Positive Urine Cytology Research Articles

Intravesical Seeding of Upper Urinary Tract Urothelial Carcinoma Cells During Nephroureterectomy: An Exploratory Analysis from the THPMG Trial

The Pirarubicin Monotherapy Study Group trial was a randomized Phase II study that evaluated the efficacy of intravesical instillation of pirarubicin in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. This study conducted further analysis of the Pirarubicin Monotherapy Study Group cohort, focusing on intravesical seeding of cancer cells. Using the data from the Pirarubicin Monotherapy Study Group trial, bladder recurrence-free survival rates and factors associated with bladder recurrence in the control group were analyzed. Of 36 patients in the control group, 14 with positive urine cytology had more frequent recurrence when compared with the 22 patients with negative cytology (P = 0.004). Based on the multivariate analysis in the control group, voided urine cytology was an independent predictive factor of bladder recurrence (hazard ratio, 5.54; 95% confidence interval 1.12-27.5; P = 0.036). Of 72 patients in the Pirarubicin Monotherapy Study Group trial, 31 had positive urine cytology. Among the 31 patients, 17 patients who received pirarubicin instillation had fewer recurrences when compared with 14 patients who received control treatment (P = 0.0001). On multivariate analysis, pirarubicin instillation was an independent predictor of better recurrence-free survival rates in the patients with positive urine cytology (hazard ratio, 0.02; 95% confidence interval, 0.00-0.53; P = 0.018). Of 21 patients with bladder recurrence, 17 had recurrent tumor around cystotomy or in the bladder neck compromised by the urethral catheter, supporting the notion that tumor cells seeded in the injured urothelium. Intravesical instillation of pirarubicin immediately after nephroureterectomy significantly reduced the bladder recurrence rate in patients with positive voided urine cytology. The results suggest that intravesical seeding of upper urinary tract urothelial carcinoma occurs during nephroureterectomy.

Predictive factors for worse pathological outcomes of upper tract urothelial carcinoma: experience from a nationwide high‐volume centre in China

To analyse the predictive factors for worse pathological outcome (muscle invasive pT2+, non-organ-confined pT3+ or N+ and histological Grade 3) of upper tract urothelial carcinoma (UTUC) in a Chinese population from a nationwide high-volume centre in China. Predictors were studied by retrospectively reviewing the clinicopathological data of 729 consecutive patients with UTUC treated in our centre from January 2002 to December 2010. Univariate and multivariate logistic regression analyses were used. There were more female patients (56.4%) than males and more tumours were located in the ureter (52.7%) than in the pelvis. In multivariate analysis, male gender (hazard ratio [HR] 1.898, P = 0.001), sessile architecture (HR 3.249, P < 0.001), high grade (HR 5.007, P < 0.001), ipsilateral hydronephrosis (HR 4.768, P < 0.001), renal pelvis location (HR 2.620, P < 0.001) and tumour without multifocality (HR 1.639, P = 0.028) were predictive factors for muscle-invasive UTUC. Male gender (HR 2.132, P < 0.001), renal pelvis location (HR 3.466, P < 0.001), tumour without multifocality (HR 2.532, P = 0.001), sessile tumour architecture (HR 3.274, P < 0.001), and high grade (HR 3.019, P < 0.001) were predictive factors for non-organ-confined disease. Chronological old age (HR 1.047, P < 0.001), sessile tumour architecture (HR 25.192, P < 0.001), ipsilateral hydronephrosis (HR 1.689, P = 0.024), and positive urinary cytology (HR 1.997, P = 0.006) were predictive factors for histological Grade 3 UTUC. There was a predominance of female patients and ureteric tumours in UTUCs of this Chinese population. Male gender, sessile architecture, tumour location, tumour without multifocality, high histological grade and preoperative ipsilateral hydronephrosis were independent predictive factors for worse pathological outcome of UTUCs.

