Jonker, L.T. (2015) De doelmatigheid van protocollaire blaasbiopten na BCG-inductie therapie bij hooggradig niet-spierinvasief urotheelcelcarcinoom van de blaas. thesis, Medicine.
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Abstract
Introduction The need for invasive and costly routine bladder biopsies after an induction course of intravesical Bacillus Calmette-Guérin (BCG) in patients with high grade non-muscle invasive bladder cancer is being questioned. Previous studies focused on differences in cystoscopic, cytologic and pathological results, whereas the clinical impact was disregarded. The aim of this study is to determine the impact of routine bladder biopsies on treatment. Methods This retrospective, multicenter study included 273 patients in an existing database with patients who had their BCG therapy evaluated between 2005 and 2014. Results of cystoscopy and/or cytology were compared with pathology outcomes. The influence of the malignancies missed by UCS and/or cytology on further treatment was analysed for a total of 348 patients and for the subgroups of patients with and without carcinoma in situ (CIS) separately. Secondary outcomes were costs and complications. Results Malignancies were found in 27/228 (11,8%), 19/216 (14%) and 8/92 (8,7%) of patients with normal cystoscopy in respectively all patients, patients with CIS and patients without CIS. This resulted in a radical cystectomy in only 6 (2,6%) patients, of which 5 (3,7%) with and 1 (1,1%) without CIS. In thirty-eight patients routine biopsies have to be done to effect therapeutic treatment in 1. Twenty-three of 348 (6,6%) transurethral biopsies were complicated. If biopsy was only done in our patients with cystoscopic abnormalities, approximately €436.908 would have been saved. Conclusion The decision to perform bladder biopsy should be made according to cystoscopic, cytologic and patient characteristics. Because of the small clinical impact and cost-effectiveness, routine bladder biopsies in evaluation of BCG treatment is not recommended.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Jong, Prof. Dr. I.J. de |
| Supervisor name: | Luijendijk, Drs. D. and Uroloog Martini Ziekenhuis Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/712 |
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