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BACKGROUND:Patients with low-grade urothelial carcinoma (LGUC) are at risk of recurrence and must undergo lifelong surveillance. To date, cytology and cystoscopy are the gold standard for the detection of de novo and recurrent LGUC.The objective of the current study was is to further characterize the role of cytology and cystoscopy in determining the risk of recurrence and progression in these patients. METHODS: The authors retrospectively identified patients with LGUC who had urine cytology within 2 months of biopsy, and data were abstracted from their electronic charts. Electronic medical records were reviewed for cystoscopic findings and histologic and cytologic follow-up data over a 5-year period. Statistical analysis was performed with chi-square tests. RESULTS: In total, 76 patients were identified who had histologic follow-up material available, and 49% of those patients demonstrated progression or recurrence of urothelial carcinoma.The initial presence of multiple lesions on cystoscopy was associated with any recurrence or progression (67.7% vs 31%; P ¼ .002), tumor size >2 cm was associated with initial positive or suspicious urine cytology (23.8% vs 3.7%; P ¼ .076), and positive or suspicious initial cytology was associated with high-grade recurrence (58.3% vs 19.4%; P ¼ .009). CONCLUSIONS:Cystoscopic findings, such as the presence of multiple lesions, together with concurrent positive or suspicious urine cytology, were associated with recurrence or progression of LGUC. These findings may help to identify highrisk patients. Cancer (Cancer Cytopathol) 2013;121:398-402.

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