Copy number aberrations using multicolour fluorescence in situ hybridization (FISH) for prognostication in non‐muscle‐invasive bladder cancer (NIMBC)

To investigate if detection of copy number aberrations of chromosomes 3, 7, 9p21, and 17 using multicolour fluorescence in situ hybridization (FISH) predicts patient outcome in non-muscle-invasive bladder cancer (NMIBC). In all, 118 bladder wash samples were prospectively collected from patients who underwent transurethral resection of bladder tumour (median age 50.5 years, male/female: 91/27, tumour grade 1/2/3: 18/52/42, stage pTis/Ta/T1: 8/62/42) from 2007 to 2010. The 118 samples were analysed using the UroVysion® kit to detect the copy numbers of chromosomes 3, 7, 9p21, and 17. The variant fraction (VF; the sum of the non-modal copy number fraction of each chromosome) was defined as abnormal when the percentage was ≥16%. The percentage deletion of 9p21 (fraction of null or one copy number of the 9p21 locus) was defined as abnormal when the percentage was ≥12%. Maffezzini risk criteria were also analysed in our cohorts. There was recurrence in 57 (48.3%) patients and disease progression in 12 (10.1%), with a median follow-up of 35.7 months. Multivariate analysis showed that the percentage 9p21 loss (>12%) was an independent prognostic factor for recurrence (P < 0.001, odds ratio [OR] 3.24, 95% confidence interval [CI] 1.85-5.62). For disease progression, tumour grade, positive urine cytology, concurrent carcinoma in situ, and a mean VF of >16% were significant prognostic factors in univariate analysis. In multivariate analysis, a mean VF of >16% was a prognostic factor for disease progression (P = 0.048, OR 6.07, 95% CI 1.02-57.45). Multicolour-FISH analysis using a commercially available kit could be a powerful tool not only for diagnosis, but also for prognostication in patients with NMIBC.

Survival Impact of Followup Care after Radical Cystectomy for Bladder Cancer

Due to substantial variation in patient followup after radical cystectomy for bladder cancer, we sought to understand the effect of urine and laboratory tests, physician visits and imaging on overall survival. We analyzed a cohort of patients treated in the fee for service Medicare population from 1992 through 2007 using Surveillance Epidemiology and End Results (SEER)-Medicare data. Using propensity score analysis, we assessed the relationship between time and geography standardized expenditures on followup care and overall survival during 3 postoperative periods, including perioperative (0 to 3 months), early followup (4 to 6 months) and later followup (7 to 24 months). Using instrumental variable analysis, we assessed the overall survival impact of the quantity of followup care by category, including physician visits, imaging, and laboratory and urine tests. We found no improvement in survival due to followup care in the perioperative and early followup periods. Receiving followup care during later followup was associated with improved survival in the low, middle and high expenditure tertiles (HR 0.23, 95% CI 0.15-0.35, HR 0.27, 95% CI 0.18-0.40 and HR 0.47, 95% CI 0.31-0.71, respectively). Instrumental variable analysis suggested that only physician visits and urine testing improved survival (HR 0.96, 0.93-0.99 and 0.95, 0.91-0.99, respectively). Followup care after radical cystectomy in the later followup period was associated with improved survival. Physician visits and urine tests were associated with this improved survival. Our results suggest that aspects of followup care significantly improve patient outcomes but imaging could be done more judiciously after cystectomy.

691 LIMITED SIGNIFICANCE OF ROUTINE EXCRETORY UROGRAPHY AS A SURVEILLANCE OF THE UPPER URINARY TRACT IN FOLLOW-UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER AFTER TRANSURETHRAL RESECTION

