History Of Transitional Cell Carcinoma Research Articles

Case Report: Suspicions of metastasis in a patient with transitional cell carcinoma were revealed to be spinal tuberculosis

Background: Infection withMycobacterium tuberculosis(TB) is one of the major causes of mortality in developing countries. TB is primarily a lung disease, but can affect almost every organ of the body. Skeletal TB involves the bones or joints. In this report, we will introduce a patient with a medical history of transitional cell carcinoma (TCC) of the bladder that presented with spinal tuberculosis (Pott's disease).Case Report:The patient was a 74-year-old man with medical history of TCC of the bladder who had come to hospital due to severe weakness and sprains of lower extremities. Other symptoms noted by the patient included anorexia, weight loss (of 5 kg), and night sweats, but he did not complain of fever, coughs or respiratory symptoms. The lab data were as follows: WBC, 16/9*103; ESR, 88 mm/hr; CRP, 78mg/dl. Radiology findings revealed degenerative process in the L2-L3 lumbar vertebrae and disk. PCR and sample tissue culture results showed the presence ofMycobacterium tuberculosis.Conclusion:In the lesions of the lumbar vertebrae, even if there is another underlying disease, spinal TB should also be considered as a possibility. Furthermore, in patients with any type of cancer, any other organ conflict is not considered as metastasis, and tissue sampling should be provided because a change in the type of disease can influence prognosis.

NBI-assisted cystoscopy to improve follow-up of patients with transitional cell carcinoma of the bladder.

400 Background: Narrow Band Imaging (NBI) is a new technique of urethrocystoscopy, in which only a certain bandwidths of illumination (415 (blue) and 540nm (green)) of the spectrum is used to detect urothelial carcinoma. The aim of the investigation was to analyse the potential benefit of NBI in the follow up of patients with transitional cell carcinoma of the bladder. Methods: In the time between August 2013 until August 2014, patients with history of transitional cell carcinoma of the bladder, who presented for follow-up cystoscopy , were either examined via flexible white light endoscopy [WLE] plus second look WLE (n = 317, controls) or second look NBI-cystoscopy alone (n = 308) in the same session. Results: Rates of recurrences were similiar in both groups (NBI 95 (25%); WLE 85 (26.8%)). NBI after WLE identified more tumours in 21 patients (6.1 vs. 3.81). In 9 patients NBI showed no vascularization in suspicious areas. In the control arm, in 9 cases more tumours (4,67 vs. 3.33) were identified in the second WLE. After macroscopical identification of a recurrence, the time since the last resection was measured (WLE 10,67 months, NBI 16,85 months). Conclusions: While the number of patients with recurrent bladder cancer is not influenced by the use of NBI, the additional use of NBI in the follow-up cystoscopy of patients after transurethral resection of superficial bladder cancer (TUR) leads to an increased number of detected tumors. A part of the additionally detected tumors can be explained by the double examination. In addition NBI appears to provide a hint in individual cases whether a TUR is necessary at all.

Metastatic transitional cell carcinoma of the skin presenting as painful zosteriform eruptions

Metastatic skin disease is an uncommon manifestation of visceral malignancies and failure to diagnose this early may result in incorrect treatment. Here, we report a 65-year-old man with bilateral painful eruptions on the abdominal skin and a past history of transitional cell carcinoma of urinary bladder.

Inverted papilloma of the urinary tract

• To compare the clinical and pathological details of inverted papilloma (IP) of the urinary tract diagnosed in Western Australia with those published. • To determine whether urinary tract IP requires post-treatment cystoscopic follow-up. • Clinical and pathological details were summarized for 41 cases of IP of the urinary tract diagnosed in Western Australia between 1998 and 2010. • Publications on IP of the urinary tract were reviewed and summarized. • IP of the urinary tract is a rare benign tumour most commonly diagnosed in older men presenting with haematuria or symptoms of lower urinary tract obstruction. • IP is most frequently identified in the bladder neck or trigone as a polypoid growth with a smooth surface. • The major differential diagnosis is transitional cell carcinoma (TCC) with an inverted growth pattern, with differentiation based mainly on morphological criteria. • Treatment involves transurethral resection for lower urinary tract lesions whereas upper urinary tract IPs are resected by ureteroscopy, percutaneous endoscopy, partial ureterectomy or nephroureterectomy. • IP is weakly associated with a history of TCC and with increased risk of concomitant or subsequent TCC. • Based on the association with TCC, post-treatment follow-up for IP of the urinary tract should include cystoscopic follow-up.

