scholarly journals Should National Institute for Clinical Excellence (NICE) Guidelines Remove Urine Cytology as a Suggested Adjunct in Suspected Bladder Cancer (haematuria) Investigations?

2021 ◽  
Vol 4 (3) ◽  
pp. e1-e7
Author(s):  
Madeline Moore ◽  
Andrew Robinson ◽  
Mark Kitchen ◽  
Lyndon Gommersall
Keyword(s):  
Bladder Cancer ◽  
Patient Outcomes ◽  
Cancer Diagnosis ◽  
Bladder Tumour ◽  
Clinical Excellence ◽  
Outcome Data ◽  
Urine Cytology ◽  
Nice Guidelines ◽  
Benefit Patient

BackgroundDespite National Institute for Clinical Excellence (NICE) guidelines suggesting the use of urine cytology (UC) for the diagnosis of bladder cancer, its use is variable. Reasons for this include sub-optimal sensitivity, financial cost, availability of alternative tests, and uncertainty over interpretation of results. Anecdotally, however, suspicious or malignant UC when other investigations are normal, occasionally leads to a cancer diagnosis. Therefore, we retrospectively assessed a cohort of our haematuria patients to determine the value of UC in cancer diagnosis and the clinical significance of atypical UC (graded as C3). Patients and methodsWe identified 3018 patients with haematuria referred on the suspected cancer pathway (“two-week wait”) in 2015. We retrospectively analysed clinical, demographic, and follow-up/outcome data in a random cohort of 500 cases. ResultsMedian follow up was 58 months. Urological malignancy was diagnosed in 61/500 patients; all were identified by cystoscopy or imaging, i.e., irrespective of UC result. No cases of atypical UC re-presented with a ‘missed’ cancer diagnosis within the five-year follow-up period. However, suspicious and malignant cytology was associated with high-grade/aggressive tumours and subsequent tumour recurrence. ConclusionUrine cytology did not identify any cancers that were not already found by imaging or cystoscopy. Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for transurethral resection of bladder tumour (TURBT), however, it is unclear whether this might benefit patient outcomes. We conclude therefore that UC has no role in haematuria investigations.

scholarly journals The pattern of urine cytology among patients with clinical diagnosis of bladder tumor in a tertiary hospital northwest Nigeria

2019 ◽  
Vol 6 (10) ◽  
pp. 3521
Author(s):  
Ahmed M. Umar ◽  
Uzodimma E. Onwuasoanya ◽  
Emmanuel U. Oyibo ◽  
Adamu Dahiru ◽  
Ismaila A. Mungadi
Keyword(s):  
Bladder Cancer ◽  
Clinical Diagnosis ◽  
Bladder Tumour ◽  
Tertiary Hospital ◽  
Urine Cytology ◽  
Female Ratio ◽  
Non Invasive ◽  
And Gender ◽  
Low Sensitivity ◽  
Age Range

Background: Urine cytology is a simple, safe, non-invasive and cheap investigation that is used as adjunct to cystoscopy in the diagnosis of bladder cancer. Its low sensitivity is a major limitation against its use as a sole diagnostic test for bladder cancer. The objective of this study was to determine the pattern of urine cytology seen in patients with clinical diagnosis of bladder tumour in our practice.Methods: This is a retrospective study of patients with clinical diagnosis of bladder tumour that had urine cytology in our centre. The age and gender of the patients, number of urine cytology per patient per year and cytologic diagnosis were analysed using the SPSS 20.Results: During the period under review, a total of 512 urine cytology was done for patients with clinical diagnosis of bladder tumour. The age range of the patients was 6 to 90 years with modal age of 60 years. 457 (89.3%) were males while 54 (10.5%) were females and 1 (0.2%) was unspecified. Male to female ratio was 8.5:1. The highest number of urine cytology was done in 2013 with 64 (12.5%) while the least number was 1 (0.2%) recorded in 2001 and 2003. Only 68 (13.3%) specimens were reported to be malignant while 245 (47.9%) were reported as negative representing the most common cytological diagnosis in the study.Conclusions: Although urine cytology is useful in the diagnostic workup of patients with bladder mass, it is unlikely it would supplant cystoscopy and biopsy in the diagnosis of bladder cancer. 

