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PD11-11 BLADDER ULTRASONOGRAPHY, CYTOLOGY AND URINE ANALYSIS AS ALTERNATIVES TO CYSTOSCOPY DURING SCREENING FOR NON-MUSCLE INVASIVE BLADDER CANCER
THE JOURNAL OF UROLOGYâ
e292
RESULTS: The operative notes for 325 TURBTs, during which the checklist was prospectively implemented, were compared to 428 TURBTs performed prior to checklist implementation. After checklist implementation the mean number of items reported increased from 4.8 to 8.0 per TURBT, resulting in an estimated increase of 3.3 (95% CI 1.9, 4.7) items on meta-analysis. The percentage of reports that included all 10 items increased from 0.5% to 28% (p<0.0001) with the checklist. Checklist use was not associated with a significant increase in biopsy specimens containing muscle. However, when considering all 753 procedures, surgeons who reported more checklist items tended to have a higher proportion of biopsies that contained muscle (p¼0.062). CONCLUSIONS: The use of a simple 10-item checklist during TURBT improved reporting of critical procedural elements. Although the checklist did not have a clear impact on the inclusion of muscle in the specimen, checklist use may enhance surgeon attention to important aspects of the procedure and be a lever for quality improvement.
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Cytology had the lowest sensitivity (21.2%). Among different combinations, US and hematuria achieved a sensitivity of 100%. Using ROC curve, cystoscopy achieved the highest diagnostic accuracy (AUC: .73; p<.001) followed by US (AUC: .67; p<.001), hematuria (AUC: .65; p<.001), while cytology was the lowest (AUC: .56; p¼.07). When comparing the combination of hematuria and US (AUC: 0.64; p<.001) with cystoscopy, the difference was non-significant (p¼.08) (Fig. 1). CONCLUSIONS: A combination of absent hematuria and negative US can significantly exclude the presence of tumors during screening for NMIBC and was not significantly different from the results of OPC.
Source of Funding: NONE
PD11-12 COMPARISON OF OUTCOMES BETWEEN ULTRASONOGRAPHY AND CYSTOSCOPY IN THE SURVEILLANCE OF PATIENTS WITH LOW- OR INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER Naoya Niwa*, Kazuhiro Matsumoto, Tokyo, Japan; Nobuyuki Tanaka, Saitama, Japan; Nozomi Hayakawa, Yujiro Ito, Takahiro Maeda, Tokyo, Japan; Seiya Akatsuka, Takeshi Masuda, Saitama, Japan; So Nakamura, Mototsugu Oya, Tokyo, Japan Source of Funding: None
PD11-11 BLADDER ULTRASONOGRAPHY, CYTOLOGY AND URINE ANALYSIS AS ALTERNATIVES TO CYSTOSCOPY DURING SCREENING FOR NON-MUSCLE INVASIVE BLADDER CANCER Mohamed Elkenawi, Ahmed Harraz*, Hashim Farg, Mohamed Abou ElGhar, Ahmed El-Hefnawy, Yasser Osman, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: The corner stone for followup of patients with non-muscle invasive bladder cancer (NMIBC) is outpatient cystoscopy (OPC). This study aims at testing non-invasive screening modalities with higher sensitivity as an alternative to OPC for NMIBC. METHODS: A prospective study was conducted from January to October 2015 in a tertiary referral center and included patients attending the clinic for followup after treatment of NMIBC. Pelvic ultrasonography (US), cytology, and urine analysis were performed prior to outpatient cystoscopy (OPC). Hematuria was defined as > 5 RBCs/ HPF. The standard diagnostic procedure was inpatient bladder biopsies (BB). The significant modalities were modelled to determine the best combination for prediction of BB findings. RESULTS: A total of 149 patients with mean (SD) age of 61 (9) years were eligible for the analysis. Malignant lesions were found in 33 (22%) patients. There was a significant association between hematuria, positive cytology, US, and OPC with positive BB. US had the highest sensitivity (90.9%), followed by hematuria (72.7%), and OPC (60.6%).
INTRODUCTION AND OBJECTIVES: There has been little research on the postoperative surveillance of patients with non-muscle invasive bladder cancer (NMIBC). In this study, we examined the clinical outcomes of regular use of ultrasonography (US) compared with those of cystoscopy (CS) in the follow-up of patients with low- or intermediate-risk NMIBC METHODS: A total of 196 patients with TaG1-2 NMIBC who received transurethral resection of bladder tumor (TUR-BT) between 1990 and 2012 were examined retrospectively. We assessed recurrence-free survival rates in 82 patients who were followed up by US after TUR-BT, and those in 114 patients followed up by CS. We also analyzed the differences in clinicopathological characteristics of recurrent tumors between the US and CS follow-up groups. RESULTS: Of the 196 patients, 122 and 74 patients had lowand intermediate-risk NMIBC, respectively. There were no significant differences in tumor characteristics between the US and CS groups in patients with low- or intermediate-risk NMIBC. During the follow-up period, 43 patients with low-risk NMIBC and 27 patients with intermediate-risk NMIBC experienced recurrence. The 5- and 10-year recurrencefree survival rates (RFS) of patients with low-risk NMIBC were 64.4% and 61.0% in the US group and both 58% in the CS group, respectively (p¼0.543) (Figure 1a). There were no significant differences in the recurrent tumor characteristics between the two groups. Regarding intermediate-risk patients, the 5- and 10-year RFS were 77.8% and 48.6% in the US group, and 62.6% and 52.6% in the CS group, respectively (p¼0.332) (Figure 1b). Of the 27 recurrent cases, one patient followed up by CS experienced development of muscle invasive cancer. In the remaining 26 patients, there were no significant differences in the recurrent tumor characteristics between the two groups.
