Small urothelial carcinoma: diagnosis and treatment by cold forceps biopsy

From 1987 to 1988 we used cold biopsy forceps to remove completely 92 urothelial neoplasms ranging from 0.3 to 3 mm. Rigid biopsy forceps were used. The urologist usually treats these bladder neoplasms by diathermy coagulation, which obviously makes histological study impossible. On the other hand, due to the small size of these lesions even removal with the cutting loop inevitably causes deep regressive modifications that prevent accurate morphological evaluation. Histological examination of the neoplasms removed revealed the presence of low to medium grade (stage Ta, grades 1 to 2) noninfiltrating papillary carcinoma in 75 cases, high grade (stage Ta, grade 3) noninfiltrating papillary carcinoma in 9 and medium to high grade (stage T1, grades 2 to 3) infiltrating papillary carcinoma in 8, 1 of which had areas of squamous cell carcinoma. This method enabled us to study the morphology of the urothelial lesions in the initial phase. In our study population the number of high grade lesions and/or lesions with early signs of infiltration (17 of 92) appears to be noteworthy despite the small size of the tumors.