The clinical value of urinary cytology: 12 years of experience with 615 patients.

Maier, Ulrich; Simak, R.; Neuhold, N.

doi:10.1136/jcp.48.4.314

Cited by 68 publications

(42 citation statements)

References 16 publications

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“…Conventional cytology was not considered despite the well-known specificity of cytology to detect high-grade bladder cancer and pTis, the main targets of BCG therapy. 9,17 To our knowledge, this is the first prospective study to investigate the predictive value of both methods in the follow-up of NMIBC after BCG treatment. The fact that neither post-BCG FISH nor post-BCG cytology reached independent prognostic significance in multivariate analysis when using the clinically useful definition of positive (G3-G2) and negative (G0-G1) cytology suggests that both are highly interrelated and equally valuable in assessing the risk of failure after BCG therapy.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Fluorescence in situ hybridization (FISH) in urinary cytology using the multiprobe UroVysion 1 FISH assay for detection of chromosomal aberrations is a sensitive and objective method for improved diagnosis of urothelial carcinoma as it can detect chromosomal changes characteristic for cancer cells before they become morphologically apparent. 11,12 The usefulness of FISH relative to conventional cytology in monitoring NMIBC after BCG treatment has not been investigated so far.…”

Section: Uiccmentioning

confidence: 99%

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The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

Savic

Zlobec

Thalmann

et al. 2009

Intl Journal of Cancer

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Molecular markers reliably predicting failure or success of Bacillus Calmette-Guerin (BCG) in the treatment of nonmuscle-invasive urothelial bladder cancer (NMIBC) are lacking. The aim of our study was to evaluate the value of cytology and chromosomal aberrations detected by fluorescence in situ hybridization (FISH) in predicting failure to BCG therapy. Sixty-eight patients with NMIBC were prospectively recruited. Bladder washings collected before and after BCG instillation were analyzed by conventional cytology and by multitarget FISH assay (UroVysion 1 , Abbott/ Vysis, Des Plaines, IL) for aberrations of chromosomes 3, 7, 17 and 9p21. Persistent and recurrent bladder cancers were defined as positive events during follow-up. Twenty-six of 68 (38%) NMIBC failed to BCG. Both positive post-BCG cytology and positive post-BCG FISH were significantly associated with failure of BCG (hazard ratio (HR)5 5.1 and HR5 5.6, respectively; p < 0.001 each) when compared to those with negative results. In the subgroup of nondefinitive cytology (all except those with unequivocally positive cytology), FISH was superior to cytology as a marker of relapse (HR5 6.2 and 1.4, respectively). Cytology and FISH in post-BCG bladder washings are highly interrelated and a positive result predicts failure to BCG therapy in patients with NMIBC equally well. FISH is most useful in the diagnostically less certain cytology categories but does not provide additional information in clearly malignant cytology. ' UICCKey words: nonmuscle-invasive urothelial bladder cancer; Bacillus Calmette-Guerin; cytology; fluorescence in situ hybridization High-and intermediate risk nonmuscle-invasive urothelial bladder cancers (NMIBC) frequently recur and, more importantly, can progress to potentially life-threatening muscle-invasive carcinomas. Intravesical instillation of Bacillus Calmette-Guerin (BCG) after transurethral resection of bladder cancer (TURB) is the most effective treatment. However, 50% of NMIBC do not respond to BCG treatment. [1][2][3] The progression rate has been estimated to be 9.8%, and 5.6% of patients with NMIBC die from bladder cancer. 4 Although an early cystectomy provides an excellent chance of cure, 50% of patients are overtreated with this aggressive approach. 5,6 Decision on therapy strategy of bladder cancer is based on clinicopathological tumor characteristics (number of tumors, tumor size, prior recurrence rate, tumor category, presence of pTis and tumor grade). Several clinicopathological tumor characteristics have recently been suggested as predictors for recurrence and progression after BCG therapy. 7 However, clinicopathological or molecular markers that can reliably predict failure or success of BCG therapy are still lacking. 8 Such markers would be of great value to individually tailor the follow-up schedule and stratify patients at high risk of tumor recurrence or progression.Although conventional cytology has a very high diagnostic accuracy for high-grade urothelial carcinomas, false-positive results have been repor...

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Section: Discussionmentioning

confidence: 99%

Section: Uiccmentioning

confidence: 99%

The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

Savic

Zlobec

Thalmann

et al. 2009

Intl Journal of Cancer

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“…5 Cystoscopy and urine cytology represent the standard of care in the surveillance of urothelial carcinoma despite their limitations. 5,6 Cytology reportedly has a high specificity but poor sensitivity for urothelial carcinomas, particularly low-grade urothelial carcinomas. 3,[6][7][8] Cystoscopy, which is considered the gold standard in the diagnostic evaluation of urothelial carcinomas, is an excellent diagnostic tool for papillary urothelial lesions, but it has a reported lower sensitivity for flat carcinoma in situ.…”

mentioning

confidence: 99%

“…5,6 Cytology reportedly has a high specificity but poor sensitivity for urothelial carcinomas, particularly low-grade urothelial carcinomas. 3,[6][7][8] Cystoscopy, which is considered the gold standard in the diagnostic evaluation of urothelial carcinomas, is an excellent diagnostic tool for papillary urothelial lesions, but it has a reported lower sensitivity for flat carcinoma in situ. 8,9 In addition, cystoscopy is an invasive and costly procedure.…”

