- Email: [email protected]
UP-01.031 Does Atypia in Urine Cytology Predict Malignancy?
UNMODERATED POSTER SESSIONS
Toktas G, Erkan E, Oktem C, Kucukpolat S, Toker A, Unluer E Dept. of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey Introduction and Objective: To evaluate the efficacy of cystoscopy, CT, and TRUS imaging and cytology separately and together, in the diagnosis and staging of bladder cancer in comparison to pathological staging. Materials and Methods: An initial cystoscopy and washout cytology were performed to 206 patients with proven bladder cancer. Tumor size and invasion degree was the study endpoints for CT. TRUS staging of the patients were performed in the day they were admitted to the hospital for surgery. An invasive tumor was characterized as disruption of bladder wall and perivesical invasion in TRUS. All patients had standard TUR procedures. Tumors were classified as either superficial (pTa) or invasive (pT1, 2 or 3). Results: Patients were divided into three categories according to tumor size observed in cystoscopy: 1. Tumor size ⱕ1cm (88 patients- 42.7%) 2. Between 1-3cm (51 patients-24.8%) and 3. ⱖ3cm (67 patients-32.5%). CT did not reveal any tumor in 78 patients (37.9%) but showed tumors of ⱕ1cm in 34 (16.5%), tumors between the sizes of 1-3cm in 52 patients (25.2%) and tumors ⱖ 3cm in 40 (20.4%). Of the patients, 170 had superficial (82.5%) and 36 invasive tumors according to the CT findings. TRUS revealed invasion in 46 patients (22.3%) and 160 (77.7%) were categorized as non-invasive. In a univariate analysis of variance separately for CT and TRUS, keeping cystoscopy as the dependent variable, TRUS correlated in 68.5% of the cystoscopic findings whereas, this rate is 58.4% for CT.Thus TRUS seemed to be a better imaging technique than CT in bladder tumor detection. When pathological findings and TRUS results are compared, sensitivity of TRUS in tumor detection was 77.4%, specifity 60%, positive predictive value (PPV) 94.7% and the negative predictive value was 22.2%. Conclusions: Cystoscopy remains as the mainstay in diagnosis of bladder cancer patients. The combined use of all CT, TRUS and cytology results in a detection rate of 72% of the cystoscopically proven tumors. Among the three, TRUS has the highest correlation with cystoscopy. In staging of the bladder cancer, both CT and TRUS have statistically significant correlation with pathology but TRUS results are clearly better than CT. Thus, TRUS is a valuable imaging modality in both detec-
S194
tion and staging of bladder cancer and seems to be beneficial as in the case of prostate cancer, even more. Based on these encouraging results, we advise urologists to use TRUS more frequently in bladder cancer work-up.
UP-01.030 A Prospective Multi-Center Study of a Novel Urinary Diagnostic Test for the Detection of Transitional Cell Carcinoma (TCC) in Patients with Gross Hematuria Gilling P1,2,3, Davidson P1,2,3, Dalphin M1,2,3, O’Sullivan P1,2,3, Guilford P1,2,3 1 Tauranga Hospital, Tauranga; 2 Christchurch Hospital, Christchurch; 3 Pacific Edge Biotechnology, Dunedin, New Zealand Introduction and Objective: To investigate its utility in screening patients for TCC, a novel urine test was studied in a multi-center prospective clinical trial. Materials and Methods: Patients with gross hematuria at initial presentation were studied. The urine test (Cxbladder) quantifies 5 RNA transcripts (using multiplex qRT-PCR technology). A linear regression algorithm was used to generate a single patient score from the RNA data which was compared to voided cytology and both the NMP22 BladderChek and NMP22 ELISA assays. Results: This preliminary study comprised 467(56 with TCC) patients presenting with gross haematuria. The assay had an overall sensitivity of 84% for TCC at a prescribed specificity of 85%.100% of stage T1, T2 and Tis tumours, 77% of Ta tumours and 96% of all high grade tumours were detected. Overall Positive and Negative Likelyhood Ratios (LR⫹ and LR-) were 6.78 and 0.18 respectively indicating the high clinical utility of the test. Ratiometric analysis of specific genes of interest had an 80% accuracy for triaging high grade from low grade disease. Conclusions: This urinary diagnostic test may have utility for both diagnosis and surveillance of TCC.
