THE SIGNIFICANCE OF UROTHELIAL DYSPLASIA AS DIAGNOSED BY CUP BIOPSIES

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Abstract
A prospective study was carried out in which four quadrant cold cup biopsies of the bladder were taken from patients with either a bladder tumour (57) or irritative bladder symptoms (44), and a control group (23). Five histopathological patterns were recognized: normal urothelium, mild, moderate and severe dysplasia, and carcinoma in situ (CIS). In the control group, 22 of the 23 patients had normal urothelium, giving a 4% incidence of mild dysplasia. Of the 57 patients with all stages and grades of transitional cell carcinoma, 38 (67%) had dysplastic urothelium. This association is significant (P < 0.01, chi-squared). Thirty-seven patients had Ta or T1 tumors, and 24 (65%) of these had dysplasia, including four (11%) with CIS. Twenty patients had T2-T4, Grade 111 tumors and 14 (70%) of these had dysplasia, including five (25%) with CIS. There was no statistical difference between these two groups. The recurrence rate was evaluated for all patients presenting with a first bladder tumour. Seventy-three percent of patients with normal cup biopsies remained recurrence free during a mean follow-up of 3 years (s.d. 1.15 years). Of patients with dysplastic urothelium, 72% remained recurrence free over a mean follow-up of 3.25 years (s.d. 1.23 years). Hence, the presence of dysplasia did not predict the likelihood of tumour recurrence. Thirty patients had dysuria or suprapubic pain for which there was no explanation. Sixteen (53%) had dysplasia on cup biopsy including three (10%) with CIS (P < 0.01, chi-squared). It seems clear, therefore, that the dysplasia was the cause of these symptoms. The mean age of these patients was 53 years (s.d. 13.5) compared to a mean age of 63 years (s.d. 11.7) for those patients with both dysplasia and bladder tumour (P < 0.01, t test). This suggests that dyplasia precedes the development of transitional cell tumour by an interval of approximately 10 years.