Surveillance Of Non-muscle Invasive Bladder Cancer Research Articles

Urinary Tumor DNA-Based Diagnosis and Surveillance for Nonmuscle-Invasive Bladder Cancer—Current Landscape and Future Directions

Bladder cancer has a significant impact on patients, in terms of both morbidity and financial burden. This is especially true for patients with nonmuscle-invasive bladder cancer, who undergo long-term surveillance via cystoscopy and imaging, resulting in significant costs and risks. To address this issue, urinary tumor DNA analysis, or “urinary liquid biopsy,” has emerged as a potential solution to reduce the testing burden and mitigate many of the costs and risks. Over time, urinary tumor DNA analysis has undergone several refinements. However, existing FDA-approved urinary biomarker assays currently lack the sensitivity and specificity to significantly impact clinical decision-making. Subsequent iterations of these technologies have attempted to bridge this gap by improving their diagnostic accuracy, and ultimately, clinical utility. Here, we discuss the current role as well as future directions of urinary tumor DNA analysis for the detection and long-term surveillance of nonmuscle-invasive bladder cancer.

RNA-based urinary assays for non-muscle invasive bladder cancer.

To provide an overview of the recent literature on RNA-based molecular urine assays for the diagnosis and surveillance of non-muscle invasive bladder cancer (NMIBC). Articles were eligible for inclusion if performance metrics sensitivity, specificity, and negative-predictive value (NPV) were reported or could be calculated. Only prospective studies published between 2020-2022 were included. Five out of fourteen studies addressed the primary diagnostic setting; the proportion of gross hematuria patients in all study populations was >50%. Only one study reported performance metrics within a microscopic hematuria subgroup. This study evaluated Xpert Bladder and reported a sensitivity: 73%, specificity: 84%, NPV: 99%, and PPV: 12%. Ten studies assessed test performance during surveillance for NMIBC. For the detection of high-grade (HG) and high-risk (HR) NMIBC, sensitivity, specificity, NPV, and PPV varied between 78-100%, 64-89%, 97.0-99.7%, and 9.2-39%. Multiple RNA-based urine assays have been investigated for the detection of urothelial cancer in the primary or surveillance setting. However, studies included within this review have important limitations, hampering the interpretation of study results. As such, performance metrics should be interpreted with caution and further research is required to evaluate the clinical impact of RNA-based urine assays in daily practice.

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

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.

Treatment and surveillance for non-muscle-invasive bladder cancer: a clinical practice guideline (2021 edition)

Non-muscle invasive bladder cancer (NMIBC) is a major type of bladder cancer with a high incidence worldwide, resulting in a great disease burden. Treatment and surveillance are the most important part of NIMBC management. In 2018, we issued “Treatment and surveillance for non-muscle-invasive bladder cancer in China: an evidence-based clinical practice guideline”. Since then, various studies on the treatment and surveillance of NMIBC have been published. There is a need to incorporate these materials and also to take into account the relatively limited medical resources in primary medical institutions in China. Developing a version of guideline which takes these two issues into account to promote the management of NMIBC is therefore indicated. We formed a working group of clinical experts and methodologists. Through questionnaire investigation of clinicians including primary medical institutions, 24 clinically concerned issues, involving transurethral resection of bladder tumor (TURBT), intravesical chemotherapy and intravesical immunotherapy of NMIBC, and follow-up and surveillance of the NMIBC patients, were determined for this guideline. Researches and recommendations on the management of NMIBC in databases, guideline development professional societies and monographs were referred to, and the European Association of Urology was used to assess the certainty of generated recommendations. Finally, we issued 29 statements, among which 22 were strong recommendations, and 7 were weak recommendations. These recommendations cover the topics of TURBT, postoperative chemotherapy after TURBT, Bacillus Calmette–Guérin (BCG) immunotherapy after TURBT, combination treatment of BCG and chemotherapy after TURBT, treatment of carcinoma in situ, radical cystectomy, treatment of NMIBC recurrence, and follow-up and surveillance. We hope these recommendations can help promote the treatment and surveillance of NMIBC in China, especially for the primary medical institutions.

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

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 ...

Diagnostic Accuracy of MCM5 for the Detection of Recurrence in Nonmuscle Invasive Bladder Cancer Followup: A Blinded, Prospective Cohort, Multicenter European Study.

