Document Detail

The role of FISH and cytology in upper urinary tract surveillance after radical cystectomy for bladder cancer.
MedLine Citation:
PMID:  21396845     Owner:  NLM     Status:  MEDLINE    
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.
Mario I Fernández; Sahil Parikh; H Barton Grossman; Ruth Katz; Surena F Matin; Colin P N Dinney; Ashish M Kamat
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-03-10
Journal Detail:
Title:  Urologic oncology     Volume:  30     ISSN:  1873-2496     ISO Abbreviation:  Urol. Oncol.     Publication Date:    2012 Nov-Dec
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-07-25     Revised Date:  2014-02-26    
Medline Journal Info:
Nlm Unique ID:  9805460     Medline TA:  Urol Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  821-4     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
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MeSH Terms
Carcinoma, Transitional Cell / diagnosis*,  urine
In Situ Hybridization, Fluorescence*
Neoplasm Grading
Neoplasm Recurrence, Local / diagnosis*
Neoplasm Staging
Sensitivity and Specificity
Urinary Bladder Neoplasms / diagnosis*,  urine
Grant Support
5P50CA091846-03/CA/NCI NIH HHS; P50 CA091846/CA/NCI NIH HHS

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