The role of urinary cytology for detection of bladder cancer

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Abstract

Purpose

The aim of the present study was to test the value of urinary cytology in the diagnosis of bladder cancer.

Materials and methods

One thousand three hundred and eighty voided urine and bladder wash specimens of 495 patients were evaluated by urinary cytology. All patients then underwent transurethral resection of suspicious bladder areas if cystoscopy and/or preceding biopsy were positive. Statistical differences were analysed using the two-sided Fisher's exact test and Cochran's test (p<0.05).

Results

In 495 patients including 142 patients with bladder cancer urinary cytology revealed a sensitivity of 38.0% and a specificity of 98.3% with a positive and negative predictive value of 90.6 and 78.6, respectively. Sensitivity increased significantly with malignancy grade (p<0.05). In high grade tumours sensitivity improved from initial 52.2% up to 78.3% after the third sample. In sensitivity and specificity of voided urine and barbotage washing samples no significant difference was detected.

Conclusions

Urinary cytology has its place as an additive diagnostic tool to cystoscopy. None of the currently available urinary markers can replace cystoscopy but are helpful for specific diagnostic problems.

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.

Section snippets

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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