Lotan - Figure 24
Normal Cystoscopy and Positive Marker
FIG. 24: What do we do in the case of a normal cystoscopy and a positive biomarker? To assess whether this is likely to be a missed cancer or a false positive, we have to ask several questions.
- One question is when the last assessment for upper tract disease was carried out. The current recommendation for imaging of the upper tract is yearly for high-grade disease.[5,6,10,11]
- Does this patient likely have disease missed by cystoscopy? A patient with previous history of carcinoma in situ or positive urethral disease might be such a candidate.
- Is cytology normal or abnormal? If cytology is abnormal, then a biopsy is likely indicated because there is a high positive predictive value in these settings.
- The last question is, how well does the marker perform? Does it have a high specificity and a high positive predictive value? If so, then biopsy would be the better course.
References
Chang SS, Boorjian SA, Chou R, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO Guideline. J Urol. 2016;196:1021−9 http://dx.doi.org/10.1016/j.juro.2016.06.049
Chang SS, Bochner BH, Chou R, et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol. Published online April 26, 2017 https://doi.org/10.1016/j.juro.2017.04.086
Babjuk M, Böhle A, Burger M, et al. EAU guidelines on non–muscle-invasive urothelial carcinoma of the bladder: Update 2016. Eur Urol. 2017;71:447−61 http://dx.doi.org/10.1016/j.eururo.2016.05.041
Witjes JA, Lebret T, Compérat EM, et al. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol. 2017;71:462−75 http://dx.doi.org/10.1016/j.eururo.2016.06.020
