Routine slide reviews in bladder cancer patients need not be routine

Although routine, the practice of automatically reviewing pathology slides that accompany referred bladder cancer patients nets little gain for physicians or patients. In an overwhelming majority of instances, the practice does little more than add unnecessarily to the cost of treatment, according to a study presented here yesterday.

"Every patient with bladder cancer does not need his or her slides reviewed. Certainly, patients with T1 lesions do, but patients with low-grade superficial Ta lesions or obvious muscle-invasive lesions do not need to have their slides reviewed. Usually, patients scheduled for cystectomies are going to be re-examined with cytoscopy prior to radical surgery," study author Robert E. Weiss, MD, associate professor of urology at the Robert Wood Johnson Medical Center, NJ, told Urology Times.

Dr. Weiss asked whether this practice produced additional useful clinical information and, subsequently, whether the effort justified the cost. Both answers appear to be "No."

Dr. Weiss's team compared the pathologic type, stage, and grade of 49 cases from referring institutions to information from their review of the 206 slides. When the initial readings did not correlate with findings on review, patient charts were analyzed to determine if the interpretation from the review altered clinical decisions or outcomes.

Five (10%) of the 49 cases and 11 slides (5%) produced different interpretations on review. The diagnosis was downgraded or downstaged in each of the 11 slides. Four of five cases underwent workups that found significant disease leading to cystectomy in three patients and BCG treatment in one.

"In no case did the different interpretation lead to a change in management," the authors stated, noting that the cost of slide review per patient was $250, totaling $12,250 for the 49-patient series.