Routine bladder cancer slide reviews need not be routine

August 1, 2005

San Antonio--Although it may be routine at any number of tertiary care institutions and centers of excellence, the practice of automatically reviewing pathology slides that accompany referred bladder cancer patients nets little gain for either physicians or patients. In an overwhelming majority of instances, the practice does little more than add unnecessary dollars to the cost of treatment, according to a study presented at the 2005 AUA annual meeting here.

San Antonio-Although it may be routine at any number of tertiary care institutions and centers of excellence, the practice of automatically reviewing pathology slides that accompany referred bladder cancer patients nets little gain for either physicians or patients. In an overwhelming majority of instances, the practice does little more than add unnecessary dollars to the cost of treatment, according to a study presented at the 2005 AUA annual meeting here.

"Every patient who comes in 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 their slides reviewed," lead author Robert E. Weiss, MD, associate professor of urology at Robert Wood Johnson Medical Center, New Brunswick, NJ, told Urology Times. "Usually, patients scheduled for cystectomies are going to be re-examined with cystoscopy prior to radical surgery."

The questions Dr. Weiss and colleagues asked were whether the practice produced additional useful clinical information andwhether the effort justified the costs.

Different interpretations, same response

In cases in which the initial readings did not correlate with findings on review, the patients' charts were analyzed to determine if the interpretation derived from the review altered clinical decisions or outcomes.

Five (10%) of 49 cases and 11 slides (5%) produced different interpretations on review. The diagnosis was downgraded or downstaged in each of the 11 slides. One case was initially interpreted as muscle-invasive disease that could not be found on review. Four of five cases underwent workups that found significant disease leading to cystectomy in three patients and bacillus Calmette-Guérin treatment in one.

"In no case did the different interpretation lead to a change in management," the researchers wrote, adding that the cost of reviewing the slides was $250 per case, totalling $12,250 for the 49-patient series.

Dr. Weiss observed that community urologists are referring more invasive bladder cancer cases to larger centers.

"It is routinely required that a [slide] review should be part of a second opinion for patients with bladder cancer. We wanted to determine if this is necessary. We suggest that certain select patient slides be reviewed, but that it is not necessary in most cases. This will result in better clinical practice and economic savings."