LBA5 INITIAL RESULTS OF A PROSPECTIVE COHORT STUDY EVALUATING RELIABILITY OF ENDOSCOPIC EVALUATION IN PREDICTING PT0 DISEASE AT THE TIME OF RADICAL CYSTECTOMY: WHERE AND HOW DOES CYSTOSCOPY FALL SHORT? (2018)

You have accessJournal of UrologyPlenary: Next Frontier1 Apr 2018LBA5 INITIAL RESULTS OF A PROSPECTIVE COHORT STUDY EVALUATING RELIABILITY OF ENDOSCOPIC EVALUATION IN PREDICTING PT0 DISEASE AT THE TIME OF RADICAL CYSTECTOMY: WHERE AND HOW DOES CYSTOSCOPY FALL SHORT? Daniel Parker, Aeen Asghar, John O'Neill, Richard Greenberg, Marc Smaldone, David Chen, Rosalia Viterbo, Robert Uzzo, Joshua Eccles, Daniel Geynisman, Matthew Zibelman, Eric Ross, Philip Abbosh, Elizabeth Plimack, and Alexander Kutikov Daniel ParkerDaniel Parker More articles by this author , Aeen AsgharAeen Asghar More articles by this author , John O'NeillJohn O'Neill More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Joshua EcclesJoshua Eccles More articles by this author , Daniel GeynismanDaniel Geynisman More articles by this author , Matthew ZibelmanMatthew Zibelman More articles by this author , Eric RossEric Ross More articles by this author , Philip AbboshPhilip Abbosh More articles by this author , Elizabeth PlimackElizabeth Plimack More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.084AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Concern for discordance between endoscopic evaluation and final pathology drives current clinical management of patients deemed appropriate candidates for radical cystectomy (RC). Yet some 30% of patients who undergo neoadjuvant chemotherapy (NAC) prior to RC do not harbor detectable malignancy within the bladder at the time of surgery. Our objective was to better understand reliability and shortcomings of cystoscopic evaluation in RC candidates utilizing a protocol where all patients undergoing RC at our institution first receive a Systematic Endoscopic Evaluation (SEE). METHODS Patients undergoing RC for urothelial carcinoma (UC) at our institution were enrolled in a prospective, non-randomized, IRB-approved cohort study to evaluate the reliability of SEE in predicting pT0 bladder cancer. Rigid cystoscopy with targeted biopsy of visible tumor and/or tumor bed/scar, plus two additional random biopsies were performed immediately prior to RC. A standardized bladder map diagram was used to index cystoscopic findings. The endoscopic findings and transurethral biopsy results were then compared to the final pathologic cystectomy specimen RESULTS To date, 39 patients consented to the study, and 36 have received RC. 35 had adequate data for analysis. 22 (63%) underwent RC for MIBC, while 13 (37%) had high-risk NMIBC. 21 (60%) received NAC. On SEE, 17 (49%) patients were noted to have detectable cancer. Upon extirpation, pT0, pTis, pTa, pT1, pT2, pT3, and pT4 UC was found in 11 (31%), 7 (20%), 1 (3%), 2 (6%), 2 (6%), 6 (17%), 6 (17%), respectively. The sensitivity of SEE to predict presence of MIBC at RC was 80.0%. Negative predictive value of SEE to rule out any residual cancer at RC was 55%, and to rule out MIBC was 77.8%. Of 18 patients with no residual disease on SEE, 10 had concordant and 8 had discordant findings on final pathology. MIBC was found in 4 of the 8 discordant patients (Table 1), two of whom had prostatic stromal involvement and were known to have cT4a disease prior to NAC. CONCLUSIONS Our assessment of SEE′s test characteristics immediately prior to RC affords a unique understanding of its limitations and provides potential opportunities for identifying patients whose bladders no longer harbor malignancy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e578-e579 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Parker More articles by this author Aeen Asghar More articles by this author John O'Neill More articles by this author Richard Greenberg More articles by this author Marc Smaldone More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Joshua Eccles More articles by this author Daniel Geynisman More articles by this author Matthew Zibelman More articles by this author Eric Ross More articles by this author Philip Abbosh More articles by this author Elizabeth Plimack More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...