The role of urinary cytology for detection of bladder cancer
Introduction
Cystoscopy and biopsy is the golden standard for detection of urothelial carcinoma of the urinary bladder but it is invasive and causes significant patient discomfort. Urinary cytology is a non-invasive method for detection of urothelial carcinoma of the urinary bladder. Urinary cytology has high sensitivity in high grade bladder tumours but is less sensitive in grade 1 tumours with a sensitivity of 0–50% and a still high specificity of 99%.1, 2, 3, 4
The ideal marker should be rapid, inexpensive and non-invasive with high sensitivity and specificity. In the present study we evaluated conventional urinary cytology in 626 patients to establish whether a higher number of samples affects the sensitivity of cytology. We compared voided urine and barbotage bladder washings in terms of sensitivity and specificity. Methods based on the immunocytological detection of antibodies Immunocyt, Lewis X and p486 3/12, NMP test, BTA test, telomerase test, FDP test, haemoglobin dip stick, flow and DNA image cytometry and fluorescence in situ hybridisation are discussed. In face of these new markers and tests and the results of our study we ask whether urinary cytology still mandatory.
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Patient population
Six hundred and twenty-six patients were evaluated by urinary cytology. Mean age was 62±14 years.4, 5, 6, 7, 8, 9 We excluded those with renal cell carcinoma, prostate cancer, metastatic disease, carcinomas others than of urothelial origin and patients after radical cystectomy. Four hundred and ninety-five patients fulfilled the inclusion criteria and 1380 urinary specimens with 346 voided urine and 149 bladder wash of first sample were evaluated. Additional bladder wash specimens were obtained
Results
There were 57 cases of pTa, 27 pT1, 21 pT2, 26 pT3 and 9 pT4 transitional cell carcinoma, two cases of carcinoma in situ and 10 cases of concomitant carcinoma in situ of the bladder. Urothelial carcinoma of the bladder was grade 1 in 42 cases, grade 2 in 55 and grade 3 in 45. Histology revealed a urothelial carcinoma of the urinary bladder in 142 patients. Three hundred and fifty-three patients had no history of bladder cancer and bladder cancer was excluded by cystoscopy and randomised
Sensitivity and specificity of urinary cytology
Early detection of new tumours and effective surveillance for recurrences could reduce morbidity of urothelial cancer. Acceptance of screening and early detection methods in cancer is related to invasiveness and specificity. Currently, cystoscopy and/or biopsy is the golden standard method in detecting a carcinoma of the urinary bladder. Clinical research in bladder cancer has always been searching for alternative, less invasive methods to detect a carcinoma or at least to indicate further
Conclusion
The results of this study, recent literature and a widespread practical use show, that urinary cytology has its place for screening and as an additive diagnostic tool being a cheap procedure with known limitations. Urinary cytology will be improved by use of the whole voided specimen for centrifugation and increasing number of samples. Urinary cytology is valuable in detecting flat lesions such as carcinoma in situ and high-grade tumours. Therefore, it may add additional information to
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