[Whole layer needle biopsy for evaluation of neoadjuvant therapy to invasive bladder cancer]

The most important information for treatment of bladder cancer is to know its exact staging. A whole layer needle biopsy technique has been developed for this purpose. Recently, neoadjuvant therapy has been used for invasive bladder cancer. Although down staging of bladder cancer after neoadjuvant therapy are evaluated by CT or ultrasound, these imaging are not reliable. We examined 11 invasive bladder cancer patients by whole layer needle biopsy pre and post neoadjuvant therapy. All cases were pT3-4 by pretreatment biopsy. After neoadjuvant therapy 4 were changed to pT0 by needle biopsy, other cases were no change or minimal change. In 4 changed to pT0, 3 were done total or partial cyctectomy and the results of pathological diagnosis of cystectomized specimens were also pT0. Another one case changed to pT0 is selected as candidate for bladder sparing and the patient is now in close surveillance. All 4 cases changed to pT0 were done combined treatment by chemo (internal iliac artery infusion) and radiotherapy. In remaining 7 cases, pathological staging of surgical or autopsy specimen agreed with that of whole layer needle biopsy. Whole layer needle biopsy showed no severe complication, except minor bleeding from the bladder wall. Tumor seeding into the needle tract was not observed up to present time. In conclusion, this biopsy system is useful for evaluation of the change of stage with chemotherapy and/or radiation therapy. By using this technique we can select the cases for candidate of bladder sparing.