1772 REFLEX FLUORESCENCE IN-SITU HYBRIDIZATION (FISH) ASSAY FOR ATYPICAL URINARY CYTOLOGY IN BLADDER CANCER PATIENTS UNDERGOING SURVEILLANCE CYSTOSCOPY

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial (II)1 Apr 20131772 REFLEX FLUORESCENCE IN-SITU HYBRIDIZATION (FISH) ASSAY FOR ATYPICAL URINARY CYTOLOGY IN BLADDER CANCER PATIENTS UNDERGOING SURVEILLANCE CYSTOSCOPY Philip H. Kim, Ranjit Sukhu, Billy H. Cordon, John P. Sfakianos, Daniel D. Sjoberg, Oscar Lin, Guido Dalbagni, and Harry W. Herr Philip H. KimPhilip H. Kim New York, NY More articles by this author , Ranjit SukhuRanjit Sukhu New York, NY More articles by this author , Billy H. CordonBilly H. Cordon New York, NY More articles by this author , John P. SfakianosJohn P. Sfakianos New York, NY More articles by this author , Daniel D. SjobergDaniel D. Sjoberg New York, NY More articles by this author , Oscar LinOscar Lin New York, NY More articles by this author , Guido DalbagniGuido Dalbagni New York, NY More articles by this author , and Harry W. HerrHarry W. Herr New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2862AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chromosomal changes in normal appearing urothelium may precede visual evidence of recurrence or progression in patients on surveillance for non-muscle invasive bladder cancer (NMIBC). We report the results of reflex UroVysion FISH testing in NMIBC patients with atypical cytology but negative cystoscopy. METHODS Patients on surveillance for NMIBC were followed with office flexible cystoscopy and urinary cytology every three to six months. Between March 2007 and February 2012, all surveillance patients with atypical cytology underwent reflexive FISH analysis. FISH was deemed uninformative if the submitted specimen did not have enough cells for analysis. All relevant clinical and pathologic data were reviewed. Recurrence-free (RFS) and progression-free survival (PFS) were estimated using Kaplan Meier analysis. Predictors for recurrence and progression were evaluated using univariate and multivariate Cox regression analyses. RESULTS Of 500 patients who had FISH ordered reflexively for atypical cytology results during surveillance for NMIBC, 243 also had negative cystoscopy. Median age was 66.5 (IQR 63, 77) and 202 (83%) were male. Prior NMIBC diagnosis was Ta, T1, and Tis-only in 106 (44%), 91 (37%), and 46 (19%) patients, respectively. 196 (81%) were high grade and 126 (52%) had carcinoma-in-situ (CIS). 155 (64%) patients had a history of any prior intravesical therapy, with 121 (50%) receiving BCG only. Initial FISH results were positive in 103 (42%), uninformative in 64 (26%), and negative in 76 (31%). Recurrence and progression occurred in 97 and 24 patients, with median follow up for survivors of 25 and 17.5 months, respectively. Differences in RFS were statistically significant by FISH result, with three-year recurrence rates of 34%, 43%, and 64% for patients with negative, uninformative, and positive FISH (p = 0.001, log rank test). On multivariate analysis, positive FISH result was a significant predictor of recurrence (HR 2.4, 95% CI 1.4, 4.0). Differences in PFS were also significant, with three-year progression rates of 7%, 8%, and 22% for patients with negative, uninformative, and positive results (p = 0.024, log rank test). In univariate analysis, positive FISH was also a predictor for progression (HR 3.9, 95% CI 1.3, 11.6). CONCLUSIONS Urinary FISH is a useful adjunct in the surveillance regimen for NMIBC patients with atypical cytology but negative cystoscopy. For these patients, positive FISH reflects an increased risk of recurrence and may warrant more frequent, long-term cystoscopic follow-up. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e728-e729 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philip H. Kim New York, NY More articles by this author Ranjit Sukhu New York, NY More articles by this author Billy H. Cordon New York, NY More articles by this author John P. Sfakianos New York, NY More articles by this author Daniel D. Sjoberg New York, NY More articles by this author Oscar Lin New York, NY More articles by this author Guido Dalbagni New York, NY More articles by this author Harry W. Herr New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...