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Kundlia A, Dharwadkar A, Gore C, Viswanathan V, Ingale Y. Exploring the Histopathological Landscape of Urinary Bladder Diseases: A Tertiary Care Center Study. Cureus 2024; 16:e64557. [PMID: 39144899 PMCID: PMC11323198 DOI: 10.7759/cureus.64557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Urinary bladder lesions encompass a wide spectrum, from benign inflammatory conditions to malignant neoplasms, presenting diagnostic and therapeutic challenges. Urothelial carcinoma predominates among bladder malignancies, exhibiting diverse clinical presentations and prognoses. Objective This study aimed to delineate the histopathological spectrum of urinary bladder lesions and correlate demographic profiles, clinical features, and cystoscopic findings with various bladder lesions. Methods This prospective descriptive observational study spanned 24 months at a tertiary care center, involving 65 cases of urinary bladder biopsies, including transurethral resection of bladder tumors, cystoscopic biopsies, and cystectomy specimens. The histopathological examination followed the WHO 2022 classification of urinary bladder tumors and the American Joint Committee on Cancer eighth edition staging. Clinical data, including age, gender, cystoscopic findings, and presenting symptoms, were correlated with histopathological diagnoses to explore the spectrum of bladder lesions. Results Neoplastic lesions predominated, constituting 92.3% of cases, with urothelial carcinoma comprising 83.33% of these cases. Among neoplastic lesions, invasive high-grade urothelial carcinoma (36.7%) and non-invasive low-grade papillary urothelial neoplasm (20.0%) were the most frequently observed subtypes. Non-neoplastic lesions accounted for 7.7%, including various forms of cystitis. Hematuria was the predominant presenting symptom (81.5%), while cystoscopic examinations revealed that most lesions were situated in the lateral bladder wall. High-grade urothelial carcinomas were mostly associated with muscularis propria invasion. Conclusion This study underscores the critical role of histopathological examination in diagnosing and managing urinary bladder diseases and distinguishing between non-neoplastic and neoplastic lesions. Urothelial carcinoma, prevalent among older age groups, often demonstrated muscle invasion indicative of high-grade tumors. Including the muscle layer in cystoscopic biopsies is crucial for an accurate diagnosis. Conversely, though less common, non-neoplastic conditions encompass various forms of cystitis. These findings highlight the importance of precise diagnostic tools such as cystoscopy and histopathological examination for the early detection and management of bladder neoplasms. Histopathological assessment offers essential prognostic guidance, aids in precise staging and grading, and directs tailored treatment strategies.
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Affiliation(s)
- Aakriti Kundlia
- Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Arpana Dharwadkar
- Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Charusheela Gore
- Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Vidya Viswanathan
- Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Pune, IND
| | - Yaminy Ingale
- Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Pune, IND
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Mahmoud Daoud R, Ali AH, Salim Fredericks S, Daoud S, Gomaa HR, AlHashimi FS. Utility of the Paris System in Urine Cytology for Improved Screening of High-Grade Urothelial Carcinoma in Bahrain. Cureus 2024; 16:e57189. [PMID: 38681345 PMCID: PMC11056096 DOI: 10.7759/cureus.57189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Urothelial carcinoma, a prevalent and aggressive urological malignancy, necessitates early detection for improved prognosis. Urine cytology serves as a cost-effective screening tool, but inconsistencies in reporting due to the lack of standardized criteria limit its efficacy. The Paris System for reporting urinary cytology (TPS) was introduced to address this issue, aiming to improve diagnostic accuracy. This retrospective study investigates the effectiveness of urine cytology in detecting high-grade urothelial carcinoma (HGUC) using TPS classification, specifically focusing on atypical urothelial cells (AUC) categorized as TPS-III and suspicious for high-grade urothelial carcinoma (SHGUC) categorized as TPS-IV. METHODS We reviewed 470 urine cytology samples collected over two years at a tertiary healthcare center in Bahrain. All samples were re-evaluated using TPS classification by two independent consultant cytopathologists blinded to the original cytology report. The analysis included only samples categorized as TPS-III or TPS-IV with corresponding histopathology reports from confirmatory biopsies performed within four months of urine collection. Biopsy results were categorized as either benign/low-grade urothelial carcinoma (non-HGUC) or malignant (HGUC). The positive predictive value (PPV) of urine cytology for HGUC detection was calculated for both TPS-III and TPS-IV categories. Statistical significance was assessed using Fisher's exact test. RESULTS Among the 470 urine cytology samples, 40 (8.5%) were classified as TPS-III or TPS-IV. Within this subset, 16 patients underwent confirmatory biopsies. Histopathological analysis revealed HGUC in 12 (75%) patients and non-HGUC (benign or low-grade) in 4 (25%) patients. The PPV of TPS-III for HGUC was 50%, while TPS-IV demonstrated a higher PPV of 90%. However, the difference between these values was not statistically significant (p = 0.25). This study explored the utility of TPS classification in urine cytology for HGUC detection. While SHGUC (TPS-IV) exhibited a numerically higher PPV compared to AUC (TPS-III), the lack of statistical significance necessitates further investigation. Our findings highlight the potential of TPS to improve the accuracy of urine cytology. TPS implementation has been shown to reduce the number of inconclusive "atypical" diagnoses, leading to more targeted investigations. CONCLUSION Our study suggests that SHGUC (TPS-IV) within TPS classification framework might hold promise as a more specific indicator for HGUC compared to AUC (TPS-III). However, further research with larger cohorts is necessary to definitively establish the clinical significance of this observation. This investigation paves the way for future studies exploring the potential of TPS, particularly the SHGUC category, as a reliable screening tool for HGUC, potentially leading to earlier diagnoses and improved patient outcomes.
