Weerink, M. (Maud) (2014) Klinische waarde van protocollaire blaasbiopten na BCG-inductie bij patiënten met een niet-spierinvasief urotheelcelcarcinoom van de blaas. thesis, Medicine.
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Abstract
Introduction: Intravesical therapy with Bacillus Calmette-Guérin (BCG) plays an important role in the treatment of patients with high grade non-muscle-invasive bladder cancer. After an induction course of 6 BCG instillations, the effect is evaluated by standard bladder biopsies. Taking biopsies is an invasive and costly procedure. This study was conducted to evaluate to what extent the outcome of these biopsies influences the choice of treatment and if there are less invasive strategies to evaluate the effect of BCG. Methods: This retrospective study included 233 patients with high grade non-muscle-invasive bladder cancer, diagnosed between 2004 and 2013. After BCG induction, cystoscopy results were compared with biopsy outcomes. The influence of the found malignancies on therapeutic treatment was evaluated. Patients with and without carcinoma in situ (CIS) were analyzed separately. Results: After BCG induction, cystoscopy revealed no abnormalities in 67% of patients (122/181). However, in 10% (12) of these patients a malignancy was found in the bladder biopsies, resulting in 4 patients undergoing a cystectomy. Routinely performed bladder biopsies in patients with a normal cystoscopy led to a change of treatment in 1 out of 31 patients. In patients with CIS this was 1 out of 23. The negative predictive value of cystoscopy was 89% in patients with CIS and 94% in patients with bladder cancer without (concomitant) CIS. Conclusion: After BCG induction, 31 patients with a normal cystoscopy have to be biopsied to lead to a change of treatment in 1 of them. Therefore the necessity and cost-effectiveness should be questioned. An analysis of costs set against benefits, preferably expressed in QALYs, could indicate whether it is economically and socially acceptable to perform routine post-BCG biopsies.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Jong, Prof. Dr. I.J. de |
| Supervisor name: | Cornel, Dr. E.B. and ZIekenhuisgroep Twente |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1230 |
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