CODE: 8.4 - Comparison of the quality of tru-cut biopsy and transurethral resection of the bladder tumour specimens in clinical staging of bladder cancer
Article published in Urologia Polska 2006/59/Suplement 1.
Piotr Chłosta 1, Tomasz Szopiński 2, Artur A. Antoniewicz 2, Jakub Dobruch 2, Tomasz Dzik 3, Janusz Kopczyński 4, Andrzej Borówka 1
- 1 Oddział Urologii, Świętokrzyskie Centrum Onkologii w Kielcach
2 Klinika Urologii, I Zespół Dydaktyki Urologicznej CMKP, Międzyleski Szpital Specjalistyczny w Warszawie
3 Zakład Patologii, Międzyleski Szpital Specjalistyczny w Warszawie
4 Zakład Patologii i Biologii Nowotworów, Świętokrzyskie Centrum Onkologii w Kielcach
- Introduction. Treatment of bladder cancer is influenced by clinical stage of a tumor. Transurethral resection of a bladder tumor (TURBT) and microscopic examination of the specimen are used to estimate the local stage of the tumor. Some solid, nonpapillary lesions seen during cystoscopy seem to be infiltrative, advanced bladder cancer. Transurethral, cystoscopically guided tru-cut biopsy offer simple way to confirm cancer infiltration of the bladder wall and enable to prepare better quality material for histopathological (HP) examination.
- Objectives. The aim of the this study is to compare the quality of transurethral tru-cut core biopsy and transurethral resection of the bladder tumour specimens in the diagnosis of bladder cancer detrusor muscle infiltration.
- Material and methods. 42 invasive bladder cancers (IBC) were analyzed. Radiological findings, bimanual examination and cystoscopy were suggestive of IBC in each patient. Transurethral, cystoscopically guided tru-cut biopsy was performed under anesthesia before planned, diagnostic TURBT. Rigid cystoscope with direct working channel and tru-cut automatic Cook 18 G / 48 cm needle or self constructed tru-cut 16 G / 40 cm adapted to work with standard biopsy gun were used. The average number of cores was 2 (1-3). TURBT specimens were fragmented as a standard procedure for: the tumour, margin and the bottom of electroresection. Histological quality of material from biopsy cores and TURBT were compared with the special regard to local stage and pathological grade of IBC. All specimens of biopsy cores underwent microscopic examination after hematoxylin and eosin staining and immunohistochemical examination (DAB) confirming the presence of cytokeratin and smooth muscle actine. IBC tru-cut biopsy and radical cystectomy specimens were also compared.
- Results. There were no complications of bladder biopsy procedure. The average length of cores was 15 mm (8-17 mm). In each case tru-cut cystoscopy guided bladder cancer biopsy revealed muscle infiltration which was in agreement with microscopic examinations of TURBT and radical cystectomy specimens. In six patients (14%) TURBT specimens revealed significant thermal tissue damages and crushed areas which suggested only the cancer infiltration. HP examination of tru-cut cores confirmed IBC in each case. HP examination of TURBT specimens confirmed clearly bladder wall infiltration in 36 (86%) patients. Invasive transitional cell cancer was found in 28 patients, squamous cell cancer in 3 patients and glandular cancer in one patient. Tumor grade (G) revealed by microscopic examination of tru-cut biopsy and radical cystectomy specimens were identical in 39 (93%) cases.
- Conclusions. Endoscopic tru-cut biopsy is simple, short and safe procedure which can be efficiently performed in patients with highly suggestive of muscle infiltration bladder tumor. Core bladder biopsy is less invasive than standard TURBT in diagnosis and staging of invasive tumors. It is effective in selected cases to confirm muscle involvement before radical cystectomy in order to avoid TURBT. The histological quality of tru-cut biopsy cores is significantly better than quality of TURBT specimens. Immunohistochemical examination based on cytokeratin and smooth muscle actin labeling enable to diagnose histological type of cancer and precise assessment of muscles invasion respectively (offers the simple way in different diagnosis between muscle and submucosal / membrane tissues infiltration).