UP-01.031 Does Atypia in Urine Cytology Predict Malignancy? Kwok S1, Cheong Y1, Chu P1, Ng K2, Yu C1, Cheng C1, Cho C1, Ngo C1, Lee Y1, Chow K2, Man C1 1 Division of Urology, Dept. of Surgery; 2 Dept. of Clinical Pathology, Tuen Mun Hospital, Hong Kong, SAR
Introduction and Objective: Retrospective analysis of the correlation between urinary atypical cell and urological malignancy. Materials and Methods: From Jan 2000July 2010, hospital records of urine cytology specimens with atypia in 2962 patients were retrieved from pathology laboratory in Tuen Mun Hospital. Patients who had completed cystoscopy and upper tract imaging were included. Patient’s demographic data, presenting symptoms and final diagnosis were analyzed. Results: Twelve hundred and twenty patients (883 male, 337 female, mean age 65 years [20-98]) were included into the study. There were 930 patients presented with gross haematuria: Painful (237/930) and painless (693/930). There were 247 patients (26.6%) with gross haematuria later diagnosed with urological malignancy. There were 133 patients with microscopic haematuria who had atypical urine cytology detected during investigations in our general out-patient clinic. There were 122 (92%) patients who did not reveal any urological malignancy after thorough investigation. However, in this group of patient, the percentage of urological malignancy was 4%, 18% and 33% in one, two and three consecutive urine cytology atypia group respectively. Overall, 16.5% (134/814) of one urine cytology atypia, 30.5% (79/259) of two consecutive urine cytology atypia and 49.7% (73/147) of three consecutive urine cytology atypia were later diagnosed to have urological malignancy. Conclusions: In our review, the number of urine cytology atypia has positive correlation with urological malignancy. Up to 49.7% of patients with three or more urine cytology atypia has urological malignancy. for those microscopic haematuria, majority of them did not reveal any urological malignancy. However, patient with risk factors are still advised for further workup.
UP-01.032 NMP22 Bladder Check Tests Urine Cytology for Detecting NMIBC Caliolo C, Salvitti M, Simonelli G, Tartaglia N, Franco G, De Dominicis C, Leonardo C Dept. of Urology, Sapienza University of Rome, Rome, Italy Introduction and Objectives: The aim of our study was to evaluate the diagnostic value of Nuclear Matrix Protein Bladder check test (NMP22 Matritech Inc.)
UROLOGY 78 (Supplement 3A), September 2011
Toktas G, Erkan E, Oktem C, Kucukpolat S, Toker A, Unluer E Dept. of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey Introduction and Objective: To evaluate the efficacy of cystoscopy, CT, and TRUS imaging and cytology separately and together, in the diagnosis and staging of bladder cancer in comparison to pathological staging. Materials and Methods: An initial cystoscopy and washout cytology were performed to 206 patients with proven bladder cancer. Tumor size and invasion degree was the study endpoints for CT. TRUS staging of the patients were performed in the day they were admitted to the hospital for surgery. An invasive tumor was characterized as disruption of bladder wall and perivesical invasion in TRUS. All patients had standard TUR procedures. Tumors were classified as either superficial (pTa) or invasive (pT1, 2 or 3). Results: Patients were divided into three categories according to tumor size observed in cystoscopy: 1. Tumor size ⱕ1cm (88 patients- 42.7%) 2. Between 1-3cm (51 patients-24.8%) and 3. ⱖ3cm (67 patients-32.5%). CT did not reveal any tumor in 78 patients (37.9%) but showed tumors of ⱕ1cm in 34 (16.5%), tumors between the sizes of 1-3cm in 52 patients (25.2%) and tumors ⱖ 3cm in 40 (20.4%). Of the patients, 170 had superficial (82.5%) and 36 invasive tumors according to the CT findings. TRUS revealed invasion in 46 patients (22.3%) and 160 (77.7%) were categorized as non-invasive. In a univariate analysis of variance separately for CT and TRUS, keeping cystoscopy as the dependent variable, TRUS correlated in 68.5% of the cystoscopic findings whereas, this rate is 58.4% for CT.Thus TRUS seemed to be a better imaging technique than CT in bladder tumor detection. When pathological findings and TRUS results are compared, sensitivity of TRUS in tumor detection was 77.4%, specifity 60%, positive predictive value (PPV) 94.7% and the negative predictive value was 22.2%. Conclusions: Cystoscopy remains as the mainstay in diagnosis of bladder cancer patients. The combined use of all CT, TRUS and cytology results in a detection rate of 72% of the cystoscopically proven tumors. Among the three, TRUS has the highest correlation with cystoscopy. In staging of the bladder cancer, both CT and TRUS have statistically significant correlation with pathology but TRUS results are clearly better than CT. Thus, TRUS is a valuable imaging modality in both detec-
S194
tion and staging of bladder cancer and seems to be beneficial as in the case of prostate cancer, even more. Based on these encouraging results, we advise urologists to use TRUS more frequently in bladder cancer work-up.
