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C30 COMBINED NARROW BAND IMAGING CYSTOSCOPY AND BIPOLAR PLASMA VAPORIZATION IN CASES OF LARGE NON-MUSCLE INVASIVE BLADDER TUMORS – BETTER THAN THE STANDARD APPROACH?
when compared to WLC (19% versus 6.3%). 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 and a significant impact concerning the postoperative treatment modifications. Subsequently, the long-term recurrence rates were significantly improved in the HAL-BLC group.
C29
NBI cystoscopy in non-muscle invasive bladder cancer – A prospective comparison to the standard approach
Geavlete B., Jecu M., Moldoveanu C., Stanescu F., Iacoboaie C., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial aimed to assess the impact of narrow band imaging (NBI) cystoscopy in cases of non-muscle invasive bladder cancer (NMIBC). A single centre, prospective comparison to the standard white light cystoscopy (WLC) was performed. Material & Methods: A total of 95 NMIBC suspected consecutive cases were enrolled. The inclusion criteria were hematuria, positive urinary cytology and/or ultrasound suspicion of bladder tumors. All patients underwent WLC and NBI cystoscopy. Standard resection was performed for all lesions visible in WL and NBI-TURBT for only NBI observed tumors. Results: The overall NMIBC and CIS patients’ detection rates were significantly improved for NBI (96.2% versus 87.2% and 100% versus 66.7%). Also, on a lesions’ related basis, NBI cystoscopy emphasized a significantly superior detection concerning the 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 CIS, pTa, pT1 and NMIBC patients (55.5% versus 11.1%, 26.5% versus 10.2%, 30% versus 10% and 30.8% versus 10.3%) More over, pathologically confirmed positive tumoral margins secondary to white light TURBT were found at the NBI control in 10.3% of the cases. The postoperative treatment was significantly improved due to NBI results (16.7% versus 5.1%). Conclusions: NBI cystoscopy represents a valuable diagnostic alternative in NMIBC patients, with significant improvement of tumor visual accuracy as well as detection. This approach provided a substantial amelioration to the bladder cancer therapeutic management.
C30
Combined narrow band imaging cystoscopy and bipolar plasma vaporization in cases of large non-muscle invasive bladder tumors – Better than the standard approach?
Geavlete B., Stanescu F., Jecu M., Moldoveanu C., Multescu R., Georgescu D., Iacoboaie C., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial evaluated the narrow band imaging (NBI) cystoscopy and bipolar plasma vaporization (BPV) versus standard white light cystoscopy (WLC) and monopolar TURBT in cases of large bladder tumors. A prospective, long-term, randomized comparison was performed concerning the NMIBT recurrence rates specific to the 2 approaches. Material & Methods: A total of 220 patients with at least one bladder tumor over 3 cm were equally randomized for either NBI, WLC and BPV or WLC and TURBT. Preoperative assessment included abdominal ultrasound, CT and flexible WLC. Standard monopolar Re-TUR was applied in all NMIBT cases. The follow-up protocol comprised urinary cytology and WLC, performed every 3 months for 2 years. Results: The CIS (94.6% versus 67.6%), pTa (93% versus 82.4%) and overall NMIBT (94.9% versus 84.3%) detection rates were significantly improved for NBI cystoscopy versus WLC. The obturator nerve stimulation, bladder wall perforation, mean hemoglobin drop and postoperative bleeding rates were significantly reduced for BPV versus TURBT. The catheterization period and hospital stay were significantly shorter subsequent to BPV. The overall (6.3% versus 17.5%) and primary site (4.2% versus 13.4%) Re-TUR residual tumors’ rates were significantly lower for NBI-BPV. The 1 (6.9% versus 16.8%) and 2 (11.5% versus 25.8%) years’ recurrence rates were significantly reduced in the NBI-BPV group. Conclusions: NBI cystoscopy displayed improved diagnostic accuracy and BPV emphasized superior efficacy, reduced morbidity and faster recovery in large NMIBT cases. The NBI-BPV technique provided a lower Re-TUR residual tumors’ rate and reduced 1 and 2 years’ recurrence rates.
