Presented by: Orel Carmona MD
Sheba Medical Center

Introduction

Current guidelines recommend a stringent follow-up regimen that includes interval cystoureteronephscopy, CT urography, and selective urine cytology sampling for upper tract urothelial carcinoma (UTUC) patients undergoing endoscopic treatment and management. There are no recommendations regarding FISH analysis. Our purpose was to assess the efficacy of cytology and FISH as part of the follow-up protocol and its significance to clinical decision-making in this scenario.

Materials

The medical records of all patients who managed endoscopically for UTUC at our institute between 2014 and 2022 were retrospectively analyzed. Demographic and clinical data, histology, cytology, and FISH results were collected. FISH analysis was considered malignant according to Paris criteria.

Results

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During the study period, 62 patients underwent 561 ureteroscopies as part of the treatment and follow-up regimen of UTUC. Urine from the affected upper tract was sampled for cytology in 377 procedures, and FISH analyses were performed in 273. In 75.4% of FISH analyses, the result was different from the cytology results: FISH found malignant aberrations in 15.5% of cases where cytology was benign. Furthermore, FISH classified all the cells that were defined as atypical via cytology as either benign or malignant. In only one case, the urinary cytology report changed the follow-up regimen accepted at our department.

Conclusion

Cytology and FISH may be omitted from the follow-up protocol of UTUC in most cases. In the specific cases where cytology is obtained, FISH analysis has added value, particularly when cytology reports cellular atypia.

Funding

None.

Co-Authors

Nir Kleinmann, MD
Sheba Medical Center

Dorit Zilberman, MD
Sheba Medical Center

Zohar Dotan, MD
Sheba Medical Center

Asaf Shvero, MD
Sheba Medical Center