder cancer and found to have solitary red patches at flexible cystoscopy were included in the study. A proportion of these cases had biopsies taken which underwent histopathological analysis.

Results

241 flexible cystoscopies performed on 183 patients on endoscopic surveillance for bladder cancer had red patches and of these, 120 (49.8%) had a history of intravesical BCG therapy. Eighty-five patients (35.3%) underwent biopsy of the red patch. Malignancy was found in 20 biopsies (23.5%), of which, 11 out of 20 (55%) were CIS. Sixteen of these recurrences had been biopsied previously of which 11 (68.8%) were benign at last biopsy, 6 of which in the last 12 months. The remaining four recurrences had no previous biopsy. Eleven out of sixteen (68.8%) of recurrences were found in patients who had been biopsied within the last 12 months. No cases of malignancy were identified in patients with low-risk bladder cancer.

Conclusions

We recommend the biopsy of all red patches found during endoscopic surveillance of patients with intermediate/high risk bladder cancer due to the significant incidence of malignant recurrence identified, particularly if no biopsy has been performed within the previous 12 months due to the high yield of malignant recurrence identified. This is independent of previous biopsy histology.

Funding

None.