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013691 LIMITED SIGNIFICANCE OF ROUTINE EXCRETORY UROGRAPHY AS A SURVEILLANCE OF THE UPPER URINARY TRACT IN FOLLOW-UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER AFTER TRANSURETHRAL RESECTION Hideaki Miyake, Ken-ichi Harada, and Masato Fujisawa Hideaki MiyakeHideaki Miyake Kobe, Japan More articles by this author , Ken-ichi HaradaKen-ichi Harada Kobe, Japan More articles by this author , and Masato FujisawaMasato Fujisawa Kobe, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.247AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The primary objective of upper tract surveillance after transurethral resection (TUR) of non-muscle invasive bladder cancer is to identify upper urinary tract cancers (UUTCs) at an early stage in asymptomatic patients, so that curative treatment can be offered. However, because of the lack of definitive guideline, there are several controversies associated with the surveillance of UUTC, including patient selection, type of imaging study and its frequency. The objective of this study was to evaluate the utility of routine excretory urography (IVP) for detecting subsequent UUTC during follow-up of patients with non-muscle invasive bladder cancer. METHODS This study included 613 patients who underwent TUR of non-muscle invasive bladder cancer between January 1990 and December 2010, and followed for at least 1 year. After TUR, patients were followed by periodic cystoscopy, urinary cytology and IVP. The risk factors for upper urinary tract recurrence following TUR were analyzed, and based on this outcome, we then determined whether routine IVP should be performed for patients with non-muscle invasive bladder cancer. RESULTS During the observation period, UUTCs developed in 30 of the 613 patients (4.9%) with the median interval of 34 months from initial TUR to the detection of UUTCs. Among several factors examined, only multiplicity was significantly associated with upper urinary tract recurrence after TUR. Of the 30 patients with secondary UUTCs, only 3, who had multiple non-muscle invasive bladder cancers at initial presentation, were diagnosed as having UUTCs by routine IVP, while the remaining 27 presented some symptoms suggesting possible upper tract recurrence before IVP, including macrohematuria, intravesical recurrence, positive urinary cytology, abdominal pain and high fever in 15, 8, 7, 5 and 3, respectively. CONCLUSIONS The majority of patients with recurrent UUTCs presented with some subjective and/or objective symptoms, and routine IVP failed to detect recurrent diseases in such patients. Therefore, considering the low incidence of recurrent UUTCs and the expense for upper urinary tract surveillance, it may be suitable to perform routine IVP only for patients with risk factors, such as multiple tumors at an initial TUR, associated with the development of secondary UUTCs rather than for all patients who have undergone TUR for non-muscle invasive bladder cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e283-e284 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hideaki Miyake Kobe, Japan More articles by this author Ken-ichi Harada Kobe, Japan More articles by this author Masato Fujisawa Kobe, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mixed epithelial and stromal tumor of the kidney (MEST) simulating

We present a rare and interesting case of a mixed epithelial andstromal tumour (MEST) of the kidney. The case is unique as itinvolves a male patient with no history of hormonal therapy presenting with a filling defect in the renal collecting system and positive urine cytology. The patient was diagnosed with transitional cell carcinoma of the renal pelvis and subjected to nephroureterectomy, which revealed a solid tumour arising from the lower calyces and extending into the renal pelvis and upper ureter. Pathology revealed a MEST. The patient was disease-free at the 6-month follow-up.

Is the performance of urinary cytology as high as reported historically? A contemporary analysis in the detection and surveillance of bladder cancer

ObjectivesThe goal of this study was to evaluate sensitivity and specificity of urine cytology during a contemporary period at our institution in comparison with historical analysis and other reported urinary biomarkers. Materials and methodsData from 1,114 consecutive patients corresponding to 3,251 specimens (2,979 cytologic and 272 histologic specimens) between January 2006 and July 2006 were retrieved. Subsequent cytologic and surgical specimen reports were examined with a minimum 2-year follow-up period. Collected parameters included the date of collection, reason for urinary evaluation, type of specimen, and tumor grade. Atypical diagnosis was considered negative. ResultsOn cytologic examination, 71% of specimens were benign, 23% atypical, and 6% suspicious or positive for urothelial carcinoma. Reason for collection was surveillance in 61% and new symptoms in 28%. Depending on the tumor grade, sensitivity results ranged from 10% for low-grade to 51% for high-grade tumors. Importantly, specificity of urine cytology ranged from 83% to 88% (depending on the type of urine collection and type of clinical presentation). Anticipatory positive rate was 44% after a median time of 15 months. Specificity of other reported urinary markers ranges from 40% to 90%. ConclusionOur institution's experience with regard to specificity of urine cytology is lower than reported historically. Whether this is a consequence of heterogeneous study designs and parameters is open to debate. As the anticipatory positive rate was high, close surveillance remains recommended in patients with positive urine cytology and negative workup. Other institutions are encouraged to evaluate whether there remains a significant advantage for urine cytology over other urinary marker assays within their own clinical setting.

