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