Detection of MCM5 containing cells in urine has been shown to be indicative of the presence of a bladder tumor on primary diagnosis. In this study we evaluate diagnostic performance of ADXBLADDER in patients undergoing cystoscopic surveillance in nonmuscle invasive bladder cancer followup. A multicenter prospective blinded study was performed at 21 European centers with patients undergoing cystoscopy for nonmuscle invasive bladder cancer surveillance, diagnosed in the preceding 2 years. Urine was collected from all eligible patients and ADXBLADDER-MCM5 testing was performed. Performance characteristics were calculated by comparing MCM5 results to the outcome of cystoscopy plus pathological assessment. Of 1,431 eligible patients enrolled 127 were diagnosed with a bladder cancer recurrence. The overall sensitivity for the ADXBLADDER-MCM5 test in detecting bladder cancer recurrence was 44.9% (95% CI 36.1-54) with a 75.6% sensitivity for nonpTaLG tumors (95% CI 59.7-87.6). Specificity was 71.1% (95% CI 68.5-73.5). The overall negative predictive value was 93% (95% CI 91.2-94.5). However, ADXBLADDER was able to rule out the presence of a nonpTaLG recurrent tumor with a negative predictive value of 99.0% (95% CI 98.2-99.5). No statistically significant differences in the performance of ADXBLADDER were observed as a result of age or sex. This large blinded prospective study demonstrates that in the followup of patients with nonmuscle invasive bladder cancer ADXBLADDER is able to exclude the presence of the most aggressive tumors with a negative predictive value of 99%. These results indicate that ADXBLADDER could be incorporated in the followup strategy of nonmuscle invasive bladder cancer.

Validation of a Novel, Sensitive, and Specific Urine-Based Test for Recurrence Surveillance of Patients With Non-Muscle-Invasive Bladder Cancer in a Comprehensive Multicenter Study.

Bladder cancer (BC), the most frequent malignancy of the urinary system, is ranked the sixth most prevalent cancer worldwide. Of all newly diagnosed patients with BC, 70–75% will present disease confined to the mucosa or submucosa, the non-muscle-invasive BC (NMIBC) subtype. Of those, approximately 70% will recur after transurethral resection (TUR). Due to high rate of recurrence, patients are submitted to an intensive follow-up program maintained throughout many years, or even throughout life, resulting in an expensive follow-up, with cystoscopy being the most cost-effective procedure for NMIBC screening. Currently, the gold standard procedure for detection and follow-up of NMIBC is based on the association of cystoscopy and urine cytology. As cystoscopy is a very invasive approach, over the years, many different noninvasive assays (both based in serum and urine samples) have been developed in order to search genetic and protein alterations related to the development, progression, and recurrence of BC. TERT promoter mutations and FGFR3 hotspot mutations are the most frequent somatic alterations in BC and constitute the most reliable biomarkers for BC. Based on these, we developed an ultra-sensitive, urine-based assay called Uromonitor®, capable of detecting trace amounts of TERT promoter (c.1-124C > T and c.1-146C > T) and FGFR3 (p.R248C and p.S249C) hotspot mutations, in tumor cells exfoliated to urine samples. Cells present in urine were concentrated by the filtration of urine through filters where tumor cells are trapped and stored until analysis, presenting long-term stability. Detection of the alterations was achieved through a custom-made, robust, and highly sensitive multiplex competitive allele-specific discrimination PCR allowing clear interpretation of results. In this study, we validate a test for NMIBC recurrence detection, using for technical validation a total of 331 urine samples and 41 formalin-fixed paraffin-embedded tissues of the primary tumor and recurrence lesions from a large cluster of urology centers. In the clinical validation, we used 185 samples to assess sensitivity/specificity in the detection of NMIBC recurrence vs. cystoscopy/cytology and in a smaller cohort its potential as a primary diagnostic tool for NMIBC. Our results show this test to be highly sensitive (73.5%) and specific (93.2%) in detecting recurrence of BC in patients under surveillance of NMIBC.

Developing the advanced nursing practice role in non‐muscle invasive bladder cancer surveillance in Ireland

Advanced nurse practitioner (ANP) roles are continuing to emerge and evolve worldwide, including in the Republic of Ireland. Progress has been influenced by a number of factors which include; affording opportunities for nurses to advance their careers while remaining in clinical practice; health care cost containment; improving access to care; continuity of patient care and due to limits on junior doctors working hours. Confusion related to the definition of the ANP role, a multitude of role titles, what the role entails and what differentiates it from other specialist roles has impeded its overall development. This has led to difficulties in measuring clinical impact, and leads to conflicting conceptualizations of the role. This article focuses on the application of two domains of advanced practice as identified by Hutchinson et al. and applies the components of those domains of practice to an emerging advanced practice role in urology. The purpose of the article is to provide a tentative professional development framework for the advanced practice urology nursing role involved in managing a caseload of patients diagnosed with non‐muscle invasive bladder cancer (NMIBC) focusing on autonomous practice and improving systems of care. These domains of practice are discussed in cognisance of the needs of the population, the demands on the health care organization, and within the defined framework of advanced nursing practice in Ireland.