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Affiliation(s)
| | - Ali H Ali
- Emergency Medicine, Salmaniya Medical Complex, Manama, BHR
| | | | - Salma Daoud
- General Practice, Albaraka Fertility Hospital, Manama, BHR
| | - Hamza R Gomaa
- Orthopedics and Neurosurgery, Bahrain Defense Force Royal Medical Services, Riffa, BHR
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Levy JJ, Chan N, Marotti JD, Rodrigues NJ, Ismail AAO, Kerr DA, Gutmann EJ, Glass RE, Dodge CP, Suriawinata AA, Christensen B, Liu X, Vaickus LJ. Examining longitudinal markers of bladder cancer recurrence through a semiautonomous machine learning system for quantifying specimen atypia from urine cytology. Cancer Cytopathol 2023; 131:561-573. [PMID: 37358142 PMCID: PMC10527805 DOI: 10.1002/cncy.22725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Urine cytology is generally considered the primary approach for screening for recurrence of bladder cancer. However, it is currently unclear how best to use cytological examinations for assessment and early detection of recurrence, beyond identifying a positive finding that requires more invasive methods to confirm recurrence and decide on therapeutic options. Because screening programs are frequent, and can be burdensome, finding quantitative means to reduce this burden for patients, cytopathologists, and urologists is an important endeavor and can improve both the efficiency and reliability of findings. Additionally, identifying ways to risk-stratify patients is crucial for improving quality of life while reducing the risk of future recurrence or progression of the cancer. METHODS In this study, a computational machine learning tool, AutoParis-X, was leveraged to extract imaging features from urine cytology examinations longitudinally to study the predictive potential of urine cytology for assessing recurrence risk. This study examined how the significance of imaging predictors changes over time before and after surgery to determine which predictors and time periods are most relevant for assessing recurrence risk. RESULTS Results indicate that imaging predictors extracted using AutoParis-X can predict recurrence as well or better than traditional cytological/histological assessments alone and that the predictiveness of these features is variable across time, with key differences in overall specimen atypia identified immediately before tumor recurrence. CONCLUSIONS Further research will clarify how computational methods can be effectively used in high-volume screening programs to improve recurrence detection and complement traditional modes of assessment.
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Affiliation(s)
- Joshua J. Levy
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Natt Chan
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Jonathan D. Marotti
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Nathalie J. Rodrigues
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
| | - A. Aziz O. Ismail
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- White River Junction VA Medical Center, White River Junction, VT, 05009
| | - Darcy A. Kerr
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Edward J. Gutmann
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | | | | | - Arief A. Suriawinata
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Brock Christensen
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Community and Family Medicine, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Xiaoying Liu
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Louis J. Vaickus
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
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Malinaric R, Mantica G, Lo Monaco L, Mariano F, Leonardi R, Simonato A, Van der Merwe A, Terrone C. The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers-What Should a Urologist Really Know? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159648. [PMID: 35955004 PMCID: PMC9368399 DOI: 10.3390/ijerph19159648] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 05/20/2023]
Abstract
The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research.