Predictive Factors for Bladder Recurrence after Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Introduction: To identify predictive factors for developing subsequent bladder urothelial carcinoma (UC) in patients undergoing radical nephroureterectomy for the treatment of upper urinary tract UC (UUT-UC). Materials and Methods: We retrospectively reviewed the medical records of 78 patients with clinically localized UUT-UC who had undergone operation at our institution between June 1994 and December 2009. Univariate and multivariate analyses were carried out to determine the predictive factors. Results: Out of a total of 78 patients, 14 (17.9%) developed bladder UC after radical nephroureterectomy at a median interval of 10 months (range: 3-46). Of these 14 patients, 11 (78.6%) experienced bladder recurrence within the first 2 years of follow-up. All 14 patients (100%) had non-muscle-invasive bladder UC and 10 patients (71.4%) had high-grade tumors. The univariate analysis identified preoperative voided urine cytology, tumor configuration, and adjuvant systemic chemotherapy as significant predictive factors for bladder recurrence, whereas the multivariate analysis indicated that only preoperative voided urine cytology was an independent predictive factor. Conclusions: Positive preoperative voided urine cytology is an independent predictor for bladder recurrence after radical nephroureterectomy for UUT-UC. Therefore, closer surveillance of the bladder is necessary, especially in patients with positive preoperative urine cytology.

Cytologic and cystoscopic predictors of recurrence and progression in patients with low‐grade urothelial carcinoma

Patients with low-grade urothelial carcinoma (LGUC) are at risk of recurrence and must undergo lifelong surveillance. To date, cytology and cystoscopy are the gold standard for the detection of de novo and recurrent LGUC. The objective of the current study was is to further characterize the role of cytology and cystoscopy in determining the risk of recurrence and progression in these patients. The authors retrospectively identified patients with LGUC who had urine cytology within 2 months of biopsy, and data were abstracted from their electronic charts. Electronic medical records were reviewed for cystoscopic findings and histologic and cytologic follow-up data over a 5-year period. Statistical analysis was performed with chi-square tests. In total, 76 patients were identified who had histologic follow-up material available, and 49% of those patients demonstrated progression or recurrence of urothelial carcinoma. The initial presence of multiple lesions on cystoscopy was associated with any recurrence or progression (67.7% vs 31%; P = .002), tumor size >2 cm was associated with initial positive or suspicious urine cytology (23.8% vs 3.7%; P = .076), and positive or suspicious initial cytology was associated with high-grade recurrence (58.3% vs 19.4%; P = .009). Cystoscopic findings, such as the presence of multiple lesions, together with concurrent positive or suspicious urine cytology, were associated with recurrence or progression of LGUC. These findings may help to identify high-risk patients.

Endoscopic Resection. Aspects of Technique and Optimization of Outcomes. Current Indications to PDD-Guided Resection

Trans-Urethral Resection (TUR) of bladder tumors is the gold standard to make the correct diagnosis and remove all visible lesions. The strategy of resection depends on the size of the lesion. Small tumors can be resected en bloc, while larger tumors should be resected separately in fractions to obtain a correct pathological diagnosis. Random biopsies from normal-looking mucosa should be performed in patients with positive urinary cytology and absence of visible tumor in the bladder. As a standard procedure, cystoscopy and TUR are performed using white light. Photodynamic diagnosis (PDD) is most useful for detecting CIS, and therefore should be restricted to those patients with a suspected high-grade tumor.