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confidence: 99%

Reflex UroVysion testing in suspicious urine cytology cases

Ferrá

Denley

Herr

et al. 2009

Cancer Cytopathology

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BACKGROUND:UroVysion is a US Food and Drug Administration–approved fluorescence in situ hybridization (FISH) probe set for use in the detection of recurrent urothelial carcinoma and in patients with hematuria. The objective of the current study was to evaluate the usefulness of UroVysion as a reflex test in patients with a suspicious urine cytology diagnosis. The rationale was that a more aggressive workup might be indicated in patients with a suspicious cytology diagnosis and positive UroVysion test.METHODS:The study population included 161 urine specimens diagnosed as suspicious over a period of 12 months. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (NPV) were calculated based on the histologic and cystoscopic correlation.RESULTS:The results using the reporting criteria suggested by the manufacturer demonstrated a sensitivity of 68.3%, a specificity of 39.7%, a PPV of 56.8%, and a NPV of 51.9%. The results using the presence of any cytogenetic abnormality as a positive FISH test demonstrated a sensitivity of 82.9%, a specificity of 21.7%, a PPV of 54.8%, and an NPV of 51.7%.CONCLUSIONS:A negative UroVysion test did not rule out the presence of low‐grade or high‐grade urothelial carcinoma in urine specimens diagnosed as suspicious. The use of less strict criteria dramatically increased the sensitivity of UroVysion FISH; however, there was a marked decrease in specificity noted. The results in this current study appear to indicate that a more aggressive workup of patients with a suspicious cytology, positive UroVysion result, and negative cystoscopic evaluation is not currently justified. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

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“…7 The gold standard for diagnosis and surveillance of urothelial carcinoma has traditionally been cystoscopy and urine cytology, however both have limitations. [8][9][10][11][12][13][14] Although urine cytology is excellent for detecting high-grade urothelial carcinoma (sensitivity and specificity 475%), it has a low sensitivity (20-60%) for detecting low-grade tumors. 8,[10][11][12][13][14] The low sensitivity of urine cytology, the invasiveness of cystoscopy and its limited usefulness in detecting flat and inaccessible lesions have prompted increased demand for newer, more sensitive and non-invasive tests for detection of urothelial carcinoma.…”

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confidence: 99%

The use of Urovysion™ fluorescence in situ hybridization in the diagnosis and surveillance of non-urothelial carcinoma of the bladder

et al. 2009

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Urovysiont fluorescence in situ hybridization (FISH) is a sensitive and specific test used to diagnose urothelial carcinoma in urine. It detects aneuploidy of chromosomes 3, 7 and 17, and loss of both 9p21 loci in malignant urothelial cells. We evaluated Urovysiont FISH in non-urothelial carcinoma involving bladder to determine its possible application to their diagnosis and surveillance. Paraffin blocks from 31 non-urothelial bladder carcinomas, 12 pure urothelial carcinomas and 2 urothelial carcinomas with squamous differentiation were tested according to Vysis-Abbot Laboratories' recommended standards. Cases included 15 primary squamous carcinoma, 2 urothelial carcinoma with squamous differentiation, 4 primary adenocarcinoma, 5 colonic, 4 prostatic and 1 cervical adenocarcinoma. Total 60% of squamous, 83% of pure urothelial, 100% of urothelial carcinoma with squamous differentiation and 100% of primary and secondary adenocarcinomas hybridized successfully; 2/10 (11%) squamous carcinomas and 11/14 (79%) primary and secondary adenocarcinomas were Urovysiont FISH-positive with primary adenocarcinomas accounting for 75% (3/4), colonic, 80% (4/5), prostatic, 75% (3/4) and cervical, 100% (1/1) positivity. Total 70% (7/10) of pure urothelial carcinomas and 100% (2/2) of urothelial carcinomas with squamous differentiation were Urovysiont FISH-positive. In conclusion, we found that chromosomal abnormalities tested for by Urovysiont FISH may be seen in non-urothelial carcinomas of bladder. These false-positive results were frequent in primary and secondary adenocarcinoma and rare in squamous carcinoma. This has significant implications for the accurate diagnosis and management of patients with urinary tract cancer. Urovysiont FISH cannot be used to definitively diagnose squamous carcinoma or adenocarcinoma nor can it be used to differentiate the two from urothelial carcinoma. However, it may be useful as a surveillance tool in established primary and secondary bladder adenocarcinoma. Cytopathologists and urologists should correlate Urovysiont FISH results with cytomorphology and clinical information.

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The clinical value of urinary cytology: 12 years of experience with 615 patients.

Cited by 68 publications

References 16 publications

The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

The prognostic value of cytology and fluorescence in situ hybridization in the follow‐up of nonmuscle‐invasive bladder cancer after intravesical Bacillus Calmette‐Guérin therapy

Reflex UroVysion testing in suspicious urine cytology cases

The use of Urovysion™ fluorescence in situ hybridization in the diagnosis and surveillance of non-urothelial carcinoma of the bladder

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