C31
Second voided urine samples give better yields of cell-free DNA than first morning urine in bladder cancer patients and controls
Hrbáček J.1, Pazourková E.2, Brisuda A.1, Soukup V.3, Mareš J.4, Čapoun O.3, Korabečná M.2, Hořínek A.2, Hanuš T.3, Babjuk M.1 1 2nd Faculty of Medicine and Teaching Hospital In Motol, Dept. of Urology, Prague, Czech Republic, 21st Faculty of Medicine and General University Hospital, Institute For Biology and Medical Genetics, Prague, Czech Republic, 3 1st Faculty of Medicine and General University Hospital, Dept. of Urology, Prague, Czech Republic, 42nd Faculty of Medicine, Institute For Biology and Medical Genetics, Prague, Czech Republic Introduction & Objectives: Cell-free deoxyribonucleic acid (cfDNA) belongs to the newly emerging markers, potentially usable as a non-invasive test for urothelial carcinoma. No study to date compared first morning urine with the consequent samples with regard to the amount of detectable cfDNA. The aim of our study was to optimize urine sampling for a reliable cfDNA examination. Material & Methods: A total of 31 subjects were enrolled in the study: 20 patients treated for bladder cancer in the departments of urology of two academic institutions and 11 control subjects without any urological malignancy. We investigated whether there was a difference 1) in the amount of cfDNA in the first morning urine and the consequent voided sample of the same day, and 2) in the amount of cfDNA between patients and controls. Results: Significantly higher levels of cfDNA were detected in the second voided urine samples of the day (p=0.006, Wilcoxon matched paired test) than in the first morning sample irrespective of case/control status (n=18). When second voided samples in patients (n=20) and controls (n=10) were compared, higher levels of cfDNA were more likely to be present in patients than in controls (p=0.005, MannWhitney test). Mean cfDNA concentration in patients was five-fold higher than in controls. Conclusions: Second voided urine of the day should be used for cfDNA analyses rather than the first morning sample. Higher levels of urinary cfDNA were detected in patients with urothelial cancer of the bladder than in controls.Grant support: Internal Grant Agency of the Ministry of Health of the Czech Republic no. NT12417.
C32
Comparison of staging and grading in TURBT and radical cystectomy specimens
Poletajew S.1, Fus L.2, Waledziak M.2, Bender S.1, Pomada P.2, Radziszewski P.1, Wasiutynski A.2, Borkowski A.1 1 Medical University of Warsaw, Dept. of Urology, Warsaw, Poland, 2Medical University of Warsaw, Dept. of Pathology, Warsaw, Poland Introduction & Objectives: Histopathological examination of TURBT specimens belongs to the most difficult in uropathology. Simultaneously, its results play a key role in clinical decision making in bladder cancer patients. The aim of the study was to assess the value of microscopic evaluation of TURBT specimens. Material & Methods: We retrospectively analyzed pathological documentation of consecutive 161 bladder cancer patients (37 women, 124 men, mean age 67.7 years) submitted to TURBT and subsequently qualified for radical cystectomy (RC). We compared results of microscopic examination of TURBT (exam 1) and RC (exam 2) specimens regarding stage according to 2009 TNM classification and grade according to 1973 WHO classification. In case of patients who have undergone more than one TURBT, documentation of the last procedure was included. All specimens were evaluated by the same uropathologist. Results: Mean time interval between TURBT and RC was 45.4 days. We noticed discrepancies between exam 1 and exam 2 regarding stage and grade in 64.0% and 26.6%, respectively. The most commonly observed errors concerned understaging of muscle invasive bladder cancer and high risk non-muscle invasive bladder cancer. Exam 1 \ 2 T0 Ta T1 T2 T3 T4
T0 0 1 4 2 1 0
Ta 0 4 1 2 0 0
T1 0 2 12 7 0 0
T2 0 1 8 39 1 0
T3 0 1 11 28 2 0
T4 0 2 9 21 1 1
Comparison of staging (number of cases).Undergrading of G3 tumors was found in 21.2% of cases, while overgrading of G2 tumors in 28.4%. We calculated PPV for G1, G2 and G3 to be 100%, 75.3% and 70.5%, respectively. Conclusions: Microscopic examination of TURBT specimen remains one of the most challenging in pathology what may lead to relatively high rate of staging and grading errors. The great majority of errors have negative effect on patient’s prognosis, however their elimination would probably not change the treatment choice.
