Value of urine cytology versus bladder washing in bladder cancer.
Author(s): Matzkin H, Moinuddin SM, Soloway MS
Publication: Urology, 1992, Vol. 39, Page 201-3
PubMed ID: 1546409 PubMed Review Paper? No
Purpose of Paper
This paper compared the detection of bladder cancer by cytological evaluation of matched voided urine and bladder wash specimens and investigated whether tumor grade influences detection rate.
Conclusion of Paper
Of the 26 patients evaluated, 23 were found to have bladder cancer in the biopsy specimen. Of the 23 bladder cancer cases, malignant cells were observed in the bladder washings of 100% of cases. In contrast, when case-matched voided urine specimens from the 23 bladder cancer cases were examined, malignant cells were observed in 16 cases (70%), atypical (suspicious) cells in three (13%) and no tumor cells in 4 (17%). All four cases with a false negative in the voided urine were grade 1 (2 cases) or grade 2 (2 cases) transitional cell carcinoma (TCC), three of which were classified as Ta and one as T1. The three cases with only atypical cells in the voided urine specimen included a grade 2-3 T1 TCC with carcinoma in situ (CIS), a grade 2 Ta TCC, and a CIS. Analysis of the 43 voided urine specimens collected at cancer diagnosis showed that false negatives were highest in grade 1or 2 tumors. Of the 22 urine specimens obtained from patients with CIS and TCC or grade 3 TCC, 19 were positive and 2 were suspicious. In contrast, only 3 of 9 urine specimens from patients with grade 1 tumors were positive, with the remaining 6 negative; 5 of the 10 urine specimens from patients with grade 2 tumors were positive and 1 was suspicious. The authors’ literature review found that detection of bladder cancer cells was higher in bladder washings than voided urine in other studies and, similarly, the detection rate in voided urine increases with tumor grade. An analysis of the literature revealed that bladder cancer detection rate also increased with tumor grade when bladder washings were used for analysis.
Studies
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Study Purpose
This study compared the detection of bladder cancer by cytological evaluation of matched voided urine and bladder wash specimens and investigated whether tumor grade influences detection rate. Matched bladder washings, voided urine specimens (>20 mL) and biopsies (endoscopic or resection) were collected from 26 patients with suspected bladder cancer. Additionally, voided urine specimens were collected from 43 patients upon diagnosis with bladder cancer. Biopsies were fixed in Hollande’s solution and underwent “routine histologic evaluation” (no further details provided). Bladder washings were obtained by insertion of a 16-F urethral catheter and barbotage with 50-75 mL saline. Urine and washings were processed onto Milipore filters and cytology was evaluated using a modified Papanicolaou method by a single pathologist (no further details provided). The authors compare their results with those of two other studies.
Summary of Findings:
Of the 26 patients evaluated, 23 were found to have bladder cancer in the biopsy specimen. Of the 23 bladder cancer cases, malignant cells were observed in the bladder washings of 100% of cases. In contrast, when case-matched voided urine specimens from the 23 bladder cancer cases were examined, malignant cells were observed in 16 cases (70%), atypical (suspicious) cells in three (13%) and no tumor cells in 4 (17%). All four cases with a false negative in the voided urine were grade 1 (2 cases) or grade 2 (2 cases) transitional cell carcinoma (TCC), three of which were classified as Ta and one as T1. The three cases with only atypical cells in the voided urine specimen included a grade 2-3 T1 TCC with carcinoma in situ (CIS), a grade 2 Ta TCC, and a CIS. Analysis of the 43 voided urine specimens collected at cancer diagnosis showed that false negatives were highest in grade 1or 2 tumors. Of the 22 urine specimens obtained from patients with CIS and TCC or grade 3 TCC, 19 were positive and 2 were suspicious. In contrast, only 3 of 9 urine specimens from patients with grade 1 tumors were positive, with the remaining 6 negative; 5 of the 10 urine specimens from patients with grade 2 tumors were positive and 1 was suspicious. The authors’ literature review found that detection of bladder cancer cells was higher in bladder washings than voided urine in other studies and, similarly, the detection rate in voided urine increases with tumor grade. An analysis of the literature revealed that bladder cancer detection rate also increased with tumor grade when bladder washings were used for analysis.
Biospecimens
Preservative Types
- Other Preservative
Diagnoses:
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform Morphology Light microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Preaquisition Prognostic factor Grade 1
Grade 2
Grade 3
TCC+CIS
Biospecimen Acquisition Method of cell acquisition Voided urine
Bladder washing