SIU 2017: Dynamic Real-Time Microscopy of Bladder Neoplasms Using Confocal Laser Endomicroscopy

Lisbon, Portugal ( In this study, the authors assess the role of random bladder biopsies. While recent guidelines have already indicated the role of random bladder biopsies (typically in setting of positive cytology but negative cystoscopy, or in consideration of partial cystectomy), the authors complete a single institution assessment of predictors of positive bladder biopsies. 

Over a 9 year period at a single institution, random bladder biopsies were obtained at the time of initial resection in 229 patients. It is not made clear if it was 229 consecutive patients or selected patients – patient selection was not indicated. Random bladder biopsies were taken from seven locations: bladder trigone, posterior wall, dome, right lateral, left lateral, anterior wall and bladder neck. It is unclear if this was done prior to or after resection of the primary lesions. In terms of outcomes, they evaluated the relationship between the random bladder biopsies, the characteristics of the primary tumor/lesion, urine cytology, and patient predisposing factors. 

In terms of patients, patients were primarily male, age 71, with a smoking history. Most had negative cytology, though 31 has suspicious and 35 had grossly positive cytology. Random biopsy was positive in 70 cases. On univariate analysis of factors associated with positive random bladder biopsies, positive/suspicious urine cytology, abnormal appearance, smoking history, pT1 (vs. pTa), and high grade cancer were all associated with higher chance of positive RBB. On MV analysis, all except smoking history remained statistically significant.

What this study fails to assess is the added benefit of RBB over traditional TURBT? Did the biopsies find anything that would have changed management? Are there any subsets for whom we should consider adding RBB to white light cystoscopy?

The NMIBC guidelines section of the SIU-ICUD Session on Bladder Cancer highlights the indications for RBB. This was presented by Dr. Kassouf earlier in this conference. 

Presented by: Yiping Zhu 

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd, at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal

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