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Urinary cytology for the detection of urothelial carcinoma of the bladder--a flawed adjunct to cystoscopy?
- Source :
-
Urologic oncology [Urol Oncol] 2013 Apr; Vol. 31 (3), pp. 366-71. Date of Electronic Publication: 2011 Mar 16. - Publication Year :
- 2013
-
Abstract
- Objectives: To test the sensitivity of urinary cytology at a tertiary academic institution and to assess the impact of pathologist' experience on detection of urothelial carcinoma of the bladder (UCB).<br />Materials and Methods: Between April 1999 and September 2008, 8,574 cytology specimens were evaluated. There were 882 consecutive patients (612 males, 270 females) who underwent bladder biopsy or transurethral resection of bladder tumor for UCB. Sensitivity rates of prior urinary cytology were determined. We tested the influence of experience of pathologist on sensitivity.<br />Results: Urinary cytology detected 237 out of 503 UCB (overall sensitivity 47.1%). Cytology after bladder washing resulted in higher sensitivity than in voided urine (50.4% vs. 36.2%; P = 0.008). Sensitivity rates significantly increased by UCB stage; 30.6% in pTa (n = 245), 60.5% in patients with any form of CIS (n = 119), 62.9% in pT1 (n = 89), and 69.6% in ≥pT2 (n = 46; P < 0.001). Similarly, higher sensitivity was observed with increasing grade, ranging from 16.7% in low (n = 108) to 62.2% in high grade tumors (n = 283; P < 0.001). No statistically significant difference between more and less experienced investigators was observed.<br />Conclusions: Sensitivity rates of urinary cytology at our institution are not superior to those reported in the literature. Cytology missed many high grade cancers, pointing to inherent methodological limitations of urinary cytology. A higher experience level of the pathologist was not significantly associated with higher sensitivity rates. Urinary cytology represents a flawed adjunct to cystoscopy with limited potential of improvement even in the hands of experienced pathologists.<br /> (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Carcinoma, Transitional Cell urine
Cystoscopy
Female
Humans
Male
Middle Aged
Neoplasm Staging
Pathology, Clinical methods
Reproducibility of Results
Sensitivity and Specificity
Urinary Bladder Neoplasms urine
Young Adult
Carcinoma, Transitional Cell diagnosis
Cytodiagnosis methods
Urinary Bladder pathology
Urinary Bladder Neoplasms diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2496
- Volume :
- 31
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Urologic oncology
- Publication Type :
- Academic Journal
- Accession number :
- 21414815
- Full Text :
- https://doi.org/10.1016/j.urolonc.2011.01.017