Bladder Biopsy of Normal-Appearing Mucosa is Not Helpful in Patients with Unexplained Positive Cytology after Nonmuscle Invasive Bladder Cancer

Musser, John E.; O’Shaughnessy, Matthew J.; Kim, Philip H.; Herr, Harry W.

doi:10.1016/j.juro.2014.06.068

Cited by 8 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, it remains controversial whether random biopsies should be performed to identify CIS in mucosa that appears normal. An EORTC retrospective review found that 10% of random biopsy specimens were positive and proposed that when concurrent CIS is highly suspected, random biopsies are indicated only in instances of multiple tumors or positive cytology [34]. At our institution, the indication for random biopsy is widely applied to patients with UBC compared with that proposed by clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

TERT C228T mutation in non‐malignant bladder urothelium is associated with intravesical recurrence for patients with non‐muscle invasive bladder cancer

et al. 2020

View full text Add to dashboard Cite

Telomerase reverse transcriptase ( TERT ) promoter mutations are frequently found in tumors or urine from patients with urothelial carcinoma (UC). TERT promoter mutations are also detected in urine from patients with no evidence of cancer but are associated with subsequent UC development. Mutations in the TERT promoter are thought to be present in nonmalignant urothelium (NMU) during early stages of tumor formation prior to pathological change, but this has not been proven directly. In this proof‐of‐concept study, we investigated the clinical utility of TERT promoter mutation analysis in NMU of patients with non‐muscle‐invasive bladder cancer (NMIBC). This single‐institute study included 53 primary tumors and 428 systematic bladder biopsy specimens from 54 patients with NMIBC. All patients underwent systematic random biopsy and transurethral resection of the bladder tumor. Genomic DNA was analyzed for TERT C228T and C250T mutations using droplet digital PCR (ddPCR). The association between TERT promoter mutation of NMU and bladder recurrence was examined by the Kaplan–Meier method and Cox proportional hazards model. Of the 54 patients, 16 (29.6%) had a TERT C228T mutation and three (5.6%) had a TERT C250T mutation in NMU. Of 428 biopsy specimens, the TERT C228T mutation was detected in 9% (31/364) of normal urothelium, 27% (4/15) of urothelial dysplasia (UD), 50% (9/18) of UD suspicious for carcinoma in situ (CIS), and 58% (18/31) of CIS. During follow‐up (median: 3.7 years), 22 (40.7%) patients experienced bladder recurrence and five (9.3%) experienced disease progression. Cox proportional hazard analysis showed that TERT C228T mutation in NMU was significantly associated with bladder recurrence after adjustment for cofounding factors ( P = 0.0128). Thus, TERT C228T mutation was detected in NMU, which was a reliable independent prognostic factor of bladder tumor recurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

TERT C228T mutation in non‐malignant bladder urothelium is associated with intravesical recurrence for patients with non‐muscle invasive bladder cancer

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Therefore, the calculation of negative and positive predictive values was not feasible and Sn and Sp values must be interpreted with caution. This is a known difficulty, which has previously been described [22,23]. Also, the cytology samples were not centrally reviewed after initial reporting.…”

Section: Discussionmentioning

confidence: 99%

Limited Value of Bladder Wash Cytology During Follow-Up of Patients With Non-muscle Invasive Bladder Cancer

Bieri¹,

Kranzbühler²,

Wettstein³

et al. 2023

Cureus

View full text Add to dashboard Cite

We aimed to assess the performance of bladder wash cytology (BWC) in daily clinical practice in a pure follow-up cohort of patients previously diagnosed with non-muscle invasive bladder cancer (NMIBC). Materials and methodsWe analyzed 2064 BWCs derived from 314 patients followed for NMIBC (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). Follow-up investigations were performed using cystoscopy (CS) in combination with BWC. Patients with suspicious CS and/or positive BWC underwent bladder biopsy or transurethral resection. BWC was considered positive if malignant or suspicious cells were reported. Sensitivity (Sn) and specificity (Sp) were calculated for the entire cohort and separately for low-grade (LG) and high-grade (HG) tumors, and carcinoma in situ (CIS) subgroups. ResultsA total of 95 recurrences were detected, of which only three were detected by BWC alone. Overall, Sn and Sp of BWC were 17.9% and 99.5%, respectively. For LG disease, these numbers were 14.0% and 100%, and for HG disease, these were 22.2% and 99.1%, respectively. For patients with CIS at initial diagnosis, Sn and Sp were 11.0% and 71.4%, respectively. For isolated primary CIS, Sn was 50.0%, and Sp was 98.2%. ConclusionRoutine use of BWC in the follow-up for NMIBC is of limited value even in HG tumors. In the presence of isolated primary CIS, adjunct BWC might be justified.