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Affiliation(s)
- Rafaela Malinaric
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Guglielmo Mantica
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
| | - Lorenzo Lo Monaco
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Federico Mariano
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Rosario Leonardi
- Department of Urology, Casa di Cura Musumeci GECAS, 95030 Gravina di Catania, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy
| | - André Van der Merwe
- Department of Urology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town 7600, South Africa
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
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Wolfs JRE, Hermans TJN, Koldewijn EL, van de Kerkhof D. Novel urinary biomarkers ADXBLADDER and bladder EpiCheck for diagnostics of bladder cancer: A review. Urol Oncol 2021; 39:161-170. [DOI: 10.1016/j.urolonc.2020.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
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Dudderidge T, Stockley J, Nabi G, Mom J, Umez-Eronini N, Hrouda D, Cresswell J, McCracken SRC. A Novel, non-invasive Test Enabling Bladder Cancer Detection in Urine Sediment of Patients Presenting with Haematuria—A Prospective Multicentre Performance Evaluation of ADXBLADDER. Eur Urol Oncol 2020; 3:42-46. [DOI: 10.1016/j.euo.2019.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/06/2019] [Accepted: 06/07/2019] [Indexed: 11/15/2022]
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Tetteh-Quarcoo PB, Akuetteh BK, Owusu IA, Quayson SE, Attah SK, Armah R, Afutu E, Afrah A, Addo-Osafo K, Smith C, Gyasi RK, Ayeh-Kumi PF. Cytological and Wet Mount Microscopic Observations Made in Urine of Schistosoma haematobium-Infected Children: Hint of the Implication in Bladder Cancer. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2019; 2019:7912186. [PMID: 31565106 PMCID: PMC6745107 DOI: 10.1155/2019/7912186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/23/2019] [Accepted: 08/17/2019] [Indexed: 12/03/2022]
Abstract
BACKGROUND Schistosomiasis is the second major human parasitic disease next to malaria, in terms of socioeconomic and public health consequences, especially in sub-Saharan Africa. Schistosoma haematobium (S. haematobium) is a trematode and one of the species of Schistosoma that cause urogenital schistosomiasis (urinary schistosomiasis). Although the knowledge of this disease has improved over the years, there are still endemic areas, with most of the reported cases in Africa, including Ghana. Not much has been done in Ghana to investigate cytological abnormalities in individuals within endemic communities, although there are epidemiologic evidences linking S. haematobium infection with carcinoma of the bladder. AIM The aim of this study was to identify microscopic and cytological abnormalities in the urine deposits of S. haematobium-infected children. METHODOLOGY Three hundred and sixty-seven (367) urine samples were collected from school children in Zenu and Weija communities. All the samples were examined microscopically for the presence of S. haematobium eggs, after which the infected samples and controls were processed for cytological investigation. RESULTS S. haematobium ova were present in 66 (18.0%) out of the 367 urine samples. Inflammatory cells (82%, 54/66), hyperkeratosis (47%, 31/66), and squamous cell metaplasia (24%, 16/66) were the main observations made during the cytological examination of the S. haematobium-infected urine samples. CONCLUSION Cytological abnormalities in S. haematobium-infected children may play an important role in the severity of the disease, leading to the possible development of bladder cancer in later years, if early attention is not given. Therefore, routine cytological screening for urogenital schistosomiasis patients (especially children) at hospitals in S. haematobium-endemic locations is recommended.
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Affiliation(s)
- Patience B. Tetteh-Quarcoo
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Benjamin K. Akuetteh
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Irene A. Owusu
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Solomon E. Quayson
- Department of Pathology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Simon K. Attah
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Robert Armah
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Emmanuel Afutu
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Ama Afrah
- Department of Pathology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Kantanka Addo-Osafo
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Cecilia Smith
- Department of Pathology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Richard K. Gyasi
- Department of Pathology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Patrick F. Ayeh-Kumi
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
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8
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Konety B, Shore N, Kader AK, Porten S, Daneshmand S, Lough T, Lotan Y. Evaluation of Cxbladder and Adjudication of Atypical Cytology and Equivocal Cystoscopy. Eur Urol 2019; 76:238-243. [DOI: 10.1016/j.eururo.2019.04.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 04/24/2019] [Indexed: 01/03/2023]
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Urquidi V, Netherton M, Gomes-Giacoia E, Serie D, Eckel-Passow J, Rosser CJ, Goodison S. Urinary mRNA biomarker panel for the detection of urothelial carcinoma. Oncotarget 2018; 7:38731-38740. [PMID: 27231851 PMCID: PMC5122424 DOI: 10.18632/oncotarget.9587] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/28/2016] [Indexed: 11/29/2022] Open
Abstract
The early detection of bladder cancer is important as the disease has a high rate of recurrence and progression. The development of accurate, non-invasive urinary assays would greatly facilitate detection. In previous studies, we have reported the discovery and initial validation of mRNA biomarkers that may be applicable in this context. In this study, we evaluated the diagnostic performance of proposed molecular signatures in an independent cohort. Forty-four mRNA transcripts were monitored blindly in urine samples obtained from a cohort of 196 subjects with known bladder disease status (89 with active BCa) using quantitative real-time PCR (RT-PCR). Statistical analyses defined associations of individual biomarkers with clinical data and the performance of predictive multivariate models was assessed using ROC curves. The majority of the candidate mRNA targets were confirmed as being associated with the presence of BCa over other clinical variables. Multivariate models identified an optimal 18-gene diagnostic signature that predicted the presence of BCa with a sensitivity of 85% and a specificity of 88% (AUC 0.935). Analysis of mRNA signatures in naturally micturated urine samples can provide valuable information for the evaluation of patients under investigation for BCa. Additional refinement and validation of promising multi-target signatures will support the development of accurate assays for the non-invasive detection and monitoring of BCa.
