Flach, R.N. (Rachel Naomi) (2019) Urine cytology does not add to clinical decision making in the follow-up of non-muscle invasive bladder cancer: a single center retrospective cohort study. thesis, Medicine.
Full text available on request.Abstract
Introduction: Urine cytology and cystoscopy can both be performed during initial diagnosis and follow-up of non-muscle invasive bladder cancer (NMIBC). With this study, we aim to investigate the value of cytology in clinical decision making during follow-up and investigate the additional diagnostic value of cystoscopy combined with urine cytology. Method: A retrospective single center cohort study was conducted in order to evaluate the added value of urine cytology. Patients with histologically confirmed Ta or T1 urothelial carcinoma of the bladder received a follow-up schedule with cystoscopy and cytology, according to European Association of Urology guidelines. If one of the two tests or both led to suspicion of recurrence, a transurethral resection of the bladder tumor (TURBT) was performed. Determinants were cytology and cystoscopy and our outcome measures were decision for TURBT and histologically confirmed recurrence. Results: Out of 181 patients in our cohort, 81 (45%) underwent TURBT during follow-up. Fifty patients (28%) were diagnosed with recurrent disease. Cystoscopy significantly more often led to TURBT in follow-up than cytology (31.8% vs. 5.2%; p<0.001). Two out of 181 patients were diagnosed with recurrent disease based on positive cytology combined with negative cystoscopy. Positive cytology was detected significantly more often in high-risk tumors than in intermediate-risk tumors (OR = 3.04, p = 0,029). The number of patients that needed both cytologic and cystoscopic surveillance in order to diagnose a recurrent tumor that cystoscopy alone would not have caught, was 87 for any tumor and 173 for a high-grade recurrence. Conclusion: The added value of urine cytology during follow-up of NMIBC is limited. The addition of cytology next to cystoscopy seldomly leads to the decision to perform a TURBT. Our research suggests that leaving cytology out of the follow-up process does not have major consequences in terms of missing recurrent disease.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Cauberg, dr. E.C.C. urologist (Isala Hospital Zwolle) |
| Supervisor name: | Second supervisors: and Meijer, dr. R.P. urologist & and Hennus, dr. R.P. urologist (UMCU) |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/402 |
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