scholarly journals Biomarkers for Bladder Cancer Diagnosis and Surveillance: A Comprehensive Review

Diagnostics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Rui Batista ◽  
Nuno Vinagre ◽  
Sara Meireles ◽  
João Vinagre ◽  
Hugo Prazeres ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Treatment Response ◽  
Cancer Diagnosis ◽  
Complex Disease ◽  
Molecular Biomarkers ◽  
Clinical Staging ◽  
Response Monitoring ◽  
High Morbidity ◽  
Non Invasive

Bladder cancer (BC) ranks as the sixth most prevalent cancer in the world, with a steady rise in its incidence and prevalence, and is accompanied by a high morbidity and mortality. BC is a complex disease with several molecular and pathological pathways, thus reflecting different behaviors depending on the clinical staging of the tumor and molecular type. Diagnosis and monitoring of BC is mainly performed by invasive tests, namely periodic cystoscopies; this procedure, although a reliable method, is highly uncomfortable for the patient and it is not exempt of comorbidities. Currently, there is no formal indication for the use of molecular biomarkers in clinical practice, even though there are several tests available. There is an imperative need for a clinical non-invasive testing for early detection, disease monitoring, and treatment response in BC. In this review, we aim to assess and compare different tests based on molecular biomarkers and evaluate their potential role as new molecules for bladder cancer diagnosis, follow-up, and treatment response monitoring.

scholarly journals The value of the NMP22 test for superficial bladder cancer diagnosis and follow-up

2014 ◽  
Vol 39 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Caner Dogan ◽  
Eyyüp Sabri Pelit ◽  
Asif Yildirim ◽  
Itir Ebru Zemheri ◽  
Cengiz Canakci ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Diagnosis ◽  
Superficial Bladder Cancer

scholarly journals Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder

2015 ◽  
Vol 112 (10) ◽  
pp. 1626-1635 ◽  
Author(s):  
S Hafeez ◽  
A Horwich ◽  
O Omar ◽  
K Mohammed ◽  
A Thompson ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Adjuvant Chemotherapy ◽  
Organ Preservation ◽  
Bladder Tumour ◽  
Poor Responders ◽  
Bladder Preservation ◽  
Platinum Based Chemotherapy ◽  
Neo Adjuvant Chemotherapy ◽  
Muscle Invasive

Abstract Background: Radiotherapy for muscle invasive bladder cancer (MIBC) aims to offer organ preservation without oncological compromise. Neo-adjuvant chemotherapy provides survival advantage; response may guide patient selection for bladder preservation and identify those most likely to have favourable result with radiotherapy. Methods: Ninety-four successive patients with T2-T4aN0M0 bladder cancer treated between January 2000 and June 2011 were analysed at the Royal Marsden Hospital. Patients received platinum-based chemotherapy following transurethral resection of bladder tumour; repeat cystoscopy (±biopsy) was performed to guide subsequent management. Responders were treated with radiotherapy. Poor responders were recommended radical cystectomy. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan–Meier method; univariate and multivariate analyses were performed using the Cox proportional hazard regression model. Results: Response assessment was performed in 89 patients. Seventy-eight (88%) demonstrated response; 53 (60%) achieved complete response (CR); 74 responders had radiotherapy; 4 opted for cystectomy. Eleven (12%) demonstrated poor response, 10 received cystectomy. Median survival for CR was 90 months (95% CI 64.7, 115.9) compared with 16 months (95% CI 5.4, 27.4; P<0.001) poor responders. On multivariate analysis, only response was associated with significantly improved PFS, OS and DSS. After a median follow-up of 39 months (range 4–127 months), 14 patients (16%) required salvage cystectomy (8 for non-muscle invasive disease, 5 for invasive recurrence, 1 for radiotherapy related toxicity). In all, 82% had an intact bladder at last follow-up after radiotherapy; 67% had an intact bladder at last follow-up or death. Our study is limited by its retrospective nature. Conclusions: Response to neo-adjuvant chemotherapy is a favourable prognostic indicator and can be used to select patients for radiotherapy allowing bladder preservation in >80% of the selected patients.

scholarly journals THE EXPERIENCE OF UK BLADDER CANCER PATIENTS DURING THE COVID-19 PANDEMIC: A SURVEY-BASED SNAPSHOT

2020 ◽  
Author(s):  
Sarah Spencer-Bowdage ◽  
Jeannie Rigby ◽  
Jackie O’Kelly ◽  
Phil Kelly ◽  
Mark Page ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Bladder Tumour ◽  
Intravesical Therapy ◽  
Cancer Services ◽  
Patient Groups ◽  
Muscle Invasive ◽  
The Uk ◽  
Second Wave ◽  
Experienced Treatment

ABSTRACTThe Covid-19 pandemic has placed unprecedented strain on healthcare systems worldwide. Within this context, UK cancer services have undergone significant disruption to create capacity for the National Health Service. As a charity that endeavours to support bladder cancer (BC) patients and improve outcomes, Action Bladder Cancer UK (ABCUK) designed and administered a SurveyMonkey survey to investigate the prevalence of such disruption for BC patients. From 22nd April to 18th June 2020, 142 BC patients responded. Across all patient groups, 46.8% of patients described disruption to their treatment or follow-up. For non-muscle-invasive BC (NMIBC) patients, disruptions included postponement of: initial transurethral resection of bladder tumour (TURBT) (33.3%), subsequent TURBT (40.0%), and surveillance cystoscopy (58.1%). For NMIBC patients undergoing intravesical therapy, 68.4% experienced treatment postponements or curtailments. For muscle-invasive BC patients, 57.1% had experienced postponement of cystectomy and 14.3% had been changed from cystectomy to radiotherapy. Half of patients undergoing systemic chemotherapy also experienced disruption. Despite the survey’s limitations, we have demonstrated considerable disruption to the care of BC patients during the UK Covid-19 pandemic. To avoid a repeat, the UK BC community should define effective contingent ways of working ready for a possible ‘second wave’ of Covid-19, or any other such threat.

Bladder Tumor Markers: A Review of the Literature

2008 ◽  
Vol 23 (4) ◽  
pp. 249-261 ◽  
Author(s):  
A. Volpe ◽  
M. Racioppi ◽  
D. D'Agostino ◽  
E. Cappa ◽  
M. Gardi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Prognostic Markers ◽  
Urine Cytology ◽  
Diagnostic Tools ◽  
Low Grade ◽  
Predictive Capacity ◽  
Non Invasive ◽  
Increased Sensitivity ◽  
Muscle Invasive

Bladder cancer is among the top eight most frequent cancers. Its natural history is related to a combination of factors that impact on its aggressiveness. Cystoscopy and urine cytology are the currently used techniques for the diagnosis and surveillance of non-invasive bladder tumors. The sensitivity of urine cytology for diagnosis is not high, particularly in low-grade tumors. The combination of voided urine cytology and new diagnostic urine tests would be ideal for the diagnosis and follow-up of bladder cancer. However, in order to have some clinical utility, new diagnostic and/or prognostic markers should achieve better predictive capacity that the currently used diagnostic tools. None of the markers evaluated over the last years showed remarkable sensitivity or specificity for the identification of any of the diverse types of bladder cancer in clinical practice. The limitations of the known prognostic markers have led to the research of new molecular markers for early detection of bladder cancer. This research focused in particular on the discovery of biomarkers capable of reducing the need for periodic cystoscopies or, ideally, offering a non-invasive examination instead. In this review, we will examine various new markers of bladder cancer and their value in the diagnosis and follow-up of non-muscle-invasive bladder cancer. When compared with urine cytology, which showed the highest specificity, most of these markers demonstrated an increased sensitivity.

Flow Cytometry Analysis in Voided Urine of Patients with Bladder Cancer

1993 ◽  
Vol 60 (2) ◽  
pp. 162-166
Author(s):  
A. Lotto ◽  
G. Carluccio ◽  
A. Calisti ◽  
A. Disperati ◽  
E. Capuzzo ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Bladder Cancer ◽  
Quantitative Evaluation ◽  
Dna Content ◽  
Urine Cytology ◽  
Urinary Cytology ◽  
Flow Cytometry Analysis ◽  
Excellent Correlation ◽  
First Diagnosis

