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Jens Wollner - One of the best experts on this subject based on the ideXlab platform.
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clinical usefulness of Urine Cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction
Research and Reports in Urology, 2017Co-Authors: Jurgen Pannek, Franziska Rademacher, Jens WollnerAbstract:Introduction Screening for bladder cancer in patients with neurogenic lower urinary tract dysfunction is a challenge. Cystoscopy alone is not sufficient to detect bladder tumors in this patient group. We investigated the usefulness of combined cystoscopy and Urine Cytology. Materials and methods By a systematic chart review, we identified all patients with neurogenic lower urinary tract dysfunction who underwent combined cystoscopy and Urine Cytology testing. In patients with suspicious findings either in Cytology or cystoscopy, transurethral resection was performed. Results Seventy-nine patients (age 54.8±14.3 years, 38 female, 41 male) were identified; 44 of these used indwelling catheters. Cystoscopy was suspicious in 25 patients and Cytology was suspicious in 17 patients. Histologically, no tumor was found in 15 patients and bladder cancer was found in 6 patients. Sensitivity for both Cytology and cystoscopy was 83.3%; specificity was 43.7% for Cytology and 31.2% for cystoscopy. One bladder tumor was missed by Cytology and three tumors were missed by cystoscopy. If a biopsy was taken only if both findings were suspicious, four patients would have been spared the procedure, and one tumor would not have been diagnosed. Conclusion A combination of cystoscopy and Urine Cytology can improve bladder tumor detection rates and lower the number of unnecessary biopsies.
Christopher J Vandenbussche - One of the best experts on this subject based on the ideXlab platform.
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performance of novel non invasive Urine assay uroseek in cohorts of equivocal Urine Cytology
Virchows Archiv, 2020Co-Authors: Maria Del Carmen Rodriguez Pena, Simeon Springer, Diana Taheri, Aline C Tregnago, Marielisa Eich, Isam A Eltoum, Christopher J VandenbusscheAbstract:Urine Cytology is an essential element of the diagnostic work up of hematuria. A significant proportion of cases continue to be placed in the "atypical" or "suspicious" categories of the Paris system for Urine Cytology, posing difficulty in patient management. We report on the performance of our recently described Urine-based assay "UroSEEK" in cases with equivocal diagnosis in patients who are investigated for bladder cancer. Urine samples were collected from two cohorts. The first consisted of patients who presented with hematuria or lower urinary tract symptoms (early detection cohort) and the second of patients that are in follow-up for prior bladder cancer (surveillance cohort). Urine samples were analyzed for mutations in 11 genes and aneuploidy. In the early detection setting, we found high sensitivity and specificity (96% and 88%, respectively) and a strong negative predictive value of 99%. The assay performance was less robust in the surveillance cohort (sensitivity of 74%, specificity of 72%, and negative predictive value of 53%). UroSEEK demonstrated a notable lead time to cancer diagnosis. Seven cases in the early detection cohort and 71 surveillance cases were detected at least 6 months prior to clinical diagnosis. Our results suggest a potential role for UroSEEK assay in guiding management of patients with atypical Urine Cytology if confirmed in future prospective trials.
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impact of intravesical therapy for non muscle invasive bladder cancer on the accuracy of Urine Cytology
World Journal of Urology, 2019Co-Authors: Mohit Gupta, Christopher J Vandenbussche, Niv Milbar, Giorgia Tema, Filippo Pederzoli, Meera Chappidi, Max Kates, Trinity J BivalacquaAbstract:Urine Cytology remains an essential diagnostic tool in the surveillance of patients with non-muscle invasive bladder cancer (NMIBC). The correlation of Urine Cytology with biopsy specimens to determine its accuracy following induction intravesical therapy has not been investigated. A retrospective review was performed of patients who underwent intravesical therapy for biopsy-proven non-muscle invasive disease between 2013 and 2016 at our institution. All patients uniformly underwent Cytology and systematic bladder biopsies in the operating room within 12 weeks following intravesical therapy. The accuracy of urinary Cytology in predicting high-grade disease recurrence following intravesical therapy was confirmed by correlating Cytology results to post-treatment systematic biopsies, regardless of endoscopic findings. Only patients with complete information regarding Urine Cytology and pathologic biopsy results, both pre- and post-intravesical therapy, were included. 90 Cytology samples following intravesical therapy were analyzed from 76 patients who met inclusion criteria. 72 (80.0%) and 18 (20.0%) of the samples were collected from patients initially treated for high- and low-grade disease, respectively. Fifty-six (62.2%) specimens were obtained from patients following induction of bacillus Calmette–Guerin (BCG) therapy; the remainder were from patients treated with intravesical gemcitabine/docetaxel, mitomycin, or BCG/interferon. For patients treated with BCG, Cytology was positive for high-grade disease in 8/15 patients with high-grade pathology on follow-up biopsy, thus demonstrating a sensitivity of 53% (95% CI 27–79%), specificity of 95% (95% CI 84–99%), positive predictive value of 80% (95% CI 44–98%), and negative predictive value of 85% (95% CI 71–94%). If cytologic interpretation was broadened to include high-grade and “suspicious for high-grade” findings, sensitivity increased to 67% (95% CI 38–88%) and specificity decreased to 88% (95% CI 74–96%). While urinary Cytology maintains a high specificity following intravesical therapy, it demonstrates a low sensitivity for potentially aggressive high-grade urothelial carcinoma. Further evaluation of more effective, clinic-based enhanced cystoscopy techniques and biomarkers is warranted to better identify patients at risk for disease recurrence following BCG therapy.
