The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer

Fernández, Mario; Parikh, Suhag; Grossman, H. Barton; Katz, Ruth L.; Matin, Surena F.; Dinney, Colin P.; Kamat, Ashish M.

doi:10.1016/j.urolonc.2010.08.006

Cited by 33 publications

(19 citation statements)

References 18 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, an individualized approach to these patients should be considered with diagnostic evaluation commensurate with the degree of clinical suspicion. The role of adjunctive tests such as UroVysion (Abbott Molecular Inc) may further improve the diagnostic accuracy of UCy . The number of patients in the current series among whom these tests were performed was small and not sufficient for statistical analysis; therefore, it remains to be determined whether these ancillary techniques will help to identify recurrent UCa in patients with a diagnosis of AUC, as has been suggested in other studies…”

Section: Discussionmentioning

confidence: 89%

“…Although the data for RRU are consistent with those reported in the literature, in which rates of urethral recurrence were reported to range from 6% to 10% 21,22 and upper urinary tract recurrence rates were lower (range, 1%-9%), [23][24][25][26] we found that UCy had higher sensitivity and specificity for RRU than those previously reported (sensitivity of 50%-80% and specificity of 85% to > 95%). 9,23,27 The slightly higher sensitivity for detecting RRU, without any loss in specificity, noted at the study institution may be explained by multiple factors, including the interest, experience, and expertise in urinary tract cytology of the cytopathologists practicing at this institution.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Urine cytology in monitoring recurrence in urothelial carcinoma after radical cystectomy and urinary diversion

Chen

Liu

Pambuccian

et al. 2015

Cancer Cytopathology

View full text Add to dashboard Cite

BACKGROUND:After radical cystectomy and urinary diversion (RC-UD), upper urinary tract and urethral recurrences of urothelial carcinoma (UCa) are reported to occur in 2% to 17% of patients. The objective of the current study was to determine the performance of urinary cytology (UCy) in the diagnosis of recurrences in the remnant urothelium (RRU) after RC-UD. METHODS: The authors retrospectively identified all patients who underwent RC-UD for UCa at the study institution from January 2002 to April 2014, and collected data from all available follow-up UCy and biopsies. Cytologies were classified as unsatisfactory, negative, suspicious, positive for malignancy, or atypical urothelial cells (AUC). The authors calculated the sensitivity, specificity, positive predictive value, and negative predictive value of suspicious or positive UCy for the diagnosis of histologically confirmed RRU. RESULTS: Of the 222 patients who underwent RC-UD for UCa of the urinary bladder during the study period, 111 had at least 1 follow-up UCy performed at the study institution, for a total of 477 UCy samples. During a mean follow-up interval of 40.8 months (range, 3-155 months), the RRU rate was 9.9% (11 of 111 patients). Positive/suspicious UCy results were noted in 12 of 111 patients, 9 of whom had RRU. A diagnosis of AUC was made in 8.6% of samples from 29 patients (41 of 477 samples). The sensitivity, specificity, positive predictive value, and negative predictive value of UCy for RRU were 82%, 97%, 75%, and 98%, respectively. Six of the 28 patients with diagnoses of AUC (21.4%) were eventually diagnosed with RRU. CONCLUSIONS: In the current series, UCy demonstrated good sensitivity and high specificity for the detection of disease recurrence of UCa after RC-UD. Cancer Cytopathol 2016;124:273-8.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 95%

Urine cytology in monitoring recurrence in urothelial carcinoma after radical cystectomy and urinary diversion

Chen

Liu

Pambuccian

et al. 2015

Cancer Cytopathology

View full text Add to dashboard Cite

show abstract

“…Of note, by contrast to prior series [51], recent studies report on high sensitivity and specificity rates of 80–82% and 85–97%, respectively, of urinary cytology for the detection of recurrences in the remnant urothelium after RC while urine analyses by fluorescence in situ hybridization do not result in higher accuracy rates [52,53]. A recent report by Yafi et al [54] investigated patterns of recurrence among 1890 patients treated with RC for bladder cancer.…”

Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

et al. 2017

View full text Add to dashboard Cite

Context Urothelial carcinoma is considered a pan-urothelial disease. As such, the remnant urothelium in the upper urinary tract and urethra following radical cystectomy (RC) remains at risk for secondary urothelial tumors (SUTs). Objective To describe the incidence, diagnosis, treatment, and outcomes of patients with SUTs after RC. Evidence acquisition A systematic search was conducted using PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2016 reporting on malignant diseases of the urothelium after RC for bladder cancer. The search strategy separated between upper and lower tract urothelial tumors. Evidence synthesis Of a total of 1069 studies, 57 were considered for evidence synthesis. SUTs occured in approximately 4–10% of patients after RC. Carcinoma in situ of the bladder, a history of nonmuscle invasive bladder cancer, and tumor involvement of ther distal ureter are the strongest risk factors for secondary upper tract tumors. Risk factors for secondary urethral tumors represent urothelial malignancy in the prostatic urethra/prostate and bladder neck (in women), nonorthotopic diversions, and positive findings on permanent sections. The majority of patients (84%) with SUTs, presented with urothelial recurrence without evidence of metastasis. Of those, 84.0% were treated with surgery, 10.5% with systemic chemotherapy and/or radiotherapy, and 5.6% with topical chemotherapy and/or immunotherapy. After a median follow-up of 91 mo (range: 26–155), 65.9% of patients died of disease and 21.5% died of other causes. Detection and treatment of SUTs at an asymptomatic stage can reduce the risks of cancer-specfific and overall mortality by 30%. A limitation of the study is that the available data were retrospective. Conclusions SUTs are rare oncological events and most patients have an adverse prognosis despite absence of distant disease at diagnosis. Therefore, surveillance of the remnant urothelium should be implemented for patients with histological features of panurothelial disease as it may improve timely detection and treatment. Patient summary Secondary tumors of the renal pelvis, ureters, and urethra occur in approximately 4–10% of patients after radical removal of the bladder for bladder cancer. These patients’ prognoses are reduced, likely due to delayed diagnosis. Therefore, routine surveillance might be important to detect tumors at an early stage.

show abstract

“…The role ofFISH in the surveillance ofUTUC remains controversial, due to its poor performance in detecting low grade tumors, and high false positive rate (34)(35)(36)(37). Use ofFISH should be limited to cases in which there is a clinical suspicion of UTUC but urine cytology and other diagnostic modalities are negative or equivocal.…”

Section: Cytology Specimensmentioning

confidence: 99%

Pathology of Upper Tract Urothelial Carcinoma with Emphasis on Staging

Mazzucchelli

Scarpelli

Galosi³

et al. 2014

Int J Immunopathol Pharmacol

View full text Add to dashboard Cite

The first two authors contributed equally to this work Classification of upper tract urothelial preneoplastic and neoplastic lesions mirrors that of the urinary bladder, with aU lesions of the bladder urothelium being possible in the upper tract and vice versa. There are three major groups of non-invasive urothelial neoplasms: flat, papillary, and inverted. These three groups share a similar morphological spectrum of intraurothelial changes, ranging from hyperplasia to dysplasia to carcinoma in situ. However, they differ in terms of architectural growth pattern compared to the surrounding non-neoplastic mucosal surface. Infiltrating urothelial carcinoma is defined as a urothelial tumor that invades beyond the basement membrane. Unlike in non-invasive papillary urothelial neoplasms (pTa), the role of histologic grade in pTl and higher stage tumors has been suggested to be of only relative importance. The vast majority of tumors of the upper urinary tract are urothelial carcinoma. More commonly seen, however, are foci ofsquamous differentiation and, less frequently, glandular differentiation. Pure urothelial carcinomas also display a wide range of variant morphologies, and recognition of these morphologies is important for diagnosis, classification, and prognosis.The pathology ofupper tract urothelial carcinoma (UTUC) is considered to be the same as that of urothelial carcinoma of the bladder (UCB) (1-3). While this assumption seems reasonable given that the histologic features of UTUC and UCB are microscopically identical, a growing body of evidence has begun to suggest that differences between these two cancers do exist (4). Nevertheless, studies specific to the pathology of UTUC remain rare and much of what is known about UTUC is derived from studies on UCB. CLASSIFICATION AND GRADINGUreteroscopic evaluation with biopsy is currently the gold standard for diagnosing tumors of the upper

show abstract

The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer

Cited by 33 publications

References 18 publications

Urine cytology in monitoring recurrence in urothelial carcinoma after radical cystectomy and urinary diversion

Urine cytology in monitoring recurrence in urothelial carcinoma after radical cystectomy and urinary diversion

Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy

Pathology of Upper Tract Urothelial Carcinoma with Emphasis on Staging

Contact Info

Product

Resources

About