title: Intermediate-risk urothelial carcinoma: an unresolved problem?
abstract: OBJECTIVE
  To perform a biologic characterization of the urothelial neoplasms of patients in the intermediate-risk group using multicolor-fluorescence in situ hybridization (FISH). A general consensus has not been reached with regard to the optimal therapy and follow-up of patients with urothelial neoplasms at intermediate risk of progression. On the basis of the chromosomal pattern, we developed a new follow-up algorithm for this group and report our preliminary results.
  
  
  METHODS
  Voided urine samples of 51 consecutive patients (mean age 72.2 years, range 52 to 93) under follow-up after complete transurethral resection of intermediate-risk urothelial carcinoma were evaluated by liquid-based cytology (ThinPrep) and uCyt+. From the residual material, Multicolor-FISH (Urovysion) was performed. Any cystoscopically suspicious lesion was biopsied or removed transurethrally. The mean follow-up time was 14.2 months (range 6 to 30, SD 5.5).
  
  
  RESULTS
  Two of the 51 patients were not evaluated because of the presence of intense granulocytosis and insufficient urothelial cells. Of the 49 remaining patients, the results of the Multicolor-FISH analysis were negative (diploid chromosomal pattern) in 14; 20 patients showed the loss of one or both alleles of p16 and/or an aneuploidy of chromosome 3, and 15 patients had aneuploidy of chromosome 7 and/or 17. Of the 14 FISH-negative patients, 2 (14.3%) had histologically verified recurrence, and 3 (15.0%) of the 20 p16/3-positive patients had recurrence and 9 (60.0%) of the 15 7/17-positive patients had either recurrence or progression.
  
  
  CONCLUSIONS
  Using the Urovysion test, it is possible to predict the biologic behavior of urothelial cancer with a significant impact on the follow-up of patients. The intermediate-risk group of urothelial cancer can be eliminated in the routine workup by classifying these patients according to their chromosomal pattern and defining those patients who can follow the low-risk scheme and those who must be monitored according to the guidelines for high-risk superficial lesions.
authors.affiliation: Department ofUrology, General Hospital of Bolzano, Bolzano, Italy.
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Michele
authors.initials: M
authors.lastname: Lodde
authors.forename: Evi
authors.initials: E
authors.lastname: Comploj
authors.forename: Giovanni
authors.initials: G
authors.lastname: Negri
authors.forename: Eduard
authors.initials: E
authors.lastname: Egarter-Vigl
authors.forename: Fabio
authors.initials: F
authors.lastname: Vittadello
authors.forename: Lukas
authors.initials: L
authors.lastname: Lusuardi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Palermo
authors.forename: Christine
authors.initials: C
authors.lastname: Mian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000782:Aneuploidy; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000235:genetics / Q000473:pathology* / Q000601:surgery / Q000652:urine; D002869:Chromosome Aberrations; D002877:Chromosomes, Human / Q000648:ultrastructure*; D003558:Cystoscopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D019656:Loss of Heterozygosity; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000473:pathology* / Q000601:surgery / Q000652:urine; D014556:Urine / Q000166:cytology