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adequacy in voided Urine Cytology specimens the role of volume and a repeat void upon predictive values for high grade urothelial carcinoma
Cancer Cytopathology, 2016Co-Authors: Christopher J Vandenbussche, Dorothy L Rosenthal, Matthew T OlsonAbstract:BACKGROUND Adequacy assessment is one of the most controversial and overlooked components in the daily practice of cytopathology, because it is generally determined from limited samples. Because voided Urine varies widely in terms of its volume and cellularity, there is little consensus about the proper role for these variables in assessing specimen adequacy. In this study, the authors explored the role of volume in voided Urine specimens to determine whether it plays a role in determining adequacy for the detection of high-grade urothelial carcinoma. METHODS Voided Urine specimens received at the authors' laboratory over the 9.5 years since the introduction of the Johns Hopkins Template for Reporting Urinary Cytopathology were analyzed for correlations between volume, specimen adequacy, and the diagnosis of high-grade malignancy. The same data set also was queried to determine whether a patient who provided a voided low-volume specimen could yield a higher volume specimen and thereby increase adequacy. RESULTS In total, 15,731 voided Urine specimens with a cumulative volume of 891 liters originating from 8594 individual patients were analyzed. Specimen adequacy increased linearly for each increment of volume submitted to the laboratory up to 30 mL, after which the correlation was nonlinear. Low-volume specimens below this cutoff also had lower fractions of specimens that were diagnosed as malignant or suspicious. CONCLUSIONS Volume is an important component in the evaluation of adequacy for voided Urine Cytology specimens. Cancer (Cancer Cytopathol) 2015. © 2015 American Cancer Society.
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adequacy in voided Urine Cytology specimens the role of volume and a repeat void upon predictive values for high grade urothelial carcinoma
Cancer Cytopathology, 2016Co-Authors: Christopher J Vandenbussche, Dorothy L Rosenthal, Matthew T OlsonAbstract:BACKGROUND Adequacy assessment is one of the most controversial and overlooked components in the daily practice of cytopathology, because it is generally determined from limited samples. Because voided Urine varies widely in terms of its volume and cellularity, there is little consensus about the proper role for these variables in assessing specimen adequacy. In this study, the authors explored the role of volume in voided Urine specimens to determine whether it plays a role in determining adequacy for the detection of high-grade urothelial carcinoma. METHODS Voided Urine specimens received at the authors' laboratory over the 9.5 years since the introduction of the Johns Hopkins Template for Reporting Urinary Cytopathology were analyzed for correlations between volume, specimen adequacy, and the diagnosis of high-grade malignancy. The same data set also was queried to determine whether a patient who provided a voided low-volume specimen could yield a higher volume specimen and thereby increase adequacy. RESULTS In total, 15,731 voided Urine specimens with a cumulative volume of 891 liters originating from 8594 individual patients were analyzed. Specimen adequacy increased linearly for each increment of volume submitted to the laboratory up to 30 mL, after which the correlation was nonlinear. Low-volume specimens below this cutoff also had lower fractions of specimens that were diagnosed as malignant or suspicious. CONCLUSIONS Volume is an important component in the evaluation of adequacy for voided Urine Cytology specimens. Cancer (Cancer Cytopathol) 2015. © 2015 American Cancer Society.