Positive urine cytology and carcinoma in situ prior to second transurethral resection of the bladder correlate with positive second resection histology and the need for subsequent cystectomy

A second transurethral resection of the bladder (TURB) is recommended for high-grade bladder cancer (BC) yet yields negative results in over half of the cases. Aim of this study was to identify prognostic indicators of a positive second TURB or the need for a subsequent cystectomy. The study cohort consisted of 101 patients with high-risk BC (T1G2-3, TaG3, Carcinoma in situ) who underwent second TURB after complete first resection. Age, gender, stage, grade, carcinoma in situ (Cis), tumour number, size, localization, surgeon experience and bladder wash cytology before the second TURB were considered as potential prognostic factors of positive histology at second TURB or the need for subsequent cystectomy. The mean follow-up period was 23.8 months. The study cohort was comprised of 82 males and 17 females. Cytology on bladder wash urine was performed in 85/101 patients and in 39 was negative; 55.5 % of second TURB specimens were negative. The rate of upstaging to ≥T2 was 4.9 %. Cis (OR 8.4; 95 % CI 1.3-54.2; p = 0.03) and positive cytology (OR 6.8; 95 % CI 2.3-19.9; p = <0.01) were independent prognostic factors of a residual tumour in the second TURB. Cytology also correlated with clinical need for cystectomy in the follow-up (HR 6.5; 95 % CI 1.3-30.5; p = 0.02). CIS and positive cytology prior to second TURB increased the risk of a positive second TURB specimen. A positive cytology also increases the risk of the subsequent need for cystectomy.

Unilateral Urological Double Cancer after Kidney Transplantation

In organ transplant patients, the high incidence of malignancy is well known. Here we experienced a simultaneous double cancer may occur after renal transplantation in the urinary tract. The patient was a 64-year-old woman. Diagnosis of renal failure undergoing Toxemia of pregnancy in 1971. Be introduced as end stage renal disease undergoing hemodialysis since 1978. Living donor kidney transplant performed in March 1980(The donor was her father). Renal transplantation immunosuppressive therapy was introduced azathioprine · methylprednisolone. Current maintenance immunosuppressive therapy is Mizoribine · methylprednisolone. Renal function after transplantation (2.3 to value 2.5 Serum creatinine) had remained in good condition. Admitted in January 2011, gross hematuria thereafter. No abnormal urine cytology tests, especially since no observation was also asymptomatic. Again showed gross hematuria in May 2011. Subject to the inspection report positive urine cytology again. Admitted to a space-occupying lesion in the left renal pelvis examination CT. Resection underwent left nephroureterectomy, July 29, 2011 left kidney tumor was diagnosed. Ureter were removed at the intersection of the left iliac artery. Pathological diagnosis of renal tissue excised Clear cell carcinoma, pT3a, G1> G2, Fuhrman grade 1, was INFa. Pathological diagnosis of the ipsilateral ureter was excised similarly invasive urothelial carcinoma of It ureter, G2, INFb, were pT1. Ureteral stump pathologic findings were observed in excised malignancy. Postoperative renal graft function is stable even without any particular change. We had have to be continued careful watching in our outpatient clinic. We report an example of urinary tract cancers occurring simultaneously in one side to the urinary tract 21 years after renal transplantation.

Long-Term Survival Outcomes with Intravesical Docetaxel for Recurrent Nonmuscle Invasive Bladder Cancer After Previous Bacillus Calmette-Guérin Therapy

Docetaxel is a safe agent for intravesical therapy. Adding monthly maintenance treatments can extend response durability. We report our cumulative experience with intravesical docetaxel in a larger cohort with extended followup. A total of 54 patients received salvage intravesical docetaxel for bacillus Calmette-Guérin refractory nonmuscle invasive bladder cancer between 2003 and 2012, including 18 treated during the original phase I trial. All patients received 6 weekly instillations of intravesical docetaxel. After the phase I trial, those with a complete response to induction treatment were offered single dose monthly maintenance treatments for a total of up to 12 months of docetaxel therapy. Recurrence was defined as positive biopsy or urine cytology. Recurrence-free, disease specific and overall survival was determined by Kaplan-Meier analysis. Median followup was 39.1 months. Of the 54 patients 32 (59%) had a complete initial response after induction therapy, including 18 who received additional monthly maintenance treatments. Median time to recurrence in initial responders treated with vs without docetaxel maintenance was 39.3 vs 19.0 months. One and 3-year recurrence-free survival rates for the entire cohort were 40% and 25%, respectively. Of the 54 patients 17 (24%) underwent radical cystectomy at a median of 24 months of followup. Five-year disease specific and overall survival rates were 85% and 71%, respectively. Intravesical docetaxel appears to be a promising agent with significant efficacy and durability for bacillus Calmette-Guérin refractory nonmuscle invasive bladder cancer. Adding maintenance treatments may increase the duration of recurrence-free survival.

