Clinically significant tumor histology in suspected primary bladder cancer: is every transurethral resection necessary?

PURPOSE: Transurethral resection of bladder tumor (TURBT) is the standard for diagnosis and initial treatment of non-muscle-invasive bladder cancer (NMIBC) a disease with highly variable presentation. To evaluate the rate of malignancy in patients undergoing elective TURBT for suspected BC.

METHODS

A retrospective analysis of 217 patients undergoing primary TURBT for BC suspicion at our tertiary care center between January and June 2023 was performed.Key parameters included preoperative macroscopic cystoscopy findings, intraoperative macroscopic findings, and pathologic tumor characteristics from the TURBT specimen. The primary outcome was the detection rate of malignancy. Secondary outcomes included the correlation of the interobserver congruence on preoperative and TURBT findings. Multivariate logistic regression was performed to identify significant predictors of malignancy.

RESULTS

Of 217 patients, 35% had no malignancy in the TURBT specimen. Interobserver congruence was observed in 80.6% of cases. Papillary findings in the initial cystoscopy (Odds ratio (OR) = 5.6, 95% Confidence interval (CI) = 2.18-14.52, p < 0.001), age (OR = 1.057, 95%CI = 1.02-1.1 p = 0.002), interobserver congruence on preoperative and TURBT findings (p < 0.001, OR = 99.3, 95%CI = 10.9-903.9), and tumor size (OR = 1.9, 95%CI = 1.33-2.71, p < 0.001) were significant predictors for malignancy.

CONCLUSION

Direct TURBT may not be obligatory for all patients with suspicious bladder lesions. Our findings highlight the importance of a thorough preoperative diagnostic setup to avoid unnecessary procedures and spare the burden for patients. There is a need to establish more selective criteria for TURBT.