Second transurethral resection after Ta high-grade bladder tumor: a 4.5-year period at a single university center.

PURPOSE: We evaluated the results of second transurethral resections of the bladder (TURB) after pTa high-grade bladder cancer over a 4.5-year period. PATIENTS AND METHODS: From July 2007 to December 2011, 2,159 TURBs were performed at our institution, of which 1,143 were initial resections for primary bladder tumor or recurrence. Of these, 142 revealed pTa high-grade bladder cancer, and here we investigated tumor characteristics of initial TURB and results of second resection. RESULTS: The incidence of pTa high-grade tumor was 12.4% (n = 142). Of 87 patients who underwent a second resection, tumor was found in 36 (41.4%); tumors were multifocal in 25 (69.4%) and <3 cm in 29 (80.6%). Tumor was detected at the primary site in 38.9%, at other locations in 22.2%, and at both in 38.9%. Histology revealed pTa low-grade in 13 (14.9% of 87), pTa high-grade in 15 (17.2%), and pT1 in 5 (5.7%) patients. No muscle-invasive tumor was detected. A significant association was found for the number of tumors at initial TURB: in patients with tumor at second resection, 55.1% had had multiple tumors at first resection, more than twice those with solitary tumor (23.7%) (0.004). CONCLUSIONS: In our study, Ta high-grade tumors show a relevant rate of persistent tumor at second resection, most of them located at the primary tumor site. As recommended by the American and European clinical guidelines, patients with Ta high-grade tumor should undergo second resection.

Diagnostic Accuracy of Renal Mass Biopsy: An Ex Vivo Study of 100 Nephrectomy Specimens.

We investigated the diagnostic accuracy of renal mass biopsy in an ex vivo model, as well as compared the agreement of the preoperative radiological diagnosis with the final pathologic diagnosis. Two 18-gauge needle-core and 2 vacuum-needle biopsies were performed ex vivo from the tumors of 100 consecutive patients undergoing radical nephrectomy between 2006 and 2010. The median tumor size was 5.5 cm. There was no significant difference with regard to cylinder length or tissue quality between the sampling methods. At least 1 of 4 needle cores contained diagnostic tissue in 88% of patients. Biopsy specimens identified clear cell (54%), papillary (13%), or chromophobe (5%) renal cell carcinoma; urothelial carcinoma (6%); oncocytoma (5%); liposarcoma (1%); metastatic colorectal carcinoma (1%); squamous cell carcinoma (1%); unclassified renal cell neoplasm (1%); and no tumor sampled (12%). The sensitivity of the biopsy for accurately determining the diagnosis was 88% (95% CI: 79% to 93%). The specificity was 100% (95% CI: 17% to 100%). Biopsy grade correlated strongly with final pathology (83.5% agreement). There was no difference in average tumor size in cases with the same versus higher grade on final pathology (5.87 vs 5.97; P = .87). Appraisal of tumor histology by radiology agreed with the pathologic diagnosis in 68% of cases. Provided that the biopsy samples the tumor tissue in a renal mass, pathologic analysis is of great diagnostic value in respect of grade and tumor type and correlates well with excisional pathology. This constitutes strong ground for increasingly used renal mass biopsy in patients considering active surveillance or ablation therapy.