The role of fluorescence in situ hybridization to predict patient response to intravesical Bacillus Calmette–Guérin therapy for bladder cancer

Bao, Yige; Tu, Xiang; Chang, Tiancong; Qiu, Shi; Yang, Lu; Geng, Jiwen; Quan, Liuliu; Wei, Qiang

doi:10.1097/md.0000000000012227

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…A systematic review (14 studies with 2960 patients) showed a sensitivity for bladder cancer of 76% (95% confidence interval (CI) 65–84%), and a specificity of 85% (95% CI 78–92%) [ 25 ]. This test is technically challenging and expensive, but it has been suggested that this test can predict response to BCG treatment [ 26 ], future tumour recurrences in high-risk NMIBC [ 27 ], and even progression of bladder cancer [ 28 ]. A simple and quick and cheap point of care test that has been used is the Nuclear Matrix Protein (NMP) 22 test (Matritech).…”

Section: Urinary Markersmentioning

confidence: 99%

Follow-up in non-muscle invasive bladder cancer: facts and future

Witjes¹

2020

World J Urol

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Patients with non-muscle invasive bladder cancer (NMIBC) have high recurrence and progression rates in spite of tumor resection and adjuvant instillation therapy. To detect recurrences and progression, these patients remain under frequent follow-up. Follow-up, however, is not well defined. Frequency and duration of follow recommendations are based on low levels of evidence, which is illustrated by clear differences in these recommendations per guideline, even when specified per risk group. Additionally, follow-up is recommended with cystoscopy and cytology in selected patients, which both have clear limitations. Fact is that follow-up in NMIBC is too frequent, with low levels of evidence and suboptimal tools, and it is patient unfriendly and costly. Improved cystoscopy techniques are unproven or impractical in the outpatient follow-up setting. Urinary markers have been around for decades, but never widely used in clinical practice. New (epi)genetic markers, however, could play a significant role in future follow-up of NMIBC. They have been shown to have very high negative predictive values for recurrences in follow-up of NMIBC, especially high-grade recurrences. Several studies suggested that these markers could be used to adapt follow-up cystoscopy frequency. What still needs study and confirmation is the cost-effectiveness of the use of these markers, which is highly dependent on health care costs per country and marker price. In all, however, implementation of these new urinary markers after confirmation of current results might significantly reduce patient burden and health care costs in the near future without reducing quality.

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Section: Urinary Markersmentioning

confidence: 99%

Follow-up in non-muscle invasive bladder cancer: facts and future

Witjes¹

2020

World J Urol

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“…Our results showed that the overall sensitivity of FISH for detection NMIBC recurrence was 68%, and the specificity was 64%, among studies whose patients did not receive BCG treatment, the pooled sensitivity was 82% and specificity was 63%, which indicated that BCG instillation may interfere with the FISH result. Possible explanations given for the lower accuracy for BCG instillation patients noted in the current study might be attributed to: (1) Follow-up time: longer follow-up time resulting in higher recurrence rate [ 21 , 52 ]. However, the follow-up time between BCG instillation studies and non-BCG instillation studies in our research has no statistical difference (95% CI: −14.19–8.00; p = 0.54).…”

Section: Discussionmentioning

confidence: 99%

The Role of Fluorescence In Situ Hybridization in the Surveillance of Non-Muscle Invasive Bladder Cancer: An Updated Systematic Review and Meta-Analysis

et al. 2022

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Background: Fluorescence in situ hybridization (FISH) has become a popular biomarker for subsequent monitoring the recurrence of non-muscle invasive bladder cancer (NMIBC), several studies have investigated the ability of FISH to detect recurrence in the surveillance of NMIBC. However, the results were inconsistent. Methods: We conducted a systematic literature search extensively on authenticated databases including PubMed/Medline, Embase, Web of Science, Ovid, and Cochrane Library. Meta-analysis was performed to find out the sensitivity and specificity of FISH in predicting recurrence of NMIBC. Results: 15 studies were ultimately included in this meta-analysis, a total of 2941 FISH evaluations from 2385 NMIBC patients were available. The pooled sensitivity of FISH was 68% (95% CI: 0.58–0.76), and the pooled specificity was 64% (95% CI: 0.53–0.74). Subgroup analyses were performed in 7 studies without Bacillus Calmette–Guerin (BCG) treatment, the pooled sensitivity was 82% (95% CI: 0.68–0.90), and the pooled specificity was 63% (95% CI: 0.37–0.82). And in 9 studies using “UroVysion standard” to define positive FISH results showed a pooled sensitivity of 60% (95% CI: 0.50–0.70) and specificity of 70% (95% CI: 0.61–0.78). Conclusions: The findings of this study indicate that FISH has a satisfactory sensitivity (68%) and specificity (64%) and could be a potential biomarker in the surveillance of NMIBC. Moreover, BCG treatment and different FISH methods may have an impact on the sensitivity and specificity, these factors should be taken into account when making clinical strategy.

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“…Efforts to predict response to BCG treatment also include the use of urinary and tissue molecular markers [24][25][26][27]. Unfortunately, none of them has yet entered routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Assessing treatment response after intravesical bacillus Calmette–Guerin induction cycle: are routine bladder biopsies necessary?

et al. 2021

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Purpose To determine the need for routine bladder biopsies (BBs) in assessing response to the induction cycle of intravesical bacillus Calmette–Guérin (BCG) for high-risk non-muscle-invasive bladder cancer (NMIBC). Methods Our prospectively maintained NMIBC database was queried to identify patients with high-risk disease (carcinoma in situ, high-grade Ta/T1) who underwent BBs after BCG induction cycle. Urine cytology, cystoscopy, and BBs findings were evaluated. Results A total of 219 patients met the inclusion criteria. Urine cytology was positive in 20 patients and negative in 199; cystoscopy was positive in 35 patients, suspicious in 32 and normal in 152 patients. BBs yielded bladder cancer (BCa) in 43 (19.6%) patients, with a BCa rate of 9.3% in patients with negative cytology and cystoscopy as opposed to 38.0% in patients whereby one or both exams were suspicious/positive. The diagnostic accuracy of urine cytology, cystoscopy, and combined tests was 0.56, 0.70, and 0.71, respectively. The negative predictive value of combined tests was 90.7%. Performing BBs only in patients with positive cytology and/or positive/suspicious cystoscopy would have spared 140 (64%) patients to undergo this procedure while missing BCa in 13 (9.3%) of them, representing 30% of all BCa cases. Conclusion Performing BBs only in patients with positive cytology and suspicious/positive cystoscopy would spare 64% of un-necessary BBs but miss a non-negligible number of BCas. While no data are available regarding the potential consequences of missing such BCas, such information should be taken into account in patient’s counselling.

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The role of fluorescence in situ hybridization to predict patient response to intravesical Bacillus Calmette–Guérin therapy for bladder cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 13 publications

References 32 publications

Follow-up in non-muscle invasive bladder cancer: facts and future

Follow-up in non-muscle invasive bladder cancer: facts and future

The Role of Fluorescence In Situ Hybridization in the Surveillance of Non-Muscle Invasive Bladder Cancer: An Updated Systematic Review and Meta-Analysis

Assessing treatment response after intravesical bacillus Calmette–Guerin induction cycle: are routine bladder biopsies necessary?

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