The Significance of Biopsy of the Erythematous Lesion at Cystoscopy

Abstract

Purpose: At cystoscopy, bladder cancer shows various presentations; these are papillary, flat, elevated and ulcerated. Erythematous lesions could be carcinoma in situ (CIS), cancer or benign lesion, so biopsy should be done to exclude malignancy. However, this might cause many problems such as bleeding, inflammation and the added cost. The objectives of this study were to evaluate the significance of erythematous lesion biopsy at cystoscopy and to identify the factors related to the detection of bladder cancer. Materials and Methods: From January 1999 to June 2006, 337 biopsies were taken from the erythematous lesions seen at cystoscopy. We reviewed the pathologic results of the erythematous lesions. We also investigated the patients’ histories of bladder cancer, the urine cytology performed at cystoscopy, the intravesical therapy for bladder cancer and the complications after biopsy. A logistic regression analysis was performed to determine the factors associated with the diagnosis of bladder cancer. Results: In 337 erythematous lesion biopsies, malignancy was found in 36 (10.9%), and 19 of 36 (52.8%) were CIS. Among the benign lesions, chronic cystitis was most common. Bladder cancer was detected more often in patient with a history of transitional cell carcinoma (TCC) and in patients over the age of 65 years. Especially, a history of TCC was an independent risk factor for bladder cancer [odds ratio: 2.974, 95% confidence interval (CI): 1.163-7.604]. After biopsy, hematuria that was needed management occurred in 3.6% of the lesions. Conclusions: Erythematous lesion biopsy yields a positive finding of malignancy in 10.9% of the lesions and could be a valuable exam, particularly for the follow-up for TCC, and for patients over the age of 65 years. (Korean J Urol 2007;48:489-493)