Diagnostic tests in urology: urine cytology

What's known on the subject? and What does the study add? Urine cytology is frequently used by urologists to evaluate patients with microscopic or gross haematuria. The results of urine cytology can be used as impetus to perform or triage further diagnostic studies, e.g. cystoscopy. The impact of urine cytology results on patient care warrants clarifying. This evidence-based medicine article explores how positive or negative urine cytology will impact the probability that a patient has urothelial carcinoma of the bladder before cystoscopy.

Routine Urine Cytology has No Role in Hematuria Investigations

Urine cytology has been a long-standing first line investigation for hematuria and is recommended in current major guidelines. We determined the contribution of urine cytology in hematuria investigations and its cost implications. Data were prospectively collected for 2,778 consecutive patients investigated for hematuria at a United Kingdom teaching hospital from January 1999 to September 2007 with final analysis in October 2010. All patients underwent standard hematuria investigations including urine cytology, flexible cystoscopy and renal tract ultrasound with excretory urogram or computerized tomography urogram performed in those with visible hematuria without a diagnosis after first line tests. Patients with positive urine cytology as the only finding underwent further cystoscopy, retrograde studies or ureteroscopy with biopsy under general anesthesia. Outcomes in terms of eventual diagnosis were cross-referenced with initial urine cytology results (classified as malignant, suspicious, atypical, benign or unsatisfactory). Costs of urine cytology were calculated. Of the patients 124 (4.5%) had malignant cells and 260 (9.4%) had atypical/suspicious results. For urothelial cancer cytology demonstrated 45.5% sensitivity and 89.5% specificity. Two patients with urine cytology as the only positive finding had urothelial malignancy on further investigation. For the entire cohort the cost of cytology was £111,120. Routine urine cytology is costly and of limited clinical value as a first line investigation for all patients with hematuria, and should be omitted from guidelines.

Prevalence of Urinary Decoy Cells and Associated Risk Factors in a Brazilian Kidney, Pancreas, and Kidney–Pancreas Transplant Population

BackgroundPolyomavirus BK (BKV) is currently considered one of the most important infectious diseases in kidney transplants recipients. The prevalence of decoy cells (viral containing shed urothelial cells) in these patients varies between 20% and 60%. Of decoy-positive patients, 1%–8% develop BKV nephropathy, a finding that may be associated with graft failure in up to 80% of affected individuals. MethodsDecoy cells cytology is an easily performed and inexpensive assay useful for poliomavirus infection screening. Data on the prevalence of decoy cells in simultaneous pancreas–kidney or isolated pancreas recipients remains largely unreported. In the present study, we evaluated 221 patients ≥18 years old with >1 month follow-up after transplantation who had attended the outpatient clinic between September and December 2006. ResultsThe total prevalence of decoy cells was 16% (16.9% in kidney recipients, 5.9% in simultaneous kidney-pancreas recipients and 20% in pancreas alone recipients). There were no differences between patients with either positive or negative urinary cytology for decoy cells, regarding demographic (gender, age, race) or clinical (time posttransplantation, donor type [deceased vs living donation], and presence of delayed graft function or rejection, other associated viral infections and type of immunosuppressive drugs variables.

