Reflex UroVysion Testing in Abnormal Urine Cytology: Surveillance Versus Initial Evaluation.
John W Mooring, Mary Lowery-Nordberg, Songlin Zhang. Louisiana State University Health Sciences Center, Shreveport, Shreveport; Feist Weiller Cancer Center, Shreveport, LA
Background: Bladder cancer is the fourth most common cancer among men in the United States. Patients with bladder cancer require long-term surveillance for recurrence and progression, and cytoscopy and urine cytology are typically used for surveillance. However, cystoscopy often fails to detect flat tumors, and cytology has a low sensitivity for low-grade tumors. UroVysion is a FDA approved fluorescence in situ hybridization (FISH) probe set for surveillance of patients with a bladder cancer, and initial evaluation for bladder cancer in patients with urinary symptoms. However, the value of UroVysion has been under extensive debate.
Design: Cases with UroVysion testing during 2004-2009 were retrieved from the pathology database and were separated into two categories: surveillance, and initial evaluation. The follow-up histology results were retrieved.
Results: A total of 81 cases were included in this study and the cytology diagnoses were: 8 positive, 67 atypical and 6 negative. 36 cases had positive UroVysion test (44.4%, 36/81). The test was positive in 75% of positive, 41.8% of atypical, and 33.3% of cases with negative cytology. UroVysion was positive in one renal cell carcinoma and one metastatic colon carcinoma. There were 45 cases for surveillance and 36 cases for initial evaluation. The UroVysion positive rate was higher in the evaluation group (50%) than surveillance group (40%), but it was not statistically significant (p=0.33). For cases with abnormal urine cytology, UroVysion test had sensitivity, specificity, positive predicative value (PPV) and negative predicative value (NPV) 64.7%, 66.7%, 84.6% and 40% respectively.
Conclusions: The UroVysion test positive rate is slightly higher in the initial evaluation group than the surveillance group, but it is not statistically significant. For urine with abnormal cytology, UroVysion test has a good PPV (84.6%) but a poor NPV (40%). So, cases with abnormal urine cytology and negative UroVysion test should have further evaluation for possible urothelial carcinoma. Abnormal urine cytology with a positive UroVysion test has a high probability of urothelial carcinoma. The UroVysion test can also be positive in other non-urothelial lesions.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 190, Tuesday Morning