show abstract

“…Patients on adjuvant MIBC trials are at risk not only for metastases, but also for recurrent or second primary tumors arising at new locations in the remaining urothelial tract. Diagnostic studies used to detect local urothelial cancer recurrence (Table 3) should be considered and standardized during clinical trial design.…”

Section: Managing New Urothelial Tract Cancersmentioning

confidence: 99%

“…It is not clear that the biopsy of normal-appearing bladder urothelium is of any benefit if results of urine cytologic and cystoscopic examination are normal …”

Section: Managing New Urothelial Tract Cancersmentioning

confidence: 99%

Eligibility and Radiologic Assessment in Adjuvant Clinical Trials in Bladder Cancer

et al. 2019

View full text Add to dashboard Cite

To harmonize eligibility criteria and radiographic disease assessments in clinical trials of adjuvant therapy for muscle-invasive bladder cancer (MIBC).METHODS National experts in bladder cancer clinical trial research, including medical and urologic oncologists, radiologists, biostatisticians, and patient advocates, convened at a public workshop on November 28, 2017, to discuss eligibility, radiographic entry criteria, and assessment of disease recurrence in adjuvant clinical trials in patients with MIBC. RESULTSThe key workshop conclusions for adjuvant MIBC clinical trials included the following points: (1) patients with urothelial carcinoma with divergent histologic differentiation should be allowed to enroll; (2) neoadjuvant chemotherapy is defined as at least 3 cycles of neoadjuvant cisplatin-based combination chemotherapy; (3) patients with muscle-invasive, upper-tract urothelial carcinoma should be included in adjuvant trials of MIBC; (4) patients with severe renal insufficiency can enroll into trials using agents that are not renally excreted;(5) patients with microscopic surgical margins can be included; (6) patients should undergo a standard bilateral lymph node dissection prior to enrollment; (7) computed tomographic (CT) imaging should be performed within 4 weeks prior to enrollment. For patients with renal insufficiency who cannot undergo CT imaging with contrast, noncontrast chest CT and magnetic resonance imaging of the abdomen and pelvis with gadolinium should be done; (8) biopsy of indeterminate lesions to evaluate for malignant disease should be done when feasible; (9) a uniform approach to evaluate indeterminate radiographic lesions when biopsy is not feasible should be included in any trial design; (10) a uniform approach to determining the date of recurrence is important in interpreting adjuvant trial results; and (11) new high-grade, upper-tract primary tumors and new MIBC tumors should be considered recurrence events. CONCLUSIONS AND RELEVANCEA uniform approach to eligibility criteria, definitions of no evidence of disease, and definitions of disease recurrence may lead to more consistent interpretations of adjuvant trial results in MIBC.

show abstract

Bladder Biopsy of Normal-Appearing Mucosa is Not Helpful in Patients with Unexplained Positive Cytology after Nonmuscle Invasive Bladder Cancer

Abstract: Patients with malignant cytology despite normal cystoscopy have a high recurrence rate. Biopsy of normal-appearing bladder mucosa in this setting is rarely positive and does not alter the recurrence pattern.

Cited by 8 publications

References 12 publications

TERT C228T mutation in non‐malignant bladder urothelium is associated with intravesical recurrence for patients with non‐muscle invasive bladder cancer

TERT C228T mutation in non‐malignant bladder urothelium is associated with intravesical recurrence for patients with non‐muscle invasive bladder cancer

Limited Value of Bladder Wash Cytology During Follow-Up of Patients With Non-muscle Invasive Bladder Cancer

Eligibility and Radiologic Assessment in Adjuvant Clinical Trials in Bladder Cancer

Contact Info

Product

Resources

About