Primary osteosarcoma of the urinary bladder treated with external radiotherapy in a patient with a history of transitional cell carcinoma: a case report

IntroductionPrimary osteosarcoma is one of the rare tumors affecting the urinary bladder. The occurrence of osteosarcoma in a patient with a long history of transitional cell carcinoma of the bladder is even more uncommon.Case presentationWe present the case of a 74-year-old Greek man who was diagnosed with osteosarcoma 10 years after he had been diagnosed with transitional cell carcinoma of the bladder from which he had been free from recurrences for the past three years. Our patient was treated for the osteosarcoma with transurethral resection of bladder tumor and external beam radiation therapy. He died eight months after the diagnosis, suffering poor quality of life in the last months.ConclusionOsteosarcoma of the bladder has a dismal prognosis. External beam radiation therapy as an adjunct to transurethral resection of bladder tumor not only provides no benefit to patients with primary osteosarcoma of urinary bladder, but also may be associated with poor quality of life.

The Significance of Persistent Abnormal Urine Cytology

Purpose: We investigated the factors that predicted later transitional cell carcinoma (TCC) in a subgroup of patients with abnormal cytology and negative initial evaluations. Materials and Methods: From January 2002 to June 2007, we retrospectively identified 58 patients. Cases were considered discordant if a work-up of urine cytology was abnormal although initial cystoscopy, upper tract evaluation, and biopsies resulted in a negative or benign diagnosis. Patients who could complete a urine cytology test after 6 to 8 weeks and who were followed up for at least 1 year were included in this study. According to later TCC demonstration, we compared risk factors for TCC between the later TCC group and the benign group and evaluated the independent factors that predicted later TCC by use of a Cox proportional hazards regression model. Results: Of the 58 patients, the mean follow-up was 12.7±17.3 months (range: 2-83 months), and 14 patients (23.7%) had a prior history of TCC. During follow-up, 9 patients (15.3%) had TCC and 1 patient had prostate cancer. In the later TCC group, the incidence of a prior history of TCC (p=0.03) and persistent abnormal cytology (p<0.001) were higher than in the benign group in univariate analysis. In the Cox proportional hazards regression model, persistent abnormal cytology (p=0.033, relative risk (RR): 17.380 [95% CI: 1.265-238.783]) was the only independent factor to predict later TCC. The mean follow-up duration of later TCC demonstration was 8.55 months (range: 2-32 months). Conclusions: Our results suggest that in the setting of persistent abnormal urine cytology with a negative initial evaluation, 53.3% of patients will later develop TCC. Patients with persistent abnormal cytology need intensive follow-up within 1 year. (Korean J Urol 2009;50:125-129) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

The Significance of Biopsy of the Erythematous Lesion at Cystoscopy

Purpose: At cystoscopy, bladder cancer shows various presentations; these are papillary, flat, elevated and ulcerated. Erythematous lesions could be carcinoma in situ (CIS), cancer or benign lesion, so biopsy should be done to exclude malignancy. However, this might cause many problems such as bleeding, inflammation and the added cost. The objectives of this study were to evaluate the significance of erythematous lesion biopsy at cystoscopy and to identify the factors related to the detection of bladder cancer. Materials and Methods: From January 1999 to June 2006, 337 biopsies were taken from the erythematous lesions seen at cystoscopy. We reviewed the pathologic results of the erythematous lesions. We also investigated the patients’ histories of bladder cancer, the urine cytology performed at cystoscopy, the intravesical therapy for bladder cancer and the complications after biopsy. A logistic regression analysis was performed to determine the factors associated with the diagnosis of bladder cancer. Results: In 337 erythematous lesion biopsies, malignancy was found in 36 (10.9%), and 19 of 36 (52.8%) were CIS. Among the benign lesions, chronic cystitis was most common. Bladder cancer was detected more often in patient with a history of transitional cell carcinoma (TCC) and in patients over the age of 65 years. Especially, a history of TCC was an independent risk factor for bladder cancer [odds ratio: 2.974, 95% confidence interval (CI): 1.163-7.604]. After biopsy, hematuria that was needed management occurred in 3.6% of the lesions. Conclusions: Erythematous lesion biopsy yields a positive finding of malignancy in 10.9% of the lesions and could be a valuable exam, particularly for the follow-up for TCC, and for patients over the age of 65 years. (Korean J Urol 2007;48:489-493)

