Patients with bladder cancer are more likely to die from the malignancy if they have suboptimal bladder biopsies, according to researchers.

A 2-year study of 335 urologists, 278 pathologists, and 1,865 patients by researchers at the University of California Los Angeles (UCLA) found that muscle tissue was reported as absent in 30.2% and was not mentioned in 17.7% of initial pathology reports. These omissions were associated with an increased mortality risk, especially among patients with high-grade disease.

The 5-year mortality rate for patients with high-grade tumors was 7.6% when muscle was present, 12.1% when muscle was absent, and 18.8% when muscle was not mentioned.

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 “Because urologists cannot reliably discern between high- and low-grade or Ta and T1 disease, we contend that patients with bladder cancer should undergo adequate muscle sampling at the time of endoscopic resection,” the authors concluded in a paper published online ahead of print in Cancer.

Compared with the presence of muscle in a biopsy sample, the absence of muscle was associated with a 48% increased risk of death from bladder cancer. When muscle was not mentioned in the initial pathology report, patients had a nearly 2-fold increased risk.

In a UCLA press release, first author Karim Chamie, MD, assistant professor of urology and surgical director of the bladder cancer program at the university, said the findings “are very important because while patients know about the stage of their cancer, they rarely question the quality of the biopsy. We hope these findings will help empower patients to ask about the quality of their biopsy and, if it is suboptimal, then urge their doctors to repeat the biopsy prior to deciding on what type of treatment to prescribe.”

Dr. Chamie said he believes the lack of a significant improvement in bladder cancer survival in the last 2 decades may be due in part to inadequate staging.

“Appropriately staging patients with bladder cancer is a skill set that every urologist and pathologist should have in his/her armamentarium,” Dr. Chamie said. “We believe the next step is to change the staging system for bladder cancer to incorporate the quality of staging. Not all stage I cancers are alike. Some patients may have stage II cancer, but because the biopsy was insufficient, these patients were inaccurately staged and may be undertreated.”

For the study, Dr. Chamie’s team reviewed the medical records of all patients diagnosed with non-invasive bladder cancer across medical institutes in Los Angeles County. The study cohort had a median age of 73 years; 76.5% of patients were male and 69.8% were white.