Bladder biopsy (PG038)

Bladder biopsy — is a procedure for taking tissue fragments from the mucous membrane or wall of the bladder for histological analysis. It is most often performed during cystoscopy (TUR biopsy) when suspicious areas, ulcers or neoplasms are detected. Code PG038 means pathomorphological examination of the obtained material to establish an accurate diagnosis.

Research objective: The main task is to morphologically confirm the nature of the changes in the bladder. Since it is visually difficult to distinguish between chronic cystitis, precancerous conditions (carcinoma in situ) or invasive cancer, biopsy is the only reliable diagnostic method that determines the further treatment strategy.

What does the pathologist evaluate:

• Epithelium type: assessment of the condition of the urothelium and detection of signs of dysplasia (precancerous changes).

• Presence of atypia: search for malignant cells and determination of their degree of aggressiveness (Grade according to the WHO classification).

• Depth of invasion: assessment of whether the tumor has grown into the submucosa or muscle layer (a critical indicator for TNM staging).

• Inflammatory processes: diagnosis of specific forms of cystitis (for example, interstitial or follicular).

• Vascular invasion: the presence of tumor cells in blood and lymphatic vessels.

Clinical significance: The pathologist's report divides patients into two main groups: those with non-muscle-invasive cancer (which can be treated endoscopically) and those with muscle-invasive cancer (which usually requires radical removal of the organ or aggressive chemotherapy). The study also allows for early detection of cancer at stage 0 (in situ), which significantly improves the prognosis.

When is it prescribed:

• the presence of neoplasms or ulcers detected by ultrasound, CT scan or cystoscopy;

• prolonged macrohematuria (presence of blood in the urine) without an apparent cause;

• suspected bladder cancer with positive urine cytology results;

• chronic cystitis that does not respond to standard treatment;

• monitoring the condition of the mucosa after a course of intravesical chemotherapy or BCG therapy.