Correlation of cystoscopic impression with histologic diagnosis of biopsy specimens of the bladder

There is a paucity of information in the contemporary literature that would permit assessment of the urologist's ability to endoscopically discriminat e between benign and malignant lesions of the bladder or to predict the gra de and stage of papillary neoplasms. This prospective study evaluates the c orrelation between cystoscopic impression of urothelial lesions and final h istologic diagnoses. Sixty-four patients with 68 urothelial abnormalities r equiring formal biopsy or endoscopic resection were evaluated prospectively . At the time of endoscopy, treating urologists completed questionnaires do cumenting the surgeon's endoscopic impression of disease type and extent an d performed standard biopsy or resection of all suspicious lesions. Specime ns were submitted for routine histopathologic analysis, and the results wer e correlated with the questionnaire data. Endoscopic evaluation correctly d iscriminated between dysplastic/malignant and benign/reactive lesions in th is study with a sensitivity of 100%, specificity of 100%, and positive and negative predictive values of 100%. Urologists could not readily distinguis h between low- and high-grade papillary urothelial lesions and were frequen tly unable to determine if a tumor tvas invasive, particularly if the degre e of invasion tvas microscopic. Endoscopic impression at the time of bladde r biopsy or resection is accurate and discriminates between the presence an d absence of cancer. Endoscopic impression alone is a relatively poor stagi ng tool with respect to extent of invasive disease and must be coupled with careful histopathologic analysis of biopsy material, bimanual examination when appropriate, aid axial imaging for complete assessment of a given tumo r.