News Feature | October 28, 2014

Biopsy Quality Is More Important Than You Think

By Chuck Seegert, Ph.D.


A new two-year study from UCLA researchers has demonstrated that poor biopsies are directly related to bladder cancer mortality rates. The results show that the inclusion of proper amounts of tissue can significantly improve treatment success.

Despite recent advances in cancer diagnostics, tissue biopsies remain the gold standard for diagnosing many types of the disease. Small specimens are taken from tumors and then examined by pathologists to determine the stage of the disease, which is a measure of how far the cancer has progressed. Early stage cancer is less developed and therefore easier to treat.

In some cases, however, a poor biopsy that doesn’t include a representative sample of the tumor can lead pathologists to believe that the disease is at an early stage — when it is actually much more advanced.

“These findings are very important because while patients know about the stage of their cancer, they rarely question the quality of the biopsy,” said Karim Chamie, an assistant professor of urology and surgical director of the bladder cancer program at UCLA, in a recent UCLA press release. “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.”

Retrospectively examining records that included 1,865 patients, 27 pathologists, and 335 urologists, an omission of muscle tissue was seen in about 30 percent of the cases, according to a study published by the team in the journal Cancer. Many times the biopsy only included the inner wall of the bladder, and not the deeper underlying muscle. If the cancer is invading, the deeper muscle tissue indicates to clinicians that they need to use more drastic treatments.

“Appropriately staging patients with bladder cancer is a skill set that every urologist and pathologist should have in his/her armamentarium,” Chamie said in the press release. “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.”

Adding better staging to the standard pathological analysis could have an effect on how well bladder cancer is treated. According to the press release, some of the research team thinks that a lack of decreases in bladder cancer mortality over the two 0last decades may be related to this diagnostic issue.

In addition to improving diagnostics for urologic cancers, advances are being made in the surgical treatments of these diseases. Recently in an article on Med Device Online, robotic surgeries for urologic cancer treatment were shown to decrease complications versus open surgery.

Image Credit: "Surgical breast biopsy" by Linda Bartlett