Narrow-band imaging cystoscopy in non-muscle-invasive bladder cancer: a prospective comparison to the standard approach

A single-centre, prospective trial was performed aiming to assess the impact of narrow-band imaging (NBI) cystoscopy in cases of non-muscle-invasive bladder cancer (NMIBC) in comparison to standard white light cystoscopy (WLC). A total of 95 NMIBC-suspected consecutive cases were enrolled. The inclusion criteria were hematuria, positive urinary cytology or ultrasound suspicion of bladder tumors. All patients underwent WLC and NBI cystoscopy. Standard resection was performed for all lesions visible in white light and NBI transurethral resection of bladder tumors for only NBI-observed tumors. The overall detection rates of NMIBC and carcinoma in situ (CIS) were significantly improved for NBI (96.2% versus 87.2% and 100% versus 66.7% respectively). Also, NBI cystoscopy showed significantly superior detection for CIS, pTa and overall tumors (95.2% versus 61.9%, 93.9% versus 85.2% and 94.8% versus 83.9% respectively). Additional tumors were diagnosed by NBI in a significant proportion of patients with CIS, pTa, pT1 and NMIBC (55.5% versus 11.1%, 26.5% versus 10.2%, 30% versus 10% and 30.8% versus 10.3%). Postoperative treatment was significantly improved due to NBI results (16.7% versus 5.1%). NBI cystoscopy represents a valuable diagnostic alternative in patients with NMIBC, with significant improvement in tumor visual accuracy as well as detection. This approach provides a substantial improvement to bladder cancer therapeutic management.

1265 NUCLEAR MATRIX PROTEIN 22 (NMP22) AS URINE-BASED TUMOR MARKER FOR DETECTION OF PRIMARY AND RECURRENT BLADDER CANCER: COMPARISON OF THE POINT-OF-CARE VERSION (BLADDERCHEK®) AND THE ELISA

included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumors. The 181 cases of the study group underwent both WLC and HAL-BLC, while patients in the control group benefited from standard cystoscopy alone. A single postoperative mytomicin-C instillation was performed in all resection cases. No additional instillations were used in low risk patients, while adjuvant chemotherapy was applied in intermediate risk cases and BCG immunotherapy for high risk patients. The follow-up protocol consisted of abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years and every 6 months in the third year. RESULTS: In the 142 NMIBC patients of the study group, HALBLC emphasized significantly improved CIS (95.2% versus 71.4%), pTa (95.3% versus 87.1%) and overall (95.8% versus 85.9%) cases’ detection rates. Additional tumors were found by HAL-BLC in a significantly higher proportion of cases (35.2% versus 14.1%). Consequently, the recurrence (16.2% versus 4.9%) and progression (21.1% versus 7%) risk categories of patients changed significantly due to HAL-BLC by comparison to WLC. As a result, the postoperative treatment was modified due to HAL-BLC for a significantly larger proportion of patients (19% versus 6.3%). A total of 115 and respectively 106 NMIBC cases of the two study arms completed the 36 months’ evaluation period. The 3 months’ recurrence rate was significantly lower in the HAL-BLC series (6.9% versus 15.1%) due to fewer other site recurrences (0.9% versus 6.6%). During the long term follow-up, the overall 1 (20.9% versus 31.1%), 2 (30.4% versus 44.3%) and 3 (35.6% versus 51.9%) years’ recurrence rates were significantly reduced in the HAL-BLC study arm. CONCLUSIONS: HAL-BLC emphasized superior NMIBC patients’ detection rates as well as a significant impact in terms of additional tumors’ cases, risk category changes and postoperative treatment modifications. Subsequently, the 3 months’, 1, 2 and 3 years’ recurrence rates were significantly improved in the HAL-BLC group.