Flow cytometry is known to be able to give a quantitative evaluation of the DNA of cellular populations (grade of ploidy), as well as to estimate the percentages of phases (S + G2M) providing useful information about the pathology in question and its aggressivity. This method has been applied in diagnosing patients with bladder cancer, using their voided urine and comparing with urine cytology. Our data, from 59 patients, indicate flow cytometry utility in diagnosing bladder cancer; in fact there is an excellent correlation between the urinary cytology and the DNA content in cytometry which increases in higher grade bladder cancer. The sensitivity of CFM is in the range of 92% to 94%, and is superior to that of conventional voided urine cytology (range 64% to 84%). It is felt that cytofluorometric analysis permits a reliable evaluation of voided urine, not only at first diagnosis, but especially during follow-up.

scholarly journals Bladder Cancer Diagnosis and Follow-Up: The Current Status and Possible Role of Extracellular Vesicles

2019 ◽  
Vol 20 (4) ◽  
pp. 821 ◽  
Author(s):  
Eline Oeyen ◽  
Lucien Hoekx ◽  
Stefan De Wachter ◽  
Marcella Baldewijns ◽  
Filip Ameye ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Clinical Practice ◽  
Extracellular Vesicles ◽  
Urine Cytology ◽  
Diagnostic Methods ◽  
Urinary Biomarkers ◽  
Non Invasive ◽  
Low Sensitivity

Diagnostic methods currently used for bladder cancer are cystoscopy and urine cytology. Cystoscopy is an invasive tool and has low sensitivity for carcinoma in situ. Urine cytology is non-invasive, is a low-cost method, and has a high specificity but low sensitivity for low-grade urothelial tumors. Despite the search for urinary biomarkers for the early and non-invasive detection of bladder cancer, no biomarkers are used at the present in daily clinical practice. Extracellular vesicles (EVs) have been recently studied as a promising source of biomarkers because of their role in intercellular communication and tumor progression. In this review, we give an overview of Food and Drug Administration (FDA)-approved urine tests to detect bladder cancer and why their use is not widespread in clinical practice. We also include non-FDA approved urinary biomarkers in this review. We describe the role of EVs in bladder cancer and their possible role as biomarkers for the diagnosis and follow-up of bladder cancer patients. We review recently discovered EV-derived biomarkers for the diagnosis of bladder cancer.

scholarly journals 733 Long-Term Outcomes of Outpatient Laser Ablation for Recurrent Non-Muscle Invasive Bladder Cancer: A Retrospective Cohort Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Grover ◽  
S Raj ◽  
B Russell ◽  
K Thomas ◽  
R Nair ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Laser Ablation ◽  
Bladder Tumour ◽  
Invasive Disease ◽  
Invasive Bladder Cancer ◽  
Low Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Abstract Aim Non-muscle-invasive bladder cancer (NMIBC) is the most prevalent form of bladder cancer, predominantly affecting the elderly population. The most common treatment for recurrent NMIBC is transurethral resection of the bladder tumour (TURBT), which carries a risk of perioperative morbidity and mortality in this often-co-morbid population. Outpatient laser ablation of low-grade NMIBC recurrences is a minimally invasive treatment option, but long-term efficacy is poorly reported. Method We retrospectively reviewed the case notes of all patients treated with Holmium:YAG laser ablation from 2008-2016. Data regarding patient demographics, original histology, dates of procedures, follow-up time, recurrence, progression, and complications were recorded. Results A total of 199 procedures were performed on 97 patients (mean age of 83.56), 73 (75.3%) of which originally had low-grade (G1 or G2) tumours. Overall, 55 (56.7%) patients developed tumour recurrence at long-term follow-up (mean 5.36 years), and only 9 (9.3%) patients had tumour progression to a higher stage or grade, but there was no progression to muscle-invasive disease. The median recurrence-free, progression-free and overall survival times were 1.69 years (95% CI 1.20-2.25), 5.70 years (95% CI 4.10-7.60) and 7.60 years (95% CI 4.90-8.70), respectively. No patients required emergency inpatient admission after laser ablation for any associated complications. Conclusions Office-based Holmium: YAG laser ablation is an oncologically-safe method of managing recurrent low-grade non-muscle-invasive bladder cancer in the long-term, with no patients progressing to muscle-invasive disease. Furthermore, the procedure is safe, and no significant complications were seen in this elderly and co-morbid population.

Sign in / Sign up

Export Citation Format

Share Document