Eur Urol Suppl 2012;11(4):89
C29
NBI cystoscopy in non-muscle invasive bladder cancer – A prospective comparison to the standard approach
Geavlete B., Jecu M., Moldoveanu C., Stanescu F., Iacoboaie C., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial aimed to assess the impact of narrow band imaging (NBI) cystoscopy in cases of non-muscle invasive bladder cancer (NMIBC). A single centre, prospective comparison to the standard white light cystoscopy (WLC) was performed. Material & Methods: A total of 95 NMIBC suspected consecutive cases were enrolled. The inclusion criteria were hematuria, positive urinary cytology and/or ultrasound suspicion of bladder tumors. All patients underwent WLC and NBI cystoscopy. Standard resection was performed for all lesions visible in WL and NBI-TURBT for only NBI observed tumors. Results: The overall NMIBC and CIS patients’ detection rates were significantly improved for NBI (96.2% versus 87.2% and 100% versus 66.7%). Also, on a lesions’ related basis, NBI cystoscopy emphasized a significantly superior detection concerning the 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 CIS, pTa, pT1 and NMIBC patients (55.5% versus 11.1%, 26.5% versus 10.2%, 30% versus 10% and 30.8% versus 10.3%) More over, pathologically confirmed positive tumoral margins secondary to white light TURBT were found at the NBI control in 10.3% of the cases. The postoperative treatment was significantly improved due to NBI results (16.7% versus 5.1%). Conclusions: NBI cystoscopy represents a valuable diagnostic alternative in NMIBC patients, with significant improvement of tumor visual accuracy as well as detection. This approach provided a substantial amelioration to the bladder cancer therapeutic management.
C30
Combined narrow band imaging cystoscopy and bipolar plasma vaporization in cases of large non-muscle invasive bladder tumors – Better than the standard approach?
Geavlete B., Stanescu F., Jecu M., Moldoveanu C., Multescu R., Georgescu D., Iacoboaie C., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial evaluated the narrow band imaging (NBI) cystoscopy and bipolar plasma vaporization (BPV) versus standard white light cystoscopy (WLC) and monopolar TURBT in cases of large bladder tumors. A prospective, long-term, randomized comparison was performed concerning the NMIBT recurrence rates specific to the 2 approaches. Material & Methods: A total of 220 patients with at least one bladder tumor over 3 cm were equally randomized for either NBI, WLC and BPV or WLC and TURBT. Preoperative assessment included abdominal ultrasound, CT and flexible WLC. Standard monopolar Re-TUR was applied in all NMIBT cases. The follow-up protocol comprised urinary cytology and WLC, performed every 3 months for 2 years. Results: The CIS (94.6% versus 67.6%), pTa (93% versus 82.4%) and overall NMIBT (94.9% versus 84.3%) detection rates were significantly improved for NBI cystoscopy versus WLC. The obturator nerve stimulation, bladder wall perforation, mean hemoglobin drop and postoperative bleeding rates were significantly reduced for BPV versus TURBT. The catheterization period and hospital stay were significantly shorter subsequent to BPV. The overall (6.3% versus 17.5%) and primary site (4.2% versus 13.4%) Re-TUR residual tumors’ rates were significantly lower for NBI-BPV. The 1 (6.9% versus 16.8%) and 2 (11.5% versus 25.8%) years’ recurrence rates were significantly reduced in the NBI-BPV group. Conclusions: NBI cystoscopy displayed improved diagnostic accuracy and BPV emphasized superior efficacy, reduced morbidity and faster recovery in large NMIBT cases. The NBI-BPV technique provided a lower Re-TUR residual tumors’ rate and reduced 1 and 2 years’ recurrence rates.
