Natural History of Positive Urinary Cytology After Radical Cystectomy

Raj, Ganesh V.; Bochner, Bernard H.; Serio, Angel M.; Vickers, Andrew J.; Donat, S. Machele; Herr, Harry W.; Lin, Oscar; Dalbagni, Guido

doi:10.1016/j.juro.2006.07.049

Cited by 24 publications

(15 citation statements)

References 13 publications

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“…Current upper tract surveillance regimens are variable and usually include cross-sectional imaging and, most frequently, urinary cytology. A positive cytology after radical cystectomy has been reported to be an independent risk factor for urothelial recurrence in this setting [5]. However, overall sensitivity of this test when used for diagnosis of UTUC is poor (36%) and highly depends on tumor grade and stage [6].…”

Section: Introductionmentioning

confidence: 99%

The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer

Fernández

Parikh

Grossman

et al. 2012

Urologic Oncology: Seminars and Original Investigations

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Objectives Cytology and fluorescence in situ hybridization (FISH) (Urovysion) assay are often used during upper urinary tract surveillance in patients following radical cystectomy with urinary diversion, without much available data regarding efficacy in this population. Here, we evaluate the value of FISH and cytology in detecting upper tract recurrence in the face of a urinary diversion. Materials and methods A review of our cystectomy database revealed 270 patients who had at least one FISH and/or cytology assay performed during surveillance after radical cystectomy. Workup included upper tract imaging in all patients and upper tract endoscopy as indicated. A total of 163 FISH assays and 474 urinary cytology examinations were included in the analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FISH and cytology were assessed. Results Ten patients (3.4%) developed upper tract recurrence after a median follow-up time of 31 months (2–202). All but 1 patient presented either with gross hematuria or positive finding on imaging; 6 had positive FISH and cytology, and 2 had positive cytology only (no FISH done). For detection of upper tract recurrence, sensitivity, specificity, PPV, and NPV of cytology were 80.0%, 85.6%, 10.7%, and 99.5%, respectively; and that for FISH were 85.7%, 86.5%, 23.1%, and 99.2%, respectively. Conclusions The FISH assay and urinary cytology both demonstrate high rates of false positivity and are useful mainly for their negative predictive ability in patients with a urinary diversion. Unless prospective trials show otherwise, both— or at least the more expensive test— can be omitted from surveillance strategies.

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Section: Introductionmentioning

confidence: 99%

The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer

Fernández

Parikh

Grossman

et al. 2012

Urologic Oncology: Seminars and Original Investigations

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“…This selection possibly underestimated OS of patients with metachronous upper tract recurrence because patients amenable to radical surgery may have significantly better survival than those who are unable to undergo radical surgery. 2, 22 Second, our study was limited by the variability of the timing of postoperative serum eGFR measurements. 13 Third, the lack of other compounding factors, such as history of smoking and exposure to carcinogens, may overlook the risk of panurothelial tumorigenesis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence

Assel

Benfante

et al. 2017

Journal of Urology

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Purpose We report pathologic, functional, and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy. Materials and Methods We identified patients who underwent radical cystectomy then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014. Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis, and radiographic findings. Results Of the 3173 radical cystectomy patients, 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61–74). Of the 64 who underwent radical nephroureterectomy, the median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR: 1.4–4.6). Among 37 patients that underwent ureteroscopy prior to radical nephroureterectomy, 29 (78%) had positive biopsy. Radical nephroureterectomy pathology revealed 39% locally advanced disease (pT3/pT4) and 11% positive node status compared with 17% locally advanced disease, and 6% positive node status from radical cystectomy pathology. Post- radical nephroureterectomy eGFR was <60 mL/min/1.73m2 and <30 mL/min/1.73m2 for 96% and 40% of patients, respectively. Median overall survival from radical nephroureterectomy was 3.1 years (95% CI: 2.4–4.3). Only lymph node involvement on radical nephroureterectomy was significantly associated with worse overall mortality (HR=2.73, 95% CI 1.04, 7.15, p=0.041). Conclusions Prognosis is poor for patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy, with locally advanced disease in a large proportion of patients. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin-based chemotherapy.

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“…exposure to nitrosamines) and patients with known prior urothelial malignancies [1]. The utility of urine cytology in screening patients after cystectomy is highlighted by the finding that up to 90% of patients with positive urine cytology do not have clinicoradiographic signs or symptoms of recurrent disease [11]. …”

Section: Discussionmentioning

confidence: 99%

The Clinicopathologic Correlates of Cellular Atypia in Urinary Cytology of Ileal Neobladders

Cimino‐Mathews

Ali²

2011

Acta Cytologica

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Objective: Ileal neobladders (INBs) are routinely created in patients following cystectomy for urothelial carcinoma (UC). Patients are screened by urinary cytology for tumor recurrence. However, the diagnosis of urothelial atypia remains a nonstandardized category in INB specimens and has never been studied before. Study Design: The cytopathology archives from the Johns Hopkins Hospital were searched over a period of 19 years for specimens from patients with INB and atypical urine cytology. Follow-up surgical pathology results and clinical data were reviewed. Results: A total of 620 urine specimens were identified from patients with INB, 77 of which (12.4%) were diagnosed as ‘atypical’. Of the 51 patients who were followed up, only 3 developed a concordant local recurrence (5.9% positive predictive value), defined as biopsy-proven recurrence within 1 year of atypical cytology. The recurrent patients had more diagnoses of ‘atypical cells suspicious for carcinoma’ than nonrecurrent patients (66 vs. 11.4%; p > 0.10). Conclusion: A diagnosis of urothelial atypia in patients with INB is made as frequently as in patients with native bladders but with a lower positive predictive value (5.9 vs. 12%) for subsequent histologic diagnosis of UC. This suggests that the diagnosis of urothelial atypia in INB may have less clinical significance than in native bladders.

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Natural History of Positive Urinary Cytology After Radical Cystectomy

Cited by 24 publications

References 13 publications

The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer

The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer

Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence

The Clinicopathologic Correlates of Cellular Atypia in Urinary Cytology of Ileal Neobladders

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