An Unusual Cause of Acute Liver Failure

Diffuse hepatic infiltration by metastases has been recognized as a rare cause of acute liver failure (ALF). ALF due to metastatic transitional cell carcinoma is extremely rare. We report the first case of ALF due to diffuse hepatic infiltration of metastatic transitional cell carcinoma in the US. A 59-year-old man with a history of transitional cell carcinoma of the right ureter (G2, T2, N0, Mx) who underwent complete surgical resection in 07/2004. He failed to follow up with the urology clinic post surgery. One month prior to admission, the patient started to have pruritus all over his body. One week prior to admission, the patient started to have jaundice. He also complained of a vague fullness in the right upper quadrant. Physical examination was significant only for jaundice, multiple excoriations on the skin, and mildly tender hepatomegaly. The laboratory studies were significant for protein 7.6, albumin 2.7, total bilirubin 15, direct bilirubin 12.7, ALT 117, AST 141, alkaline phosphate 1505, and INR 1.3. All the following studies were negative: HAV, HBV, HCV, HIV, ANA, AMA, ASMA, AKLMA, anti-dsDNA. An ultrasound showed hepatomegaly at 18 cm with “diffuse fatty infiltration,” and no intrahepatic or extrahepatic biliary dilatation. A liver biopsy showed multiple clusters of malignant cells in the parenchyma and blood vessels; immunohistochemical stains (CD34 +, D2–40 -, CK7 +, thrombomodulin +, CK20 -) were consistent with metastatic transitional cell carcinoma. The patient rapidly developed encephalopathy and coagulopathy. He deteriorated to multi-organ failure and expired 2 weeks after admission. Metastases to the liver occur mainly as discrete single or multiple lesions. However, in ALF, liver infiltration by tumor cells typically has a diffuse pattern that is often not detected by imaging studies. The release of cytokines from neoplastic cells has been postulated to cause interlobular bile duct destruction and portal fibrosis. The consequence is obstruction of sinusoidal microcirculation and ultimately hepatocyte ischemia and death. The prognosis is extremely grave. Most patients die of multiorgan failure within six to ten days. The presence of malignant disease is an absolute contraindication for liver transplantation. Diffuse liver infiltration from a urothelial cancer is extremely rare. There are only 5 cases from Europe in the medical literature. This appears to be the first reported case of ALF due to diffuse hepatic infiltration of metastatic transitional cell carcinoma in the US.

Fluorescence in situ hybridization for detecting transitional cell carcinoma: Implications for clinical practice: Laudadio J, Keane TE, Reeves HM, Savage SJ, Hoda RS, Lage JM, Wolff DJ, Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC

To determine the diagnostic sensitivity of genetic studies using fluorescence in situ hybridization (FISH) for detecting both new and recurrent cases of transitional cell carcinoma (TCC) in a routine clinical practice setting, as bladder cancer has a significant risk of recurrence and progression to invasive disease and thus sensitive surveillance testing is very important. FISH was performed using the UroVysion kit (Vysis Inc., Downers Grove, IL, USA) Consecutive patients were assessed using FISH, both to evaluate those with a history of TCC or with suspicious symptoms, and the FISH results were compared with concurrent biopsy and cytological assessments. In all, 521 consecutive FISH tests from 300 patients were evaluated; 47% had a history of bladder cancer and 53% had suspicious symptoms. Of the 521 FISH tests, 24% were positive; concurrent cytology was available for 84% of the FISH tests, with a concordance rate of 78% (6% were positive for both and 72% were negative by both tests). For the discordant cases, FISH was positive and cytology negative in 21% of cases, and cytology was positive with a negative FISH for 1%. In all, 99 FISH tests had concurrent biopsy data. Of the 44 cases histologically positive for TCC, 32 were FISH-positive, resulting in an overall sensitivity (95% confidence interval) of 73 (60–88)%. FISH detected 95% of cases with high-grade carcinoma, while only seven of these 17 were positive by concurrent cytological assessment. FISH detected 56% and cytology detected 32% of low-grade lesions. FISH detected all nine new cases with positive histology. Overall, the specificity of FISH was 65 (53–78)%. Of 112 patients with previous TCC, 28 had a recurrence; 22 of these had positive FISH results. FISH analysis has a high sensitivity for detecting new cases of TCC, as well as recurrences. From the present data FISH is considerably more sensitive and only slightly less specific than cytology in diagnosing TCC. Therefore, we recommend FISH as a useful initial diagnostic tool in patients suspected of both new and recurrent TCC.

