Bladder biopsy quality linked to cancer survival

Research on the quality of bladder biopsy and bladder cancer survival point to problems of suboptimal biopsies and incorrect tumor staging, researchers say.

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What’s most concerning is the finding that surgeons performed inadequate biopsies or pathologists did not clearly state the extent of cancer invasion in about 50% of cases. Study authors found bladder cancer biopsies often lacked bladder wall muscle, making the material insufficient for accurately staging the cancer.

These findings, published online in Cancer (Oct. 22, 2014), suggest suboptimal biopsies and incorrect tumor staging were associated with a significant increase in deaths from bladder cancer.

“These findings are very important because while patients know about the stage of their cancer, they rarely question the quality of the biopsy,” first author Karim Chamie, MD, of UCLA, said in a press release.

Dr. Chamie and co-authors reviewed the biopsy and surgery reports of 1,865 patients diagnosed with noninvasive bladder cancer at Los Angeles County medical institutes in 2004 and 2005. The study sample included 335 urologists and 278 pathologists practicing in the county. They found:

• Muscle was present in 52.1% of biopsies studied, absent in 30.2%, and not mentioned in 17.7% of initial pathology reports.

• Patients who had aggressive tumors had a bladder cancer mortality rate of 8% in 5 years when their surgeons and pathologists appropriately staged them.

• The 5-year mortality rate rose to 12% when surgeons inadequately staged them but the pathologist alerted the physician about the inadequate staging. It climbed to 19% if the pathologist did not comment on the extent of the cancer invasion.

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“Appropriately staging patients with bladder cancer is a skill set that every urologist and pathologist should have in his/her armamentarium. We believe the next step is to change the staging system for bladder cancer to incorporate the quality of staging. Not all stage I cancers are alike. Some patients may have stage II cancer, but because the biopsy was insufficient, these patients were inaccurately staged and may be undertreated. I really do believe that one reason why we have yet to see significant improvement in bladder cancer survival over the last 2 decades may, in part, be attributed to inadequate staging,” Dr. Chamie said.

Dr. Chamie told Urology Times that before deciding on the type of treatment, patients newly diagnosed with nonmuscle-invasive bladder cancer should ascertain that muscle was included in the initial biopsy. If not present or not mentioned, they should have the specimen re-evaluated or consider proceeding with a repeat biopsy.

“Urologists should attempt to biopsy the underlying muscle to determine depth of invasion. While urologists should strongly be advised to repeat the biopsy for all patients with T1, a thorough initial resection will be [increasingly] relevant, especially in an era of total patient revenue programs,” Dr. Chamie said.

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