1264 A PROSPECTIVE, RANDOMIZED COMPARISON BETWEEN THE HEXAMINOLEVULINATE BLUE LIGHT AND THE STANDARD WHITE LIGHT CYSTOSCOPY CONCERNING THE LONG TERM RECURRENCE RATES IN NON-MUSCLE INVASIVE BLADDER CANCER CASES

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20121264 A PROSPECTIVE, RANDOMIZED COMPARISON BETWEEN THE HEXAMINOLEVULINATE BLUE LIGHT AND THE STANDARD WHITE LIGHT CYSTOSCOPY CONCERNING THE LONG TERM RECURRENCE RATES IN NON-MUSCLE INVASIVE BLADDER CANCER CASES Bogdan Geavlete, Razvan Multescu, Florin Stanescu, Dragos Georgescu, Marian Jecu, Cristian Moldoveanu, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete Bucharest, Romania More articles by this author , Razvan MultescuRazvan Multescu Bucharest, Romania More articles by this author , Florin StanescuFlorin Stanescu Bucharest, Romania More articles by this author , Dragos GeorgescuDragos Georgescu Bucharest, Romania More articles by this author , Marian JecuMarian Jecu Bucharest, Romania More articles by this author , Cristian MoldoveanuCristian Moldoveanu Bucharest, Romania More articles by this author , and Petrisor GeavletePetrisor Geavlete Bucharest, Romania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1596AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A prospective, randomized, long term study was performed aiming to compare the long term recurrence rates provided by the hexaminolevulinate blue light cystoscopy (HAL-BLC) versus the standard white light cystoscopy (WLC) in cases of non-muscle invasive bladder cancer (NMIBC). METHODS A total of 362 NMIBC suspected patients were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumors. The 181 cases of the study group underwent both WLC and HAL-BLC, while patients in the control group benefited from standard cystoscopy alone. A single postoperative mytomicin-C instillation was performed in all resection cases. No additional instillations were used in low risk patients, while adjuvant chemotherapy was applied in intermediate risk cases and BCG immunotherapy for high risk patients. The follow-up protocol consisted of abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years and every 6 months in the third year. RESULTS In the 142 NMIBC patients of the study group, HAL-BLC emphasized significantly improved CIS (95.2% versus 71.4%), pTa (95.3% versus 87.1%) and overall (95.8% versus 85.9%) cases' detection rates. Additional tumors were found by HAL-BLC in a significantly higher proportion of cases (35.2% versus 14.1%). Consequently, the recurrence (16.2% versus 4.9%) and progression (21.1% versus 7%) risk categories of patients changed significantly due to HAL-BLC by comparison to WLC. As a result, the postoperative treatment was modified due to HAL-BLC for a significantly larger proportion of patients (19% versus 6.3%). A total of 115 and respectively 106 NMIBC cases of the two study arms completed the 36 months' evaluation period. The 3 months' recurrence rate was significantly lower in the HAL-BLC series (6.9% versus 15.1%) due to fewer other site recurrences (0.9% versus 6.6%). During the long term follow-up, the overall 1 (20.9% versus 31.1%), 2 (30.4% versus 44.3%) and 3 (35.6% versus 51.9%) years' recurrence rates were significantly reduced in the HAL-BLC study arm. CONCLUSIONS HAL-BLC emphasized superior NMIBC patients' detection rates as well as a significant impact in terms of additional tumors' cases, risk category changes and postoperative treatment modifications. Subsequently, the 3 months', 1, 2 and 3 years' recurrence rates were significantly improved in the HAL-BLC group. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e511-e512 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Geavlete Bucharest, Romania More articles by this author Razvan Multescu Bucharest, Romania More articles by this author Florin Stanescu Bucharest, Romania More articles by this author Dragos Georgescu Bucharest, Romania More articles by this author Marian Jecu Bucharest, Romania More articles by this author Cristian Moldoveanu Bucharest, Romania More articles by this author Petrisor Geavlete Bucharest, Romania More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mixed epithelial and stromal tumor of the kidney (MEST) simulating an upper tract TCC.

We present a rare and interesting case of a mixed epithelial and stromal tumour (MEST) of the kidney. The case is unique as it involves a male patient with no history of hormonal therapy presenting with a filling defect in the renal collecting system and positive urine cytology. The patient was diagnosed with transitional cell carcinoma of the renal pelvis and subjected to nephroureterectomy, which revealed a solid tumour arising from the lower calyces and extending into the renal pelvis and upper ureter. Pathology revealed a MEST. The patient was disease-free at the 6-month follow-up.