The evaluation of invasion in urothelial
carcinomas of the urinary bladder cannot be determined on cytology and can be particularly challenging in biopsy cases with limited sampling. Recent studies of bladder resection specimens suggest that
fascin overexpression may be a marker of aggressive urothelial
carcinomas and can help facilitate the assessment of invasion. In this study, we evaluated urine cytology and corresponding biopsy specimens with proven invasive urothelial
carcinoma for
fascin expression by immunohistochemistry. Thirty-five patients diagnosed with positive urine cytology and biopsy-proven invasive urothelial
carcinoma between January 2003 and February 2009 were identified. We found increased
fascin expression in 100% (35/35) of SurePath™ urine cytology preparations as well as 100% (35/35) of corresponding biopsy cases with invasive urothelial
carcinoma. On urine cytology, cytoplasmic
fascin staining was moderate to intense in malignant
tumor cell clusters and single cells and not observed in benign urothelial cells. Staining in biopsy cases was generally intense and cytoplasmic and present in both the invasive (100%) and noninvasive (31%) components of the lesion. These findings uphold the association of increased
fascin expression in invasive urothelial
carcinomas of the urinary bladder. We furthermore demonstrate that
fascin staining can be performed successfully on SurePath™ urine cytology preparations in which increased
fascin expression correlates with invasion on biopsy. While not a definitive marker of invasion, as it is observed in in situ
carcinoma, we conclude that the utilization of
fascin immunohistochemistry on urine cytology might serve as a useful adjunct in predicting invasiveness in subsequent biopsies.