The importance of the biopsy of normal appearing bladder mucosa at the edge of primary tumour resection site

Introduction: European Association of Urology guidelines advocate separate biopsy of tumour base and edge during initial transurethral resection of bladder tumour (TURBT). Most evidence available analyse the prognostic value of random bladder biopsies rather than edge of resection site specifically.

Aim: To evaluate the incidence and significance of positive tumour edge biopsies at primary TURBT.

Methods: 22 cases of primary TURBT performed between October 2010 and October 2011 were retrospectively reviewed. All resections included a routine cold-cup biopsy of macroscopically normal mucosa at the resection edge. Data sources included histopathology reports and Multidisciplinary Team Meeting notes.

Results: Abnormal biopsy was found in 9 patients (41%). Carcinoma-in-situ (CIS) was found in 7 patients (32%) and in 2 cases (9%) biopsy results were corresponding with primary pathology indicating incomplete tumour resection.

Tumour edge biopsy effected management of 3 cases (22%). 2 patients (9%) with CIS received intravesical chemotherapy with Bacillus Calmette-Guerin (BCG) vaccine and 1 patient with incomplete resection underwent early check cystoscopy and biopsy within 3 weeks of primary resection. Those patients would otherwise have been scheduled for check cystoscopy at 3 months.

Conclusion: We believe that tumour edge biopsy should be standard practice at primary TURBT.