e292
RESULTS: The operative notes for 325 TURBTs, during which the checklist was prospectively implemented, were compared to 428 TURBTs performed prior to checklist implementation. After checklist implementation the mean number of items reported increased from 4.8 to 8.0 per TURBT, resulting in an estimated increase of 3.3 (95% CI 1.9, 4.7) items on meta-analysis. The percentage of reports that included all 10 items increased from 0.5% to 28% (p<0.0001) with the checklist. Checklist use was not associated with a significant increase in biopsy specimens containing muscle. However, when considering all 753 procedures, surgeons who reported more checklist items tended to have a higher proportion of biopsies that contained muscle (p¼0.062). CONCLUSIONS: The use of a simple 10-item checklist during TURBT improved reporting of critical procedural elements. Although the checklist did not have a clear impact on the inclusion of muscle in the specimen, checklist use may enhance surgeon attention to important aspects of the procedure and be a lever for quality improvement.
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Cytology had the lowest sensitivity (21.2%). Among different combinations, US and hematuria achieved a sensitivity of 100%. Using ROC curve, cystoscopy achieved the highest diagnostic accuracy (AUC: .73; p<.001) followed by US (AUC: .67; p<.001), hematuria (AUC: .65; p<.001), while cytology was the lowest (AUC: .56; p¼.07). When comparing the combination of hematuria and US (AUC: 0.64; p<.001) with cystoscopy, the difference was non-significant (p¼.08) (Fig. 1). CONCLUSIONS: A combination of absent hematuria and negative US can significantly exclude the presence of tumors during screening for NMIBC and was not significantly different from the results of OPC.
Source of Funding: NONE
PD11-12 COMPARISON OF OUTCOMES BETWEEN ULTRASONOGRAPHY AND CYSTOSCOPY IN THE SURVEILLANCE OF PATIENTS WITH LOW- OR INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER Naoya Niwa*, Kazuhiro Matsumoto, Tokyo, Japan; Nobuyuki Tanaka, Saitama, Japan; Nozomi Hayakawa, Yujiro Ito, Takahiro Maeda, Tokyo, Japan; Seiya Akatsuka, Takeshi Masuda, Saitama, Japan; So Nakamura, Mototsugu Oya, Tokyo, Japan Source of Funding: None
PD11-11 BLADDER ULTRASONOGRAPHY, CYTOLOGY AND URINE ANALYSIS AS ALTERNATIVES TO CYSTOSCOPY DURING SCREENING FOR NON-MUSCLE INVASIVE BLADDER CANCER Mohamed Elkenawi, Ahmed Harraz*, Hashim Farg, Mohamed Abou ElGhar, Ahmed El-Hefnawy, Yasser Osman, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: The corner stone for followup of patients with non-muscle invasive bladder cancer (NMIBC) is outpatient cystoscopy (OPC). This study aims at testing non-invasive screening modalities with higher sensitivity as an alternative to OPC for NMIBC. METHODS: A prospective study was conducted from January to October 2015 in a tertiary referral center and included patients attending the clinic for followup after treatment of NMIBC. Pelvic ultrasonography (US), cytology, and urine analysis were performed prior to outpatient cystoscopy (OPC). Hematuria was defined as > 5 RBCs/ HPF. The standard diagnostic procedure was inpatient bladder biopsies (BB). The significant modalities were modelled to determine the best combination for prediction of BB findings. RESULTS: A total of 149 patients with mean (SD) age of 61 (9) years were eligible for the analysis. Malignant lesions were found in 33 (22%) patients. There was a significant association between hematuria, positive cytology, US, and OPC with positive BB. US had the highest sensitivity (90.9%), followed by hematuria (72.7%), and OPC (60.6%).
INTRODUCTION AND OBJECTIVES: There has been little research on the postoperative surveillance of patients with non-muscle invasive bladder cancer (NMIBC). In this study, we examined the clinical outcomes of regular use of ultrasonography (US) compared with those of cystoscopy (CS) in the follow-up of patients with low- or intermediate-risk NMIBC METHODS: A total of 196 patients with TaG1-2 NMIBC who received transurethral resection of bladder tumor (TUR-BT) between 1990 and 2012 were examined retrospectively. We assessed recurrence-free survival rates in 82 patients who were followed up by US after TUR-BT, and those in 114 patients followed up by CS. We also analyzed the differences in clinicopathological characteristics of recurrent tumors between the US and CS follow-up groups. RESULTS: Of the 196 patients, 122 and 74 patients had lowand intermediate-risk NMIBC, respectively. There were no significant differences in tumor characteristics between the US and CS groups in patients with low- or intermediate-risk NMIBC. During the follow-up period, 43 patients with low-risk NMIBC and 27 patients with intermediate-risk NMIBC experienced recurrence. The 5- and 10-year recurrencefree survival rates (RFS) of patients with low-risk NMIBC were 64.4% and 61.0% in the US group and both 58% in the CS group, respectively (p¼0.543) (Figure 1a). There were no significant differences in the recurrent tumor characteristics between the two groups. Regarding intermediate-risk patients, the 5- and 10-year RFS were 77.8% and 48.6% in the US group, and 62.6% and 52.6% in the CS group, respectively (p¼0.332) (Figure 1b). Of the 27 recurrent cases, one patient followed up by CS experienced development of muscle invasive cancer. In the remaining 26 patients, there were no significant differences in the recurrent tumor characteristics between the two groups.