Editorial Comment

After resection of a primary non–muscle-invasive bladder cancer (NMIBC), about two-thirds of patients will develop recurrences. Kompier 1 Kompier L.C. van der Aa M.N. Lurkin I. et al. The development of multiple bladder tumour recurrences in relation to the FGFR3 mutation status of the primary tumour. J Pathol. 2009; 218: 104-112 Crossref PubMed Scopus (47) Google Scholar followed 118 patients with NMIBC. During a median follow-up of 8.8 years, these patients underwent 2133 cystoscopies and 80 patients developed 414 recurrences. The 38 patients who did not develop any recurrences underwent on average 14 cystoscopies. For these patients, surveillance by cystoscopy can be considered as overtreatment. Cystoscopy is an invasive technology that is associated with anxiety and pain. 2 van der Aa M.N. Steyerberg E.W. Sen E.F. et al. Patients' perceived burden of cystoscopic and urinary surveillance of bladder cancer: a randomized comparison. BJU Int. 2008; 101: 1106-1110 Crossref PubMed Scopus (88) Google Scholar Although the gold standard, its sensitivity is estimated to be between 46% and 86% and specificity between 31% and 93%. 3 Witjes J.A. Douglass J. The role of hexaminolevulinate fluorescence cystoscopy in bladder cancer. Nat Clin Pract Urol. 2007; 4: 542-549 Crossref PubMed Scopus (107) Google Scholar The limited sensitivity is often ignored, and this oversight is one of the reasons that urine tests have not been introduced in the clinic. We and others have demonstrated that molecular assays can detect recurrences in cells obtained from voided urine with a sensitivity that allows implementation of urine diagnostics especially for patients who are at low risk of progression and which is also cost-effective. 4 Zuiverloon T.C. Tjin S.S. Busstra M. et al. Optimization of nonmuscle invasive bladder cancer recurrence detection using a urine based FGFR3 mutation assay. J Urol. 2011; 186: 707-712 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar , 5 Zuiverloon T.C. Beukers W. van der Keur K.A. et al. Combinations of urinary biomarkers for surveillance of patients with incident nonmuscle invasive bladder cancer: the European FP7 UROMOL project. J Urol. 2013; 189: 1945-1951 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 6 van Kessel K.E. Kompier L.C. de Bekker-Grob E.W. et al. FGFR3 mutation analysis in voided urine samples to decrease cystoscopies and cost in nonmuscle invasive bladder cancer surveillance: a comparison of 3 strategies. J Urol. 2013; 189: 1676-1681 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar The Diagnostic and Prognostic Performance of Urinary FGFR3 Mutation Analysis in Bladder Cancer Surveillance: A Prospective Multicenter StudyUrologyVol. 86Issue 6PreviewTo assess the diagnostic and prognostic performance of a noninvasive FGFR3 mutation analysis. After transurethral resection (TUR) of noninvasive bladder transitional cell carcinoma (B-TCC), recurrence occurs in 70% of patients, thus justifying cystoscopic surveillance. Full-Text PDF

Prognostic relevance of positive urine markers in patients with negative cystoscopy during surveillance of bladder cancer

BackgroundThe role of urine markers in the surveillance of patients with non-muscle invasive bladder cancer (NMIBC) is discussed extensively. In case of negative cystoscopy the additional prognostic value of these markers has not been clearly defined yet. The present study is the first systematic approach to directly compare the ability of a urine marker panel to predict the risk of recurrence and progression in bladder cancer (BC) patients with no evidence of relapse during surveillance for NMIBC.MethodsOne hundred fourteen patients who underwent urine marker testing during surveillance for NMIBC and who had no evidence of BC recurrence were included. For all patients cytology, Fluorescence-in-situ-hybridization (FISH), immunocytology (uCyt+) and Nuclear matrix protein 22 enzyme-linked immunosorbent assay (NMP22) were performed. All patients completed at least 24 months of endoscopic and clinical follow-up of after inclusion.ResultsWithin 24 months of follow-up, 38 (33.0%) patients experienced disease recurrence and 11 (9.8%) progression. Recurrence rates in patients with positive vs. negative cytology, FISH, uCyt+ and NMP22 were 52.6% vs. 21.9% (HR = 3.9; 95% CI 1.75-9.2; p < 0.001), 47.6% vs. 25.0% (HR 2.7; 1.2-6.2; p = 0.01), 43.8% vs. 22.4% (HR 3.3; 1.5-7.6; p = 0.003) and 43.8% vs. 16.7% (HR 4.2; 1.7-10.8; p = 0.001). In patients with negative cytology, a positive NMP22 test was associated with a shorter time to recurrence (p = 0.01), whereas FISH or uCyt+ were not predictive of recurrence in these patients. In the group of patients with negative cytology and negative NMP22, only 13.5% and 5.4% developed recurrence and progression after 24 months.ConclusionsPatients with positive urine markers at time of negative cystoscopy are at increased risk of recurrence and progression. In patients with negative cytology, only NMP22 is predictive for recurrence. Patients with negative marker combinations including NMP22 harbour a low risk of recurrence. Therefore, the endoscopic follow-up regimen may be attenuated in this group of patients.

1104 FGFR3 mutation analysis in voided urine samples to decrease cystoscopies and cost in nonmuscle invasive bladder cancer surveillance: A comparison of 3 strategies

1104 FGFR3 mutation analysis in voided urine samples to decrease cystoscopies and cost in nonmuscle invasive bladder cancer surveillance: A comparison of 3 strategies

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

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 ...