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a review of reporting systems and terminology for Urine Cytology
Cancer Cytopathology, 2013Co-Authors: Christopher L Owens, Christopher J Vandenbussche, Frances H Burroughs, Dorothy L RosenthalAbstract:Urine Cytology continues to play an important role in the diagnosis and management of urothelial carcinoma, a common cancer of adults with significant morbidity and mortality. Because of its high sensitivity for high-grade urothelial tumors, including lesions that may be cystoscopically occult, Urine Cytology nicely compliments cystoscopic examination, a method that detects most low-grade tumors. Over the decades, several reporting schemes for Urine Cytology have been published in the literature, each of which has relative strengths and weaknesses. Unlike cervical Cytology, there has not been widespread acceptance and use of any particular reporting scheme for Urine Cytology studies. Thus, terminology and criteria for Urine Cytology reporting are not uniform among pathologists, which can frustrate clinicians and hinders interlaboratory comparisons.
Jianyu Rao - One of the best experts on this subject based on the ideXlab platform.
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molecular pathology of Urine Cytology
2016Co-Authors: Jordan P Reynolds, Meenakshi Bhasin, Neda A Moatamed, Jianyu RaoAbstract:Urine Cytology is the most widely used noninvasive test to detect and monitor urothelial malignancies. It is effective in detecting high grade cancers but has limited value in detecting low grade tumors. On the contrary, cystoscopy is effective in detecting papillary tumors including some low grade tumors, but may miss high grade flat lesions such as carcinoma in situ. Therefore, voided Urine Cytology and cystoscopy are complementary to each other and together have been quite effective in detecting and monitoring urothelial tumors. However, cystoscopy is invasive and expensive, whereas Cytology has limitations for low grade lesions. Thus, additional noninvasive molecular markers are needed for diagnosis and surveillance of primary or recurrent urothelial malignancy. There are numerous molecular markers that have been studied, some received FDA approval and widely used in clinical setting, while others are pending validation. Below we review some of the widely used or potentially useful markers, focusing on molecular tests.
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comparative study of proex c immunocytochemistry and urovysion fluorescent in situ hybridization assays on Urine Cytology specimens
CytoJournal, 2015Co-Authors: Sue Chang, Mary Levin, Jianyu Rao, Elaine Smith, Neda A MoatamedAbstract:Background: Detection of urothelial carcinoma (UC) by Urine Cytology can be challenging. Recently, ProEx C has been studied as a marker to improve detection of UC. ProEx C is an assay targeting expression of topoisomerase IIa and minichromosome maintenance protein-2 and is currently utilized to assist in diagnoses of the gynecological specimens. In this study, we compared the utility of ProEx C and UroVysion in Urine specimens. Materials and Methods: Twenty-seven Urine specimens with UroVysion assay analysis and surgical biopsy follow-up were selected. The smears were stained with ProEx C. ProEx C and UroVysion assay results were separated into two categories based on surgical biopsy follow-up (benign or neoplastic). Surgical biopsy diagnoses were used as the gold standard for comparative evaluation of the two assays. The surgical follow-up was 9 benign, 2 low grade, and 16 high grade UCs. Results: The sensitivity was 88.9% for ProEx C and 55.6% for UroVysion, while the specificity was 77.8% for ProEx C and 44.4% for UroVysion. Positive predictive value was 88.9% for ProEx C and 66.7% for UroVysion. Negative predictive value was 77.8% and 33.3% for ProEx C and UroVysion, respectively. Using the two-tailed paired t-test, P value of 0.033 was obtained when ProEx C stain was compared with the UroVysion assay. Conclusion: ProEx C immunocytochemistry has a more favorable performance than fluorescent in-situ hybridization with a significant difference between the two assays using paired two-tail t-test (P = 0.0033).
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comparative evaluation of proex c and immunocyt ucyt assays in atypical Urine Cytology
Archives of Pathology & Laboratory Medicine, 2014Co-Authors: Maria Vergaralluri, Mary Levin, Jianyu Rao, Sophia Kim Apple, Neda A MoatamedAbstract:Context.—Detection of urothelial carcinoma by Urine Cytology can be challenging. Recently, ProEx C has been studied as a marker to improve detection of urothelial carcinoma. ProEx C is an assay targeting expression of topoisomerase II-α and the minichromosome maintenance protein-2 and is used to assist in diagnoses of gynecologic specimens. Objective.—To evaluate the utility of ProEx C and uCyt in atypical Urine Cytology. Design.—Sixty-eight specimens with a diagnosis of atypical Urine Cytology, concurrent uCyt testing, and surgical biopsy follow-up were included. Slides were restained with ProEx C. ProEx C was recorded as positive when nuclear staining was seen in at least one morphologically atypical urothelial cell. The uCyt was scored as positive if at least one morphologically atypical urothelial cell showed positive fluorescence staining. Thirteen cases (19%) had benign histologic diagnoses, 18 (26%) had low-grade papillary urothelial carcinoma, and 37 (54%) had high-grade urothelial carcinoma. Resu...
