PD18-02 INCREASED URINARY VASCULAR ENDOTHELIAL GROWTH FACTOR D (VEGF-D) LEVELS ARE ASSOCIATED WITH RESPONSE TO COMBINED INTRAVESICAL BACILLUS CALMETTE−GUERIN (BCG) AND ORAL SUNITINIB REGIMEN FOR TREATMENT OF HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC)

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34.0%), and 19/94 (19.2%) using SB, TB, SBþTB, respectively. Downgrading at RP was observed in 9/94 (9.6%), 12/94 (12.8%), and 19/94 (20.2%) using SB, TB, and SBþTB, respectively.GG concordance was observed in 41/94 (43.6%), 50/94 (53.2%), 57/94 (60.6%) using SB, TB, and SBþTB, respectively.Of the 19 patients downgraded from SBþTB to RP, 4/19 were from GG5 to GG3 (21%), 8/19 (42%) were from GG4 to GG3, and 9/19 (47%) were from GG3 to GG2.CONCLUSIONS: The use of SBþTB improves overall concordance with RP specimens and decreases the rate of upgrading compared to SB or TB alone.However, the unintended consequence of MR/US fusion biopsy is overgrading in up to 20% of patients, which is likely due to oversampling.Given that the method for assigning an overall GG after MR/US fusion biopsy was not fully addressed by the ISUP 2014 Consensus Conference, future studies should focus on identifying a more accurate method for assigning an overall GG in the setting of multiple GG's assigned to each core at MR/US fusion biopsy.

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