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PURPOSE: Cancer pathology reports have traditionally been narrative with limited reliable information. In high-income countries, synoptic format reporting has gradually been introduced to improve patient care and cancer registry input. We posited that introduction of synoptic style reporting was possible in Nicaragua and could serve as a model for other low- and middle-income countries. MATERIALS AND METHODS: The Department of Pathology, Hospital Escuela Oscar Danilo Rosales Argüello (HEODRA), León, Nicaragua, decided to introduce and implement synoptic reporting for all cancer cases beginning in 2018. All 10,012 histopathologic case reports issued by the department from January 1, 2018, through June 30, 2020, were reviewed. After excluding benign lesions, recurrent or metastatic tumors, endometrial biopsies or curettage, and primary cytologic specimens, 724 cases met the criteria for synoptic style reporting. The narrative format, previously used for all cases, was intentionally abandoned. RESULTS: Of the 10,012 reports reviewed at HEODRA during the study period, synoptic-style reporting was used for all 724 cancer cases that met criteria for inclusion in the study. In addition, all elements were listed in the required order. Narrative format of reporting was not used for any of the reports. CONCLUSION: Our experience in Nicaragua has shown that establishing synoptic-style cancer pathology reporting is achievable in a low- or middle-income country. Just as in high-income countries, a dedicated collaborative step-by-step conversion to synoptic reporting can lead to improvement in cancer patient care and quality of data for population-based registries.

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OBJECTIVE: To compare the sensitivity and specificity of UroVysion fluorescence in situ hybridization assay (FISH) with cystoscopy and urine cytology in the surveillance of patients with documented non-muscle invasive bladder cancer (CIS, pTa and pT1). METHODS: This retrospective study was done on a consecutive series of patients undergoing surveillance for non-muscle invasive bladder cancer. The results of FISH were analyzed with concurrent cystoscopy and urine cytology. RESULTS: In all, 94 follow up visits from 59 patients were evaluated. The mean follow up was 52 months. FISH detected 30/48 recurrences of bladder cancer, as compared to 20/48 for cytology and 47/48 on cystoscopy. Hence, the sensitivity of FISH was 63% compared to 42% for cytology (p value 0.03) and 98% for cystoscopy (p value 0.0001). However, cytology was significantly more specific (89%) than FISH (65%) or cystoscopy (41%). FISH was significantly more sensitive in diagnosing Grade 3 tumors (p = 0.0005) than Grades 1 and 2 tumors, when compared with cytology. There was no significant difference in the sensitivity and specificity between FISH and cytology for Grade 1 and 2 tumors. Sensitivity of urine cytology was similar for Grade 3 versus Grades 1 and 2 tumors (p = 0.56). FISH was able to detect all three CIS recurrences whereas cytology was positive in two and atypical in one sample. CONCLUSIONS: FISH has a significantly higher sensitivity than cytology in diagnosing patients with Grade 3 bladder tumors. The low specificity of FISH seen in our study and based on the currently available evidence, the test does not satisfy the criteria for replacing cystoscopy or cytology for surveillance of patients with non-muscle invasive bladder cancer.

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OBJECTIVES: To compare the sensitivity and specificity of the UroVysion (Abbott Laboratories Inc., Downers Grove, IL, USA) fluorescent in-situ hybridization (FISH) assay to that of urinary cytology obtained from bladder irrigation during cystoscopic surveillance in patients with bladder carcinoma. PATIENTS AND METHODS: The medical records were retrospectively reviewed for 41 consecutive patients screened at the authors' institution between August 2000 and December 2006 for recurrence of pathologically confirmed bladder cancer. All 162 cytology examinations and 141 FISH assay results obtained from bladder washing were included. Recurrence was determined by cystoscopy, bladder biopsy and upper-tract imaging. Sensitivity, specificity, positive predictive and negative predictive values were assessed using a chi-square distribution with one degree of freedom. RESULTS: There were 24 men and 17 women (male to female ratio 0.59), the mean (range) age was 56 (33-73) years and the mean follow-up 30 (2-57) months. At the initial diagnosis, 35 of the 41 patients (85%) had superficial tumours (stage or=T2). Twenty-six (63%) had low-grade and 15 (37%) had high-grade tumours. In 16 of 141 (11%) of the FISH assays and 16 of 162 (10%) of the cytological samples that were collected from bladder irrigations, there were too few cells for an adequate analysis. The FISH assay correctly correlated with subsequent cystoscopy, bladder biopsy or upper-tract imaging in 110/125 (88%) cases but not in 15/125 (12%). Cytology correctly correlated with the subsequent evaluation in 112/146 (77%) cases but did not in 34/146 (23%). When the FISH was compared with cytology in this setting, the sensitivity was 77% (30/39) vs 74% (37/50; P > 0.1), the specificity was 93% (80/86) vs 78% (75/96; P < 0.01), the positive predictive value was 83% (30/36) vs 64% (37/58; P < 0.05), and the negative predictive value was 90% (80/89) vs 85% (75/88; P > 0.1), respectively. CONCLUSION: The UroVysion FISH assay obtained from bladder washings during cystoscopic surveillance of patients with a history of bladder cancer provides a similar specificity but greater sensitivity than that of cytology for detecting bladder cancer recurrences. Given the better specificity and similar sensitivity of UroVysion compared with urine cytology obtained from bladder washings, a reasonable approach might be to use the UroVysion assay as the primary marker for recurrence, with urine cytology used as a complementary examination.

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The diagnosis of "penile fracture" describes the traumatic rupture of the tunica albuginea of an erect penis. Penile fractures typically occur when the engorged penile corpora are forced to buckle and literally "pop" under the pressure of a blunt sexual trauma. Patients typically describe immediate detumescence, severe pain, and swelling as a result of the injury. Prompt surgical exploration and corporal repair is the most efficacious therapy. Although a majority of cases can be diagnosed from the history and physical examination alone, radiographic studies, including retrograde urethrography and corporal cavernosography can aid in the diagnosis of unusual cases.