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Urine Cytology and adjunct markers for detection and surveillance of bladder cancer
American Journal of Translational Research, 2010Co-Authors: Peggy S Sullivan, Jessica Chan, Mary Levin, Jianyu RaoAbstract:Urine Cytology coupled with cystoscopic examination has been and remains the standard in the initial evaluation of lower urinary tract lesions to rule out bladder cancer. However, cystoscopy is invasive and may miss some flat lesions, whereas Cytology has low sensitivity in low-grade papillary disease. Additional lab-based or office-based markers are needed to aid in the evaluation of these lesions. Recently, many such markers have been developed for the purpose of improving the cytologic diagnosis of bladder malignancies. In this review, we will first discuss conventional cytomorphologic analysis of Urine Cytology followed by a discussion of markers that have been developed in the past for detection and surveillance of urothelial carcinoma. We will focus on how these markers can be used in conjunction with Urine Cytology in daily practice.
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comparison of immunocyt urovysion and Urine Cytology in detection of recurrent urothelial carcinoma a split sample study
Cancer Cytopathology, 2009Co-Authors: Peggy S Sullivan, Mary Levin, Farzad Nooraie, Hope Sanchez, Sharon L Hirschowitz, Nagesh P Rao, Jianyu RaoAbstract:BACKGROUND: ImmunoCyt (uCyt) and UroVysion are ancillary studies that may aid in the detection of urothelial carcinoma in Urine specimens. We compared ImmunoCyt and UroVysion to Urine Cytology in the ability to detect recurrent urothelial carcinoma. METHODS: Single voided Urine samples were obtained from 100 patients who had a previous history of bladder cancer. All patients underwent cystoscopy immediately after Urine sample collection. Forty-one cystoscopically suspicious lesions were biopsied. Urine samples were divided and processed blindly and independently in 3 different laboratories for ImmunoCyt, UroVysion, and Urine Cytology (ThinPrep method). RESULTS: Of the 41 cystoscopically positive cases, most cystoscopy findings showed multiple tumors that were papillary and less than 1 cm. Biopsies showed many low-grade tumors (54%). Overall sensitivity of Cytology for low- and high-grade urothelial cell carcinoma was 15% and 27%, whereas ImmunoCyt was 62% and 91% and UroVysion was 8% and 18%, respectively. Overall specificity of Cytology was 97%, whereas ImmunoCyt was 63% and UroVysion was 90%. CONCLUSIONS: ImmunoCyt is more sensitive than either Cytology or UroVysion in detecting low-grade tumors. Both Cytology and UroVysion have comparable specificity in cystoscopically negative cases. Whereas ImmunoCyt may improve the cytological detection of recurrent bladder cancer, UroVysion may be used as a confirmatory test for either Cytology or ImmunoCyt. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.
Rajeev Kumar - One of the best experts on this subject based on the ideXlab platform.
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nuclear matrix protein 22 as adjunct to Urine Cytology and cystoscopy in follow up of superficial tcc of urinary bladder
Urology, 2009Co-Authors: Narmada P. Gupta, Nitin Sharma, Rajeev KumarAbstract:OBJECTIVES To assess the efficacy of nuclear matrix protein 22 (NMP-22) in the diagnosis of recurrent, superficial bladder cancer and whether it can predict for future recurrence. METHODS Patients with diagnosed and treated superficial transitional cell carcinoma urinary bladder (Stage Ta, T1, Tis, Nx, and M0) presenting for surveillance follow-up were prospectively enrolled in this study from February 2004 to August 2005. These patients underwent Urine Cytology, NMP-22 testing, and cystopanendoscopy on enrollment in the study. For the next year, these patients underwent cystopanendoscopy and Cytology at 3-month intervals. The ability of NMP-22 to predict for recurrence was determined using the cystoscopy findings as the reference standard. RESULTS A total of 145 patients were included in the study. Of these, 56 had recurrence at enrollment. Of the 56 patients, 48 had positive NMP-22 findings and 22 had positive Urine Cytology findings. The sensitivity, specificity, positive predictive value, and negative predictive value was 85.7%, 77.5%, 70.6%, and 89.6%, respectively, for NMP-22 alone and 92.9%, 75.3%, 70.3%, and 94.4%, respectively, when the Cytology and NMP-22 findings were combined. During the subsequent follow-up of 1 year, 61 recurrences developed in 47 patients. Cox regression analysis showed that those with positive NMP-22 had a 9.57 times greater risk of recurrence during 1 year compared with those with negative NMP-22. CONCLUSIONS The results of our study have shown that the addition of NMP-22 testing to Cytology increases the sensitivity for recurrence detection in patients with superficial transitional cell bladder cancer. Patients with positive NMP-22 findings developed significantly more recurrences compared with those with negative NMP-22 findings.
