title: Assessing treatment response after induction Bacillus Calmette-Guerin for carcinoma in situ of the urinary bladder: can post-induction random bladder biopsies be avoided?
abstract: OBJECTIVE
  Patients diagnosed with bladder carcinoma in situ (CIS) and treated with intravesical Bacillus Calmette-Guerin (BCG) often undergo post-induction random bladder biopsies to assess treatment response. We sought to determine the correlation between post-induction urinary cytology/cystoscopy and histopathological findings obtained by random bladder biopsies.
  
  
  METHODS
  Patients who were treated with BCG between 2006 and 2010 for CIS, had surveillance cystoscopy and cytology, and subsequently underwent random bladder biopsies were selected for analysis. Patients with a history of or concomitant urothelial cell carcinoma (UCC) stage T1 or higher were excluded. Cystoscopic finings were characterized as follows: negative - no mucosal erythema, raised lesions or papillary tumours; suspicious - mucosal erythema, but no raised lesions or papillary tumours; and positive - sessile or papillary tumours. The accuracy of cytology in predicting the results of subsequent random bladder biopsies was analysed.
  
  
  RESULTS
  Of 21 patients included, surveillance cystoscopy findings were characterized as negative in nine, suspicious in seven and positive in five. Of 16 patients with negative/suspicious cystoscopy, 13 had agreement between cytology and biopsy, nine of whom were negative and four positive. Three of 16 patients had positive cytology, but negative biopsies; on further investigation of these three, one had CIS and two subsequent UCC. In the positive cystoscopy group, four of five patients had agreement between cytology and biopsy, two of whom were negative and two positive. One of the five patients had negative cytology, but a positive biopsy.
  
  
  CONCLUSIONS
  Our data suggest foregoing random bladder biopsies in patients with negative urine cytology and no evidence of intravesical recurrence on cystoscopy following an induction course of BCG for CIS of the urinary bladder.
authors.affiliation: Department of Urology, UT Southwestern Medical School, Dallas, TX, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Y
authors.initials: Y
authors.lastname: Lotan
authors.forename: G V
authors.initials: GV
authors.lastname: Raj
authors.forename: A I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: V
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000328:Adult; D001500:BCG Vaccine / Q000008:administration & dosage; D001706:Biopsy; D002278:Carcinoma in Situ / Q000473:pathology / Q000628:therapy*; D003558:Cystoscopy; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology
chemical_list: D001500:BCG Vaccine
keywords: BCG; biopsy; carcinoma in situ; cystoscopy; cytology; urothelial cell carcinoma