The Sensitivity of Initial Transurethral Resection or Biopsy of Bladder Tumor(s) in Detecting Bladder Cancer Variants on Radical Cystectomy
Abd El-Latif A, Watts KE, Elson P, Fergany A, Hansel DE. J Urol. 2012 Oct 17. pii: S0022-5347(12)05283-4. doi: 10.1016/j.juro.2012.10.054. [Epub ahead of print]


Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH.



To determine the ability of bladder biopsy and transurethral resection of the bladder (TURB) to accurately predict bladder cancer variants on radical cystectomy (RC), as the presence of certain variants may affect prognosis and treatment.


We retrospectively evaluated 302 patients who underwent biopsy and/or TURB followed by RC between 2008-2010. The frequency of variant morphology and the sensitivity of the pre-cystectomy material was determined using the pathology at RC as the final result.


Bladder cancer variants were identified in 159 (53%) of patients either on initial biopsy/TURB, or on final pathology at RC, or both. The most common variant was urothelial carcinoma with squamous differentiation (n=72/159; 45%) followed by micropapillary urothelial carcinoma (n=41/159; 26%). In 9 patients (n=9/159; 6%), variant morphology was identified only on biopsy/TURB and not on final RC pathology. The remaining 150 patients (94%) showed variant morphology on RC, either with (79; 53%) or without (71; 47%) variant morphology on the preceding biopsy/TURB. The sensitivity of variant detection showed a broad range by variant subtype. Overall, the sensitivity of the initial biopsy/TURB was 39% in predicting variant morphology on RC.


Overall sensitivity in predicting bladder cancer variants from biopsy/TURB sampling is relatively low and is likely due to sampling and tumor heterogeneity, rather than inaccuracy in pathological diagnosis. Additional predictive markers of variant morphology may be useful in determining which tumors contain aggressive variants that may alter outcomes or therapy