What are the recommended actions following a negative cystoscopy in the evaluation of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

In the setting of findings that are negative for cystoscopy and urinary cytology but positive for FISH, 2 possible scenarios arise. One is that the FISH result is falsely positive. The other is that it is an anticipatory positive result; in such cases, the patient has a 30% chance of developing a bladder tumor over 2 years. Patients in this category should undergo surveillance with increased frequency (see Table 1, below).

Table 1. Clinical Findings and Recommended Action in Patients with Negative Cystoscopy (Open Table in a new window)

Cystoscopy Findings

Urine Cytology Findings

FISH* Findings

Action

Negative

Negative

Negative†

Routine follow-up

Negative

Negative

Positive‡

Increased frequency of surveillance, whether FISH findings are false positive or anticipatory positive

Negative

Positive

Negative or positive

Cancer until proven otherwise

  • Upper tract imaging with contrast

  • Cystoscopy with random bladder and urethral biopsies, retrograde pyelography, selective ureteral washings, and/or ureteroscopy

  • Evaluate urethra

  • Increased frequency of surveillance upon negative findings

*FISH - Fluorescent in situ hybridization.

†Negative predictive value 95%.

‡Positive predictive value 30%.


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