MP65-10 THE IMPACT OF FROZEN BIOPSY OF BLADDER TUMOR BED DURING TRANSURETHRAL RESECTION: A RANDOMIZED PROSPECTIVE TRIAL

INTRODUCTION AND OBJECTIVES: Despite recent improvements of bladder cancer treatment, recurrence and progression rates are still high, possibly related to residual or overlooked tumors at the first transurethral resection (TURBT), which strongly emphasizes the importance of this method. In order to improve the effectiveness, we sought to evaluate the impact of frozen section during TURBT, aiming on increasing muscular layer sample in the specimen, which may minimize incomplete resections and understaging. METHODS: We prospectively included 150 consecutive patients assigned to TURBT which were randomized to undergo either frozen biopsy of the tumor bed until muscle was obtained or standard resection procedure. Nineteen patients were excluded after randomization, leaving 131 for analysis. All patients repeated TURBT 4-6 weeks later. Frozen sections and final pathology reports were performed by an uropathologist. Exclusion criteria: incomplete resection at first TURBT, no criteria for repeat TURBT according to AUA Guideline and previous bladder cancer treatment (Biopsy Group, n 1⁄4 64; Control Group, n1⁄467). RESULTS: Both groups were comparable regarding age, gender, size and number of lesions. All patients in the biopsy group had muscle layer represented in the final pathology at TURBT, while only 59% of patients in the control group (p <0.001) and muscle-invasive disease was higher in this first group (23% x 3%, p1⁄40,001). Ninety percent of patients in the biopsy group had no residual tumor compared to 65% of the control group at repeat TURBT (p1⁄40,003). While all 15 patients in the biopsy group with T2 disease were diagnosed at first TURBT, only 2 of 6 patients (33%) in the control group were diagnosed initially. There were no significant differences between groups regarding complications and surgery duration. CONCLUSIONS: Our results support the prove of principal that standard TURBT with frozen biopsy of bladder tumor bed increase the disease control and T2 tumors diagnosis, which may lead to reduced number of patients in need a second TUR and avoid pT2 disease diagnosis delay. Stage in Repeat TURBT x Group