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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