Association between marijuana use and transitional cell carcinoma

Objectives Marijuana smoking has been implicated as a causative factor in traditionally tobacco-related tumors of the head and neck and of the lung. When associated with marijuana use, such tumors occur in a much younger patient population than do similar tumors in tobacco smokers. Owing to the large number of young men with a history of marijuana presenting with transitional cell carcinoma to VA facilities, this study was designed to compare the marijuana use among young (aged less than 60 years) transitional cell carcinoma patients with that among age-matched controls. Methods Fifty-two men aged less than 60 years presenting consecutively with transitional cell carcinoma and 104 age-matched controls (defined by having no history of transitional cell carcinoma, hematuria, or irritative voiding symptoms, as well as unremarkable results on urinalysis and urine cytology) completed questionnaires about exposure to various potential carcinogens, including radiation, Agent Orange, smoked or processed meats, dyes, tobacco, and marijuana. Results Of the 52 transitional cell carcinoma patients, 46 (88.5%) reported a history of habitual marijuana usage, and 72 (69.2%) of the age-matched controls gave a history of habitual marijuana use. This difference was statistically significant ( P = 0.008). In those with transitional cell carcinoma, marijuana use significantly correlated with tumor stage, grade, and number of recurrences. Conclusions Marijuana smoking might increase the risk of transitional cell carcinoma.

Fluorescence in situ hybridization for detecting transitional cell carcinoma: implications for clinical practice

To determine the diagnostic sensitivity of genetic studies using fluorescence in situ hybridization (FISH) for detecting both new and recurrent cases of transitional cell carcinoma (TCC) in a routine clinical practice setting, as bladder cancer has a significant risk of recurrence and progression to invasive disease and thus sensitive surveillance testing is very important. FISH was performed using the UroVysion kit (Vysis Inc., Downers Grove, IL, USA) Consecutive patients were assessed using FISH, both to evaluate those with a history of TCC or with suspicious symptoms, and the FISH results were compared with concurrent biopsy and cytological assessments. In all, 521 consecutive FISH tests from 300 patients were evaluated; 47% had a history of bladder cancer and 53% had suspicious symptoms. Of the 521 FISH tests, 24% were positive; concurrent cytology was available for 84% of the FISH tests, with a concordance rate of 78% (6% were positive for both and 72% were negative by both tests). For the discordant cases, FISH was positive and cytology negative in 21% of cases, and cytology was positive with a negative FISH for 1%. In all, 99 FISH tests had concurrent biopsy data. Of the 44 cases histologically positive for TCC, 32 were FISH-positive, resulting in an overall sensitivity (95% confidence interval) of 73 (60-88)%. FISH detected 95% of cases with high-grade carcinoma, while only seven of these 17 were positive by concurrent cytological assessment. FISH detected 56% and cytology detected 32% of low-grade lesions. FISH detected all nine new cases with positive histology. Overall, the specificity of FISH was 65 (53-78)%. Of 112 patients with previous TCC, 28 had a recurrence; 22 of these had positive FISH results. FISH analysis has a high sensitivity for detecting new cases of TCC, as well as recurrences. From the present data FISH is considerably more sensitive and only slightly less specific than cytology in diagnosing TCC. Therefore, we recommend FISH as a useful initial diagnostic tool in patients suspected of both new and recurrent TCC.

Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology

To evaluate patients with a history of transitional cell carcinoma (TCC) of the upper urinary tract (UUT) to determine the incidence, pathological distribution, and risk factors for developing subsequent bladder tumours. Between 1993 and 2003, 103 patients were treated at our institution for UUT-TCC. We reviewed demographic, clinical, surgical, and pathological data from these patients at a median follow-up of 38.7 months, and used univariate and multivariate analyses with logistic regression modelling to determine prognostic variables for bladder recurrences. In all, 51 (49.5%) patients developed bladder tumours after treatment for UUT-TCC, at a mean interval of 13.2 months. Patient age (P = 0.01), UUT tumour size (P = 0.03), UUT tumour multifocality (P = 0.05), a history of bladder tumours (P = 0.03), and the number of previous bladder tumours (P = 0.05) predicted the development of bladder recurrences on univariate analysis. On multivariate analysis, only a previous history of bladder tumours (odds ratio 2.6, P = 0.05) remained significant. Over 90% of the recurrent bladder tumours were superficial, with two-thirds of these being low to moderate grade. Six patients had muscle-invasive disease, and five had a cystectomy. Bladder tumours occurred in half the patients after treatment for UUT-TCC; > 60% of these subsequent bladder tumours were superficial, low- to moderate-grade lesions. Neither the pathology of the UUT tumours nor the method of treatment for the UUT disease was associated with recurrent bladder tumours. Only a history of bladder cancer predicted the development of subsequent bladder tumours.

Correlation of office-based cystoscopy and cytology with histologic diagnosis: How good is the reference standard?

Objectives To evaluate the accuracy of cystoscopy and cytology in predicting the histopathologic features of suspicious cystoscopic lesions. Methods We reviewed the bladder biopsy records at two institutions from July 2001 to July 2004. Intraoperative biopsies were performed for positive (papillary or sessile) (n = 155) and equivocal (n = 101) lesions found during office cystoscopy. The specimens were submitted for histopathologic analysis, and the results were correlated with the preceding office-based cystoscopy and cytology findings. Results Malignancy was found in 27 (26.7%) of 101 equivocal lesions and 128 (82.5%) of 155 sessile or papillary lesions. Of the 72 biopsies performed for equivocal lesions in patients with a history of transitional cell carcinoma (TCC), 24 (33%) had malignancy compared with 3 (10.3%) of 29 biopsies performed in patients without a history of TCC. For patients with no history of TCC and equivocal lesions, cytology was able to identify all neoplasms (100% sensitivity) and negative cytology always predicted a normal biopsy result (100% negative predictive value). However, for patients with a history of TCC and equivocal lesions, cytology had a sensitivity and negative predictive value of 81.8% and 88.2%, respectively. Conclusions Our findings suggest that patients without a history of TCC who have an equivocal lesion at cystoscopy may avoid an unnecessary operation if they have normal cytology findings. A large number of patients with equivocal cystoscopic findings undergo unnecessary biopsies in the operating room, and future studies should be performed to assess the value of other bladder markers in predicting oncologic status in this setting.

Cyclophosphamide is contraindicated in patients with a history of transitional cell carcinoma

Cyclophosphamide is a urotoxic agent that increases the incidence of malignant neoplasms of the urinary tract. The aim of this study was to evaluate the long-term impact of cyclophosphamide on patients with a history of superficial bladder cancer. Between July 1986 and January 1988, 58 consecutive patients with primary superficial transitional cell carcinoma of the bladder were included in this study. All patients had a transurethral R0 resection. Then 6 weekly intravesical instillations of 120 mg bacillus Calmette-Guérin (BCG) were performed. Until June 1987, 22 consecutive patients (group A) received an additional intravenous application of 700 mg/m(2) cyclophosphamide prior to the BCG immunotherapy, while from July 1987 36 patients were treated without cyclophosphamide. Survival was calculated using the Kaplan-Meier method and comparison of survival using the log rank test. Tumor staging, grading, and size were equally distributed in both groups. No significant difference could be observed regarding the 10-year overall survival rate (group A: 59%, group B: 58%), the 10-year tumor-specific survival rate (89 vs 94%), and the 10-year progression-free survival rate (85 vs 97%). There was a statistically significant deterioration of the 10-year recurrence-free survival rate in the cyclophosphamide group (44 vs 70%, log rank test: p < 0.05). Whereas there were no recurrences in the upper urinary tract among the patients of group B, 2 of the 22 patients from group A developed cancer of the renal pelvis. In patients with a history of superficial bladder cancer, a single dose of cyclophosphamide poses a significantly increased risk of tumor recurrence in the lower and in the upper urinary tract as well.