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Affiliation(s)
- Virginia Urquidi
- Cancer Research Institute, MD Anderson Cancer Center, Orlando, FL, USA
| | - Mandy Netherton
- Cancer Research Institute, MD Anderson Cancer Center, Orlando, FL, USA
| | | | - Daniel Serie
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Steve Goodison
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA.,Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Gok S, Aydin OZ, Sural YS, Zorlu F, Bayol U, Severcan F. Bladder cancer diagnosis from bladder wash by Fourier transform infrared spectroscopy as a novel test for tumor recurrence. JOURNAL OF BIOPHOTONICS 2016; 9:967-75. [PMID: 27041149 DOI: 10.1002/jbio.201500322] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/10/2016] [Accepted: 03/14/2016] [Indexed: 05/13/2023]
Abstract
This study proposes Fourier Transform Infrared (FTIR) spectroscopy as a more sensitive, rapid, non-destructive and operator-independent analytical diagnostic method for bladder cancer recurrence from bladder wash than other routinely used urine cytology and cystoscopy methods. A total of 136 patients were recruited. FTIR spectroscopic experiments were carried out as a blind study, the classification results of which were then compared with those of cytology and cystoscopy. Firstly, 71 samples (n = 37; bladder cancer and n = 34; control) were studied with transmittance FTIR spectroscopy. After achieving successful differentiation of the groups, to develop a more rapid diagnostic tool and check the reproducibility of the results, the work was continued with different samples (n = 65 as n = 44; bladder cancer and n = 21; control), using the reflection mode (ATR) of FTIR spectroscopy by a different operator. The results revealed significant alterations in moleculer content in the cancer group. Based on the spectral differences, using transmittance FTIR spectroscopy coupled with chemometrics, the diseased group was successfully differentiated from the control. When only carcinoma group was taken into consideration a sensitivity value of 100% was achieved. Similar results were also obtained by ATR-FTIR spectroscopy. This study shows the power of infrared spectroscopy in the diagnosis of bladder cancer.
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Affiliation(s)
- Seher Gok
- Department of Biological Sciences, Middle East Technical University, 06800, Ankara, Turkey
| | - Ozge Z Aydin
- Department of Biological Sciences, Middle East Technical University, 06800, Ankara, Turkey
| | - Yavuz S Sural
- Department of Urology, Tepecik Research and Training Hospital, 35110, İzmir, Turkey
| | - Ferruh Zorlu
- Department of Urology, Tepecik Research and Training Hospital, 35110, İzmir, Turkey
| | - Umit Bayol
- Department of Urology, Tepecik Research and Training Hospital, 35110, İzmir, Turkey
| | - Feride Severcan
- Department of Biological Sciences, Middle East Technical University, 06800, Ankara, Turkey.
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11
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Malta F, Lenos M, Leotsakos I, Katafigiotis I, Gakiopoulou H, Constantinides C, Mikou P. Audit of cytology of upper urinary tract. Cytopathology 2016; 27:369-73. [PMID: 26916255 DOI: 10.1111/cyt.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cytology is an essential tool for the investigation of urinary tract malignancy. In this audit, we aimed to assess our laboratory performance in the diagnosis of upper urinary tract malignancy and to use the information provided to improve our service. METHODS We retrieved cytology reports of upper urinary tract specimens from two periods, re-evaluated the cases, compared the reports with histology data and estimated the sensitivity, specificity and positive predictive value (PPV). In the time interval between the two periods, we adopted new terminology, established better communication with clinicians and gained experience in the field. Finally, the data from the two periods were compared. RESULTS In phase A, we estimated a sensitivity of 73%, specificity of 86% and PPV of 84.6%. As a result of the cytological re-evaluation, correlation with histology and clinical follow-up, plus communication with the clinicians during the audit, we established new terminology and a new request form. A three tiered grading system of atypia (mild, moderate and severe) was replaced by a two tiered grading system. The first category "atypia probably benign" corresponded to "mild atypia" while the second category "atypia, not otherwise specified" corresponded to "moderate atypia". The cases diagnosed as "severe atypia" were reclassified as "suspicious for malignancy". In phase B, the sensitivity, specificity and PPV were 75%, 89% and 90%, respectively. CONCLUSIONS Our laboratory performance is in concordance with reported data and has been improved through this study. The audit process is extremely valuable for the identification of problems, for taking action and, finally, for the improvement of the clinical cytology service in the field of upper urinary tract malignancy.
