Bladder cancer in cystoscopically normal-appearing mucosa: a case of mistaken identity?

Overview

OBJECTIVE: To test the frequency of malignancy in normal-appearing urothelium in patients with high-risk bladder cancer, as biopsy of normal-appearing mucosa using standard white-light cystoscopy (WLC) reportedly shows carcinoma in situ (CIS) in some patients with bladder tumours. PATIENTS AND METHODS: Cold-cup biopsies of normal-appearing mucosa were obtained by two experienced oncological urologists from 63 patients during transurethral resection of bladder cancers. Each biopsy labelled as 'normal' was interpreted by two expert uropathologists. RESULTS: Each of the biopsies in all 63 patients was interpreted by both urological pathologists as showing normal or benign histology, except that one showed focal CIS. CONCLUSIONS: Bladder urothelium appearing normal to expert urological oncologists using standard WLC rarely shows CIS when biopsies are evaluated by experienced uropathologists.