OBJECTIVE: To assess the ability of reflex UroVysion fluorescence in situ hybridization (FISH) testing to predict recurrence and progression in non-muscle invasive bladder cancer (NMIBC) patients with suspicious cytology but negative cystoscopy.
PATIENTS AND METHODS: Patients on NMIBC surveillance were followed with office cystoscopy and urinary cytology every three-to-six months. Between March 2007 and February 2012, 500 consecutive patients with suspicious cytology underwent reflexive FISH analysis. Clinical and pathologic data were reviewed retrospectively. Predictors for recurrence, progression, and findings on subsequent cystoscopy (within two-to-six months after FISH) were evaluated using univariate and multivariate Cox regression.
RESULTS: 243 patients with suspicious cytology also had negative surveillance cystoscopy. Positive FISH was a significant predictor for recurrence (hazard ratio 2.35, 95% confidence interval [CI] 1.42, 3.90, p=0.001) in multivariate analysis and for progression (hazard ratio 3.01, 95% CI 1.10, 8.21, p=0.03) in univariate analysis, compared to negative FISH. However, positive FISH was not significantly associated with evidence of tumor on subsequent surveillance cystoscopy compared to negative FISH (odds ratio 0.8, 95% CI 0.26, 2.74, p=1).
CONCLUSION: Positive FISH predicts for recurrence and progression in NMIBC surveillance patients with suspicious cytology but negative cystoscopy. However, an association was not found between FISH result and tumor recurrence in the immediate follow-up period. Reflex FISH testing for suspicious cytology may have limited ability to modify surveillance strategies in NMIBC.
Written by:
Kim PH, Sukhu R, Cordon BH, Sfakianos JP, Sjoberg DD, Hakimi AA, Dalbagni G, Lin O, Herr HW. Are you the author?
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
Reference: BJU Int. 2013 Oct 15. Epub ahead of print.
doi: 10.1111/bju.12516
PubMed Abstract
PMID: 24128299
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