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Comparison of NMP22 BladderChek test and Urine Cytology for the detection of recurrent bladder cancer.
Japanese journal of clinical oncology, 2006Co-Authors: Atul Kumar, Rajeev Kumar, Narmada P. GuptaAbstract:Objective: To assess the clinical performance of the NMP22 BladderChek test, which is a qualitative test, and to compare it with voided Urine Cytology for the detection of recurrent bladder cancer. We also evaluated whether cystoscopy can be omitted from the surveillance protocol by combining the two tests. Methods: A total of 131 patients with a history of superficial transitional cell carcinoma of the bladder provided Urine samples before a cystoscopic examination. Urine samples were assayed for the presence of NMP22 using the NMP22 BladderChek test and Cytology was performed by a cytopathologist. Selected patients underwent a biopsy, with appropriate additional therapy. Results of the two tests were compared with that the results of cystoscopy, which was retained as the gold standard. For positive biopsies, the results of the NMP22 test and Cytology were also correlated with the tumor stage and grade. Results: Of the 46 recurrences detected by cystoscopy, the NMP22 test was positive in 39 cases and Cytology in 19 cases. The sensitivity of the NMP22 test was 85%, which was significantly greater than that of Cytology (41%). In particular, for low-risk tumors it was eight times more sensitive than Cytology. The specificities of the NMP22 test and Cytology were 77 and 96%, respectively. Combining the two tests increased overall sensitivity to 91%. However, 9% of the tumors were still not detected. Conclusion: The NMP22 BladderChek test is an in vitro qualitative test that is easily available and cheap; it can be performed by a urologist in the office and results can be interpreted within 30 min. The NMP22 test is superior to Cytology for all grades and stages in the detection of recurrence in patients with a history of superficial bladder cancer. Our study indicates that the NMP22 test can be used as a substitute for Urine Cytology. The NMP22 test cannot replace cystoscopy, but it can be used as an adjunct to cystoscopy in the surveillance protocol for patients with superficial bladder cancer.
Jurgen Pannek - One of the best experts on this subject based on the ideXlab platform.
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clinical usefulness of Urine Cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction
Research and Reports in Urology, 2017Co-Authors: Jurgen Pannek, Franziska Rademacher, Jens WollnerAbstract:Introduction Screening for bladder cancer in patients with neurogenic lower urinary tract dysfunction is a challenge. Cystoscopy alone is not sufficient to detect bladder tumors in this patient group. We investigated the usefulness of combined cystoscopy and Urine Cytology. Materials and methods By a systematic chart review, we identified all patients with neurogenic lower urinary tract dysfunction who underwent combined cystoscopy and Urine Cytology testing. In patients with suspicious findings either in Cytology or cystoscopy, transurethral resection was performed. Results Seventy-nine patients (age 54.8±14.3 years, 38 female, 41 male) were identified; 44 of these used indwelling catheters. Cystoscopy was suspicious in 25 patients and Cytology was suspicious in 17 patients. Histologically, no tumor was found in 15 patients and bladder cancer was found in 6 patients. Sensitivity for both Cytology and cystoscopy was 83.3%; specificity was 43.7% for Cytology and 31.2% for cystoscopy. One bladder tumor was missed by Cytology and three tumors were missed by cystoscopy. If a biopsy was taken only if both findings were suspicious, four patients would have been spared the procedure, and one tumor would not have been diagnosed. Conclusion A combination of cystoscopy and Urine Cytology can improve bladder tumor detection rates and lower the number of unnecessary biopsies.
