title: Biopsy of the red patch at cystoscopy: is it worthwhile?
abstract: OBJECTIVE
  At cystoscopy red patches of urothelium are commonly seen within the bladder and frequently biopsied in order to exclude carcinoma in situ (CIS), which classically presents as a red, velvety patch. This appearance however is not specific and it is possible that many lesions are biopsied without significant benefit to the patient. The objective of this study was to determine whether routine biopsy of red patches seen in the bladder at cystoscopy is warranted.
  
  
  METHODS
  193 biopsies were taken from red patches seen at flexible and rigid cystoscopy during a 4-year period from December 1997 to January 2002 and examined by histopathology. Patients included in the study were those on cystoscopic follow-up for transitional cell carcinoma (TCC) of the bladder and those undergoing investigation for haematuria or lower urinary tract symptoms.
  
  
  RESULTS
  In 193 (17.7% of total biopsies) red patch biopsies, malignancy was found in 23 (11.9%) and 18 of 23 (78.3%) were CIS. No malignancies were detected in red patches from patients under the age of 60 years.
  
  
  CONCLUSIONS
  Red patch biopsy yields a positive finding of malignancy in 12% and was concluded to be a valuable exercise, particularly in those over the age of 60 years and on follow-up for TCC.
authors.affiliation: Department of Urology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Swinn
authors.forename: M M
authors.initials: MM
authors.lastname: Walker
authors.forename: L J
authors.initials: LJ
authors.lastname: Harbin
authors.forename: J M
authors.initials: JM
authors.lastname: Adshead
authors.forename: R O'N
authors.initials: RO
authors.lastname: Witherow
authors.forename: J A
authors.initials: JA
authors.lastname: Vale
authors.forename: A
authors.initials: A
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery