This was a multicenter prospective study including NMIBC patients who were under routine follow-up. A total of 122 patients were included. As part of their follow-up, patients received cystoscopy, urine cytology and TURBT (if required [n=31]). For the purpose of this study, at the time of cystoscopy and/or cytology, patients were screened for TERT promoter and FGFR3 mutations in cells present in the urine by using a collection kit and real-time Polymerase chain reaction (PCR). The study’s endpoint was the detection rate of bladder cancer recurrence confirmed by histology during follow-up. Sensitivity and specificity were determined according to the pathology results and compared with cytology and cystoscopy findings.
Real-time PCR detection (Mut) performance in comparison with cystoscopy (Cys) and cytology (Cyt) in recurrence (Rec) are shown in figure 1. The sensitivity and specificity of real-time PCR were demonstrated to be 80.6% and 93.4%, respectively. These results were significantly better than the ones reported for cystoscopy and cytology (Figure 1). Real-time PCR performance in recurrence detection across tumor all stages and grades is shown in figure 2. These results show that the detection rate of low-grade bladder cancer was 100% with real-time PCR and only 25% with cytology.
In conclusion, the authors suggest that real-time PCR for TERT promoter and FGFR3 mutations appears to be a useful tool that can be used in NMIBC follow-up with impressive specificity and sensitivity for disease recurrence across various stages and grades, outperforming cytology. The results of this study are very interesting and there is a need for a larger prospective cohort to validate these results, before considering a clinical application on a regular basis.
Figure 1 – Real-time PCR detection performance in comparison with cystoscopy and cytology in bladder cancer recurrence:
Figure 2 - Real-time PCR performance in recurrence detection across tumor staging and grade
Presented by: Ricardo Leão, MD, Hospital de Braga, Braga, Portugal
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain from March 15-19, 2019.