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Affiliation(s)
- F Malta
- Cytopathology Department, Laiko Hospital, Athens, Greece
| | - M Lenos
- Cytopathology Department, Laiko Hospital, Athens, Greece
| | - I Leotsakos
- 1st University Urology Clinic, Athens Medical School, Laiko Hospital, Athens, Greece
| | - I Katafigiotis
- 1st University Urology Clinic, Athens Medical School, Laiko Hospital, Athens, Greece
| | - H Gakiopoulou
- 1st Histopathology Department, Athens Medical School, Laiko Hospital, Athens, Greece
| | - C Constantinides
- 1st University Urology Clinic, Athens Medical School, Laiko Hospital, Athens, Greece
| | - P Mikou
- Cytopathology Department, Laiko Hospital, Athens, Greece.
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Ok BG, Ji YS, Ko YH, Song PH. Usefulness of urine cytology as a routine work-up in the detection of recurrence in patients with prior non-muscle-invasive bladder cancer: practicality and cost-effectiveness. Korean J Urol 2014; 55:650-5. [PMID: 25324947 PMCID: PMC4198763 DOI: 10.4111/kju.2014.55.10.650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/29/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. Materials and Methods We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected. Results Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). Conclusions Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.
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Affiliation(s)
- Bong Gi Ok
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Yoon Seob Ji
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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Horie S, Ito S, Okada H, Kikuchi H, Narita I, Nishiyama T, Hasegawa T, Mikami H, Yamagata K, Yuno T, Muto S. Japanese guidelines of the management of hematuria 2013. Clin Exp Nephrol 2014; 18:679-89. [DOI: 10.1007/s10157-014-1001-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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Ton Nu TN, Kassouf W, Ahmadi-Kaliji B, Charbonneau M, Auger M, Brimo F. The value of the “suspicious for urothelial carcinoma” cytology category: A correlative study of 4 years including 337 patients. Cancer Cytopathol 2014; 122:796-803. [DOI: 10.1002/cncy.21449] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Tuyet Nhung Ton Nu
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Wassim Kassouf
- Department of Urology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Babak Ahmadi-Kaliji
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Michele Charbonneau
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Manon Auger
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Fadi Brimo
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
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Bolenz C, West AM, Ortiz N, Kabbani W, Lotan Y. Urinary cytology for the detection of urothelial carcinoma of the bladder—a flawed adjunct to cystoscopy? Urol Oncol 2013; 31:366-71. [DOI: 10.1016/j.urolonc.2011.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 11/26/2022]
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Terrell JD, Elias KJ, Sagalowsky AI, Lotan Y. Patients with a negative cystoscopy and negative Nmp22® Bladderchek® test are at low risk of missed transitional cell carcinoma of the bladder: a prospective evaluation. Int Braz J Urol 2012; 37:706-11. [PMID: 22234001 DOI: 10.1590/s1677-55382011000600004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Urine based tumor markers have uncertain utility in diagnosis or surveillance of patients with bladder cancer while cytology is commonly used. We evaluated whether cytology provides additional diagnostic information in patients with a negative NMP22® BladderChek® test (BladderChek) and negative cystoscopy. MATERIALS AND METHODS We performed subset analyses of 2 large prospective multi-center databases evaluating BladderChek for UCB detection and surveillance. These cohorts were analyzed for presence of cancer and result of urine cytology in setting of a negative cystoscopy and negative BladderChek. Subsequently, we prospectively performed cystoscopy, cytology and BladderChek on 434 patients at our institution being evaluated for UCB. RESULTS In the detection database (n = 1331), 1065 patients had a negative cystoscopy and BladderChek. There were 3 cancers (stages Ta, Tis and T1) and cytology was atypical in one and reactive in two. In the surveillance cohort (n = 668) patients, 437 patients had negative cystