MP38-03 XPERT BLADDER CANCER MONITOR AND NARROW BAND IMAGING IN ROUTINE FOLLOW UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP38)1 Sep 2021MP38-03 XPERT BLADDER CANCER MONITOR AND NARROW BAND IMAGING IN ROUTINE FOLLOW UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER Lukas Hefermehl, Venkat Ramakrishnan, Andreas Schoetzau, Uwe Rogel, Daniel Disteldorf, Philipp Maletzki, Marc Hofmann, Jean-Pascal Adank, Kurt Lehmann, and Gad Singer Lukas HefermehlLukas Hefermehl More articles by this author , Venkat RamakrishnanVenkat Ramakrishnan More articles by this author , Andreas SchoetzauAndreas Schoetzau More articles by this author , Uwe RogelUwe Rogel More articles by this author , Daniel DisteldorfDaniel Disteldorf More articles by this author , Philipp MaletzkiPhilipp Maletzki More articles by this author , Marc HofmannMarc Hofmann More articles by this author , Jean-Pascal AdankJean-Pascal Adank More articles by this author , Kurt LehmannKurt Lehmann More articles by this author , and Gad SingerGad Singer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002053.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Continuous follow-up after the treatment of non-muscle invasive bladder cancer (NMIBC) is mandatory for early recurrence detection. This study investigates the clinical relevance of new diagnostic tools such as an mRNA-based urine test (Xpert© Bladder Cancer Monitor, Cepheid, USA) and Narrow Band Imaging© (NBI, Olympus) and compares them to the established follow-up methods. METHODS: This was a prospective single-center study involving patients undergoing NMIBC screening with enrollment from January 2018 to March 2020; the follow-up concluded in January 2021. Aside from performing the standard of care, including conventional white light cystoscopy (WLC), cytology, and sonography, patients also submitted urine for the XPERT© urine test and underwent NBI cystoscopy. These latter two tests were compared against WLC and the anatomic pathology in cases of NMIBC recurrence. Follow-up data were included in cases in which (a) WLC findings were ambiguous and pathology was postponed, or (b) in instances where XPERT© yielded a positive result while WLC was negative. According to the manufacturer, the XPERT© cut-off value (COV) for a positive result was set at a linear discriminant analysis (LDA) value of 0.5. The sensitivity (SE), specificity (SP), positive an negative predictive values (PPV, NPV) and median LDA values for tumor negative and tumor positive low- (LG) and highgrade (HG) lesions were calculated. SE and SP for different XPERT© LDA thresholds were also calculated. RESULTS: 301 patients were enrolled during the study period. 49 patients demonstrated NMIBC disease recurrence. In this subset, NBI cystoscopy was congruent with WLC in all patients. Cytology harbored an SE and SP of 27% and 97% (PPV: 65%; NPV 0.87%), respectively, whereas with XPERT©, the SE and SP were 58% and 89% (PPV: 51%; NPV: 92%; AUC: 0.79 (0.76-0.871)). Assessment of higher XPERT© LDA thresholds elicited higher SE and accordingly lower SP (for e.g., when the LDA was raised to 0.76, the SE was 98% and SP was 40%; when LDA was further raised to 1.0, the SE was 99% while SP was 23%). The overall median LDA values in a tumor negative setting was 0.33 (0.17 – 0.45); in an overall tumor positive bladder, the median LDA was 0.56 (0.35 – 0.95), while LG disease exhibited an LDA of 0.38 (0.26 – 0.52) and HG disease was 0.85 (0.51 – 1.06) (p < 0.001). A subgroup analysis revealed better SE but similar SP (PPV, NPV) for HG compared to LG recurrence, where SE was 74% and SP of 89% (39%, 97%) vs. SE of 33%, and SP of 89% (21%, 94%). CONCLUSIONS: NBI cystoscopy does not necessarily offer any additional benefit to standard WLC, and WLC remains the gold standard for visualization in NMIBC surveillance. Yet, the XPERT© Bladder Cancer Monitoring platform may confer better sensitivity and a diagnostic advantage in high grade, but not low grade, disease recurrence. Source of Funding: No direct financial support. Tests were provided by Cepheid/Axonlab © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e693-e693 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lukas Hefermehl More articles by this author Venkat Ramakrishnan More articles by this author Andreas Schoetzau More articles by this author Uwe Rogel More articles by this author Daniel Disteldorf More articles by this author Philipp Maletzki More articles by this author Marc Hofmann More articles by this author Jean-Pascal Adank More articles by this author Kurt Lehmann More articles by this author Gad Singer More articles by this author Expand All Advertisement Loading ...