SIU 2017: Red Patches Seen during Endoscopic Surveillance of Bladder Cancer – When Should we Biopsy?

Lisbon, Portugal ( “Red patches” are a common finding on surveillance or initial cystoscopy that urologists are often concerned represent carcinoma-in-situ (CIS). However, bladder irritation, infection, or scope trauma can cause similar findings. 

In this study, the group from the UK retrospectively reviewed the charts of 4805 flexible cystoscopy reports over a 12 month period for the finding of “red patch.” Not every patient with the finding of “red patch” went on to biopsy, but they evaluate those that did.

241 flexible cystoscopies performed on 183 patients in that 12 year period had a finding of a red patch, of which 120 (49%) had a history of BCG therapy, and 85 (35.3%) went on to biopsy. Of the remaining, sixty (25%) had a repeat second-look flexible cystoscopy within 4-6 weeks, while 80 (37%) had a routine 3-month surveillance cystoscopy. 

Of the 85 who went on to biopsy, malignancy was found in 20 (23.5%) of the patients – 11 CIS and 9 pTa/T1 lesions. 

The diagnostic rate of 23.5% when biopsied is misleading as it represents such a small proportion of patients with red patches. Obviously, the intent of the authors is understood, but this does not really answer the question. In a highly select group, 23.5% had malignancy in a red patch. But, why did the remaining patients with red patches not get biopsy – what reassured the urologist that a biopsy was not warranted?

Further study is needed, but I doubt it will change management. Red patches on white light cystoscopy are difficult to assess. Perhaps the addition of blue light cystoscopy may help.

Presented by: Nkwam Nkwam

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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