UP-01.030 A Prospective Multi-Center Study of a Novel Urinary Diagnostic Test for the Detection of Transitional Cell Carcinoma (TCC) in Patients with Gross Hematuria Gilling P1,2,3, Davidson P1,2,3, Dalphin M1,2,3, O’Sullivan P1,2,3, Guilford P1,2,3 1 Tauranga Hospital, Tauranga; 2 Christchurch Hospital, Christchurch; 3 Pacific Edge Biotechnology, Dunedin, New Zealand Introduction and Objective: To investigate its utility in screening patients for TCC, a novel urine test was studied in a multi-center prospective clinical trial. Materials and Methods: Patients with gross hematuria at initial presentation were studied. The urine test (Cxbladder) quantifies 5 RNA transcripts (using multiplex qRT-PCR technology). A linear regression algorithm was used to generate a single patient score from the RNA data which was compared to voided cytology and both the NMP22 BladderChek and NMP22 ELISA assays. Results: This preliminary study comprised 467(56 with TCC) patients presenting with gross haematuria. The assay had an overall sensitivity of 84% for TCC at a prescribed specificity of 85%.100% of stage T1, T2 and Tis tumours, 77% of Ta tumours and 96% of all high grade tumours were detected. Overall Positive and Negative Likelyhood Ratios (LR⫹ and LR-) were 6.78 and 0.18 respectively indicating the high clinical utility of the test. Ratiometric analysis of specific genes of interest had an 80% accuracy for triaging high grade from low grade disease. Conclusions: This urinary diagnostic test may have utility for both diagnosis and surveillance of TCC.
UP-01.031 Does Atypia in Urine Cytology Predict Malignancy? Kwok S1, Cheong Y1, Chu P1, Ng K2, Yu C1, Cheng C1, Cho C1, Ngo C1, Lee Y1, Chow K2, Man C1 1 Division of Urology, Dept. of Surgery; 2 Dept. of Clinical Pathology, Tuen Mun Hospital, Hong Kong, SAR
Introduction and Objective: Retrospective analysis of the correlation between urinary atypical cell and urological malignancy. Materials and Methods: From Jan 2000July 2010, hospital records of urine cytology specimens with atypia in 2962 patients were retrieved from pathology laboratory in Tuen Mun Hospital. Patients who had completed cystoscopy and upper tract imaging were included. Patient’s demographic data, presenting symptoms and final diagnosis were analyzed. Results: Twelve hundred and twenty patients (883 male, 337 female, mean age 65 years [20-98]) were included into the study. There were 930 patients presented with gross haematuria: Painful (237/930) and painless (693/930). There were 247 patients (26.6%) with gross haematuria later diagnosed with urological malignancy. There were 133 patients with microscopic haematuria who had atypical urine cytology detected during investigations in our general out-patient clinic. There were 122 (92%) patients who did not reveal any urological malignancy after thorough investigation. However, in this group of patient, the percentage of urological malignancy was 4%, 18% and 33% in one, two and three consecutive urine cytology atypia group respectively. Overall, 16.5% (134/814) of one urine cytology atypia, 30.5% (79/259) of two consecutive urine cytology atypia and 49.7% (73/147) of three consecutive urine cytology atypia were later diagnosed to have urological malignancy. Conclusions: In our review, the number of urine cytology atypia has positive correlation with urological malignancy. Up to 49.7% of patients with three or more urine cytology atypia has urological malignancy. for those microscopic haematuria, majority of them did not reveal any urological malignancy. However, patient with risk factors are still advised for further workup.
UP-01.032 NMP22 Bladder Check Tests Urine Cytology for Detecting NMIBC Caliolo C, Salvitti M, Simonelli G, Tartaglia N, Franco G, De Dominicis C, Leonardo C Dept. of Urology, Sapienza University of Rome, Rome, Italy Introduction and Objectives: The aim of our study was to evaluate the diagnostic value of Nuclear Matrix Protein Bladder check test (NMP22 Matritech Inc.)
UROLOGY 78 (Supplement 3A), September 2011