Gemcitabine and Cisplatin following Surgical Treatment of Urinary Bladder Carcinosarcoma

The clinical case of a 73-year-old man with a history of transitional cell carcinoma of the bladder, an ulcerated mass on the left hemitrigone and left hydronephrosis who underwent radical cystoprostatectomy and urinary diversion followed by cisplatin-gemcitabine chemotherapy is presented. Pathological examination revealed a biphasic mixed tumor characterized by an epithelial and a mesenchymal component. At 24 months of follow-up the patient is alive and free from recurrent disease, with good quality of life and preserved renal function. Carcinosarcoma is highly aggressive and often has a dismal outcome regardless of treatment. Among all the studied prognostic factors, pathological stage is the main predictor of survival. The outcome of our patient suggests that the relatively well tolerated gemcitabine-cisplatin regimen after surgical treatment of invasive carcinosarcoma of the bladder might improve the currently dismal prognosis of selected elderly patients.

Clinical Evaluation of a Multi-target Fluorescent in Situ Hybridization Assay for Detection of Bladder Cancer

The UroVysion fluorescence in situ hybridization assay (UroVysion Bladder Cancer Recurrence Kit, Vysis, Inc., Downers Grove, Illinois) is a multi-target assay that detects aneuploidy of chromosomes 3, 7 and 17, and loss of the 9p21 band in exfoliated cells in urine from patients with transitional cell carcinoma. We performed 2 multicenter trials. In 1 trial we compared the sensitivity of the FISH assay to the BTA Stat test (Bion Scientific, Redmond, Washington) and voided cytology in the detection of transitional cell carcinoma. In a separate study of healthy volunteers and patients with other (nontransitional cell carcinoma) conditions we determined the specificity of the FISH assay. A total of 176 patients with transitional cell carcinoma in the previous 9 months provided voided urine before cystoscopy. Each specimen was split, preserved and shipped to a central laboratory where all 3 tests were performed. All sites were blinded to results. Sensitivity calculations were based on central pathology review of resected tissue. Specificity was determined by testing 275 volunteers who were healthy and with nontransitional cell carcinoma conditions. The 21 sites enrolled 176 patients with a history of transitional cell carcinoma, with 62 recurrences while undergoing surveillance. Overall sensitivities (with 95% CI) were FISH 71% (95% CI 58 to 82), BTA Stat test 50% (37 to 63) and cytology 26% (16 to 39). FISH was negative in 260 of the 275 healthy volunteers or patients with no history of transitional cell carcinoma (specificity 94.5%). Sensitivity of the FISH assay is superior to that of cytology and at least equivalent to the BTA Stat test in detecting recurrent transitional cell carcinoma. Its specificity approaches that of cytology. Further testing of its clinical use is warranted.

Bladder tumor antigen assay as compared to voided urine cytology in the diagnosis of bladder cancer

Background: The study was aimed at comparing the diagnostic accuracy of the quantitative bladder tumor antigen (BTA) TRAK™ immunoassay with exfoliative urine cytology in the detection of primary and recurrent bladder cancer. Methods: The analysis was carried out on 194 high risk patients undergoing a diagnostic cystoscopy, 279 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy, and 45 healthy controls. Urine cytology was performed by a skilled cytopathologist on three consecutive samples. Results: BTA TRAK values resulted significantly higher in tumor positive cases than in absence of bladder tumor for both groups of patients. Non neoplastic urothelial diseases as well as the absence of mucosal abnormalities were associated with a marked increase in BTA TRAK levels with respect to the control group. Overall sensitivity and specificity was 63 and 63% for BTA TRAK (cut-off 34 U/ml), and 68.3 and 73.4% for urine cytology, respectively. The diagnostic advantage of urine cytology was maintained when patients were stratified by tumor grade. Conclusions: The clinical performance of the BTA TRAK in the detection of primary or recurrent bladder cancer is acceptable and reproducible as shown by similar results with previous reports, although urine cytology performed on three samples showed the highest sensitivity and specificity.

