scholarly journals THE VALUE OF URINARY CYTOLOGY AND HYDRONEPHROSIS TO PREDICT MUSCLE INVASIVE BLADDER CANCER

2016 ◽  
Vol 23 (1) ◽  
Author(s):  
Ferdi Ardiansyah ◽  
H R Danarto

Objective: We evaluated the value of urinary cytology, and presence of hydronephrosis to predict muscle invasive bladder cancer. Material & methods: We retrospectively analyzed data of 167 patients that diagnosed bladder cancer from medical record at Sardjito General Hospital Yogyakarta, between 2004-2011. Preoperative parameters were evaluated including age, gender, number and location of bladder cancer, urinary cytology, as well as presence of hydronephrosis. The outcome was muscle invasive bladder cancer. Results: A total of 96 (57.5%) patients had positive urinary cytology, 80 (47.9%) had hydronephrosis, most location of tumor were in trigone 43 (25.7%). The youngest patient was 26 years and the oldest was 84 years old, male was most affected in 145 (86.8%). On bivariate analysis, positive urinary cytology and hydronephrosis were associated with muscle invasive bladder cancer (OR 0.08 CI 0.038–0.167; OR 30.24 CI 12.72–71.89, respectively, each p < 0.05). Combination urinary cytology and hydronephrosis incrementally improved prediction of muscle invasive bladder cancer with positive and negative predictive value were 93.9% and 71.4%, respectively. Presence of hydronephrosis was associated with tumor location in trigone (p < 0.05). Conclusion: Urinary cytology and hydronephrosis were associated with muscle invasive bladder cancer, and can be used to predict muscle invasive bladder cancer.

2016 ◽  
Vol 98 (8) ◽  
pp. 547-551 ◽  
Author(s):  
VA During ◽  
GM Sole ◽  
AK Jha ◽  
JA Anderson ◽  
RT Bryan

INTRODUCTION In the 75–80% of urothelial bladder cancers (UBC) presenting as non-muscle invasive bladder cancer (NMIBC), transurethral resection of bladder tumour (TURBT) is the key treatment and staging procedure. In the 20–25% of patients with muscle invasive bladder cancer (MIBC), further cross-sectional imaging is required to complete the staging process before considering radical treatment. Given the adverse effects of ionising radiation, clinicians identify patients believed to have MIBC, and so requiring further imaging pre-TURBT, at the tumour histology/stage based on the tumour’s visual characteristics. There is minimal evidence describing the accuracy of such predictions in newly-diagnosed patients. METHODS Over a 6-year period, a database of patients undergoing resection of newly-diagnosed bladder lesions in a single UK centre was prospectively established. Predictions based on histology were simultaneously recorded, and the accuracy of these predictions of histology/stage subsequently assessed. RESULTS One hundred and twenty two (73.1%) patients with histologically confirmed NMIBC had predictions recorded versus 45 (26.9%) patients with MIBC. Visual assessment predictions of MIBC had a sensitivity of 88.9% (95% confidence interval [CI] 76.5%–95.2%) and a specificity of 91.0% (95% CI 84.6%–94.9%), giving a positive predictive value of 78.4% (95% CI 65.4%–87.5%) and a negative predictive value of 95.7% (95% CI 90.3%–98.1%). CONCLUSIONS We find that visual assessment is accurate in predicting the presence of MIBC. This supports the practice of stratifying patients at the time of initial cystoscopy for those requiring further radiological staging pre-TURBT.


2020 ◽  
pp. 1-5
Author(s):  
Łukasz Białek ◽  
Katarzyna Czerwińska ◽  
Łukasz Fus ◽  
Wojciech Krajewski ◽  
Anna Sadowska ◽  
...  

BACKGROUND: Mini Chromosome Maintenance 5 (MCM5) is considered as a urinary biomarker of bladder cancer. ADXBLADDER is a commercially available test to detect MCM5 antibodies. OBJECTIVE: External validation of ADXBLADDER test as a urinary biomarker of histopathologically confirmed non-muscle invasive bladder cancer (NMIBC) recurrence. METHODS: The study enrolled 119 consecutive patients with a history of NMIBC and 37 healthy volunteers matched as controls. Single, full-void urine samples were collected from patients before cystoscopy ± TUR. To measure MCM5 expression, Arquer Diagnostics ADXBLADDER test was used. The study protocol was registered within the clinical trials database (NCT03796299). RESULTS: Among patients with NMIBC history, recurrence was diagnosed in 83 patients (69.7%). ADXBLADDER demonstrated sensitivity of 73.5% (95% confidence interval (CI) 62.7%–82.6%), specificity of 33.3% (95% CI 18.6% to 51%), overall negative predictive value (NPV) of 35.3% (95% CI 23.3% to 49.5%) and overall positive predictive value of 71.8% (95% CI 66.1% to 76.8%) for detecting recurrence. In a control group, false positive ADXBLADDER results were noticed in 18 patients (48.6%). The sensitivity and NPV were the highest in invasive tumors (100% and 100%, respectively) and in high-grade recurrences (81.8% and 94.1%, respectively). CONCLUSIONS: ADXBLADDER has a moderate sensitivity and poor specificity in detecting NMIBC recurrence. However, it properly diagnoses patients with T1+ stage recurrence or high-grade tumors.


Author(s):  
Richard P. Meijer ◽  
Alexandre R. Zlotta ◽  
Bas W.G. van Rhijn

High-grade non-muscle-invasive bladder cancer (HG-NMIBC) represents the most aggressive spectrum of this non-invasive cancer. This collective term includes all high-grade NMI urothelial carcinoma (UC), such as those without invasion (pTa), those with lamina propria invasion (pT1), and those that are only/have concomitant carcinoma in situ (CIS; pTis). These cancers have a high risk for intravesical recurrence (around 46–78% at five years) and progression (between 6–45% at five years) to muscle-invasive bladder cancer (MIBC). As with all UC, their presentation can be with visible haematuria or irritative lower urinary tract symptoms. The latter are common in patients with CIS. CIS may be detected in isolation (so-called primary CIS) or with a coexisting UC elsewhere (termed concomitant CIS). While urinary cytology has a moderate sensitivity and high specificity (>90%) for the detection of HG-NMIBC, cystoscopy is the most important diagnostic tool.


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