Historical and modern role of cystoscopy and bladder mucosal biopsy in detecting bladder cancer in a high-risk population.

The use of cystoscopy and bladder biopsy to screen cohorts of persons with no history of bladder carcinoma would be unsatisfactory because of the low prevalence of the disease, even in the highest risk occupations. Cystoscopy/biopsy should follow noninvasive modern-day techniques that can be used for screening at reasonable cost and no risk to the workers involved. Dipstick testing for hematuria, urinary cytology, flow cytometry, quantitative fluorescence image analysis, and other emerging technologies are far more useful as screening methods. Examples of bladder tumors and benign lesions are included to demonstrate the heterogeneity of bladder carcinoma and the difficulties the urologist faces in deciding which lesions may be malignant. Positive preliminary tests increase the sensitivity and specificity of the diagnostic examination.