BTA-TRAK Combined with Urinary Cytology is a Reliable Urinary Indicator of Recurrent Transitional Cell Carcinoma (TCC) of the Bladder

This study evaluated the diagnostic accuracy of BTA-TRAK in combination with urinary cytology (UC) in the follow-up of patients with a history of transitional cell carcinoma (TCC) of the bladder. The overall sensitivity of BTA-TRAK, UC and the two tests combined for the detection of recurrences was 82.7% (48/58), 84.2% (48/57) and 91.2% (52/57), respectively. BTA and UC showed comparable sensitivity for superficial recurrences (76.7% (33/43) and 78.5% (33/42), respectively) and for invasive recurrences (100% (15/15)); when the two tests were used in combination, the sensitivity for superficial lesions increased to 88% (37/42). BTA-TRAK was more sensitive than UC for G1 recurrences (81.2% (13/16) vs. 68.7% (11/16)), and when the two tests were combined the sensitivity increased to 87.5% (14/16). The sensitivity of the combination was 100% (15/15) for G3 lesions. The differences in urinary BTA-TRAK levels between patients with recurrences and those without evidence of disease were statistically significant (Wilcoxon's test, p<0.05); among patients with recurrences BTA levels were significantly higher in the invasive and poorly differentiated subtypes. In the series of patients studied by us, BTA-TRAK combined with UC was shown to be a non-invasive, accurate test to predict TCC recurrences. Periodic measurement of BTA-TRAK combined with urinary cytology seems to provide additional information for the monitoring of patients treated for TCC; however, due to the presence of false positive and false negative results, this test cannot replace cystoscopy. In a selected group of patients it could, if combined with cytology and ultrasonography and if correctly used and interpreted, orient the timing and indication for cystoscopy.

BTA Quantitative Assay and NMP22 Testing Compared with Urine Cytology in the Detection of Transitional Cell Carcinoma of the Bladder

Purpose: Both BTA TRAK and NMP22 urine concentrations have shown a sensitivity superior to urine cytology in the detection of bladder cancer. We compared these tumor markers with urine cytology performed on 3 consecutive samples and evaluated by an expert cytopathologist. Patients and Methods: The investigations were conducted on 94 patients undergoing a diagnostic cystoscopy for a high suspicion of bladder cancer (group 1) and on 102 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy (group 2). Biopsy specimens were obtained also from tumor negative patients. Immunoassays for BTA TRAK and NMP22 were carried out according to standard methods. The choice of the cut-off was based on the ground of sensitivity and specificity curves intersection. Urine cytology results were expressed as positive, negative and ‘dubious’. Results: Overall sensitivity was 56% for NMP22 (cut-off 11 U/ml) and 57% for BTA TRAK (cut-off 60 U/ml). When dubious results were considered as positive cases, urine cytology achieved a sensitivity of 73.3%. Assuming dubious cases as negative results, urine cytology sensitivity resulted 59.3%. When the 2 groups of patients were evaluated separately with different cut-off, there was no significant gain in sensitivity for BTA TRAK and NMP22 over urine cytology. Conclusions: Urine cytology performed on 3 samples showed the highest sensitivity and specificity. The diagnostic advantage of urine cytology over BTA TRAK and NMP22 was maintained when patients were stratified by tumor grade.

The long-term outcome in patients with superficial transitional cell carcinoma of the bladder: a single-institutional experience.

To determine the natural history of transitional cell carcinoma (TCC) of the bladder, and to identify factors which place patients at lifelong risk of developing progression and dying from bladder carcinoma. The long-term outcome was evaluated retrospectively in 231 patients with superficial bladder TCC, assessed for the first time within a 6-year period from 1981 to 1986, with a median follow-up of 108 months. Of 231 patients, 217 (94%) were initially treated by transurethral or segmental resection. Recurrence developed in 141 of 217 (65%) patients; the duration of the interval free of recurrence was significantly less for patients with initial G3 tumours than that for those with G1 (P<0.01) and for pT1 compared with pTa disease (P<0.01). The disease progressed in 42 of 231 (18%) patients. Differences in the progression-free interval between patients with G1 and G3 tumours, and with pTa and pT1 disease, were statistically significant (P<0. 005 and P<0.001, respectively). In 27 of 231 patients (12%), TCC of the bladder was the cause of death, whilst 118 (51%) died from unrelated causes. There were no deaths among patients with initial pTaG1 tumours, compared with 10 of 26 (38%) deaths in those with pT1G3 disease at presentation. The long-term prognosis is good for patients with pTaG1 tumours, whilst pT1G3 is a potentially aggressive disease. Lifelong endoscopic surveillance is mandatory in patients in whom new tumours are very active, at least in those of younger age. Routine cystoscopy can possibly be discontinued in patients with low-grade, low-stage disease in whom a low liability of recurrence has been shown during follow-up.