C31
Second voided urine samples give better yields of cell-free DNA than first morning urine in bladder cancer patients and controls
Hrbáček J.1, Pazourková E.2, Brisuda A.1, Soukup V.3, Mareš J.4, Čapoun O.3, Korabečná M.2, Hořínek A.2, Hanuš T.3, Babjuk M.1 1 2nd Faculty of Medicine and Teaching Hospital In Motol, Dept. of Urology, Prague, Czech Republic, 21st Faculty of Medicine and General University Hospital, Institute For Biology and Medical Genetics, Prague, Czech Republic, 3 1st Faculty of Medicine and General University Hospital, Dept. of Urology, Prague, Czech Republic, 42nd Faculty of Medicine, Institute For Biology and Medical Genetics, Prague, Czech Republic Introduction & Objectives: Cell-free deoxyribonucleic acid (cfDNA) belongs to the newly emerging markers, potentially usable as a non-invasive test for urothelial carcinoma. No study to date compared first morning urine with the consequent samples with regard to the amount of detectable cfDNA. The aim of our study was to optimize urine sampling for a reliable cfDNA examination. Material & Methods: A total of 31 subjects were enrolled in the study: 20 patients treated for bladder cancer in the departments of urology of two academic institutions and 11 control subjects without any urological malignancy. We investigated whether there was a difference 1) in the amount of cfDNA in the first morning urine and the consequent voided sample of the same day, and 2) in the amount of cfDNA between patients and controls. Results: Significantly higher levels of cfDNA were detected in the second voided urine samples of the day (p=0.006, Wilcoxon matched paired test) than in the first morning sample irrespective of case/control status (n=18). When second voided samples in patients (n=20) and controls (n=10) were compared, higher levels of cfDNA were more likely to be present in patients than in controls (p=0.005, MannWhitney test). Mean cfDNA concentration in patients was five-fold higher than in controls. Conclusions: Second voided urine of the day should be used for cfDNA analyses rather than the first morning sample. Higher levels of urinary cfDNA were detected in patients with urothelial cancer of the bladder than in controls.Grant support: Internal Grant Agency of the Ministry of Health of the Czech Republic no. NT12417.
C32
Comparison of staging and grading in TURBT and radical cystectomy specimens
Poletajew S.1, Fus L.2, Waledziak M.2, Bender S.1, Pomada P.2, Radziszewski P.1, Wasiutynski A.2, Borkowski A.1 1 Medical University of Warsaw, Dept. of Urology, Warsaw, Poland, 2Medical University of Warsaw, Dept. of Pathology, Warsaw, Poland Introduction & Objectives: Histopathological examination of TURBT specimens belongs to the most difficult in uropathology. Simultaneously, its results play a key role in clinical decision making in bladder cancer patients. The aim of the study was to assess the value of microscopic evaluation of TURBT specimens. Material & Methods: We retrospectively analyzed pathological documentation of consecutive 161 bladder cancer patients (37 women, 124 men, mean age 67.7 years) submitted to TURBT and subsequently qualified for radical cystectomy (RC). We compared results of microscopic examination of TURBT (exam 1) and RC (exam 2) specimens regarding stage according to 2009 TNM classification and grade according to 1973 WHO classification. In case of patients who have undergone more than one TURBT, documentation of the last procedure was included. All specimens were evaluated by the same uropathologist. Results: Mean time interval between TURBT and RC was 45.4 days. We noticed discrepancies between exam 1 and exam 2 regarding stage and grade in 64.0% and 26.6%, respectively. The most commonly observed errors concerned understaging of muscle invasive bladder cancer and high risk non-muscle invasive bladder cancer. Exam 1 \ 2 T0 Ta T1 T2 T3 T4
T0 0 1 4 2 1 0
Ta 0 4 1 2 0 0
T1 0 2 12 7 0 0
T2 0 1 8 39 1 0
T3 0 1 11 28 2 0
T4 0 2 9 21 1 1
Comparison of staging (number of cases).Undergrading of G3 tumors was found in 21.2% of cases, while overgrading of G2 tumors in 28.4%. We calculated PPV for G1, G2 and G3 to be 100%, 75.3% and 70.5%, respectively. Conclusions: Microscopic examination of TURBT specimen remains one of the most challenging in pathology what may lead to relatively high rate of staging and grading errors. The great majority of errors have negative effect on patient’s prognosis, however their elimination would probably not change the treatment choice.
Eur Urol Suppl 2012;11(4):89