Routine bladder biopsy after bacille Calmette-Guérin treatment: is it necessary?

Objectives: To evaluate the need for routine biopsy at first follow-up after intravesical bacille Calmette-Guérin (BCG) therapy for superficial transitional cell cancer of the bladder (TCCB). We examined the potential role of voided urine cytology and cystoscopy as screening tools to determine which patients should undergo biopsy.

Methods: The records of 71 patients with TCCB who received a total of 95 courses of BCG were reviewed. The pathology findings before BCG and the cystoscopic, voided cytologic, and biopsy results after BCG were recorded.

Results: In 54 cases, the cystoscopic and/or cytologic findings were abnormal. In 19 (35%) of these 54 cases, TCCB was found on biopsy after BCG. In 41 cases, both cystoscopy and cytology were normal. In 1 of these 41 cases, a small superficial low-grade TCCB was found on biopsy. An abnormality on voided cytology or cystoscopy was more likely to occur after treatment for carcinoma in situ.

Conclusions: Patients with papillary TCCB who have negative cystoscopic and negative urine cytologic results can safely be spared routine transurethral bladder biopsy with its associated cost and morbidity. However, patients with carcinoma in situ are very likely to have persistent abnormal cytologic or abnormal cystoscopic findings warranting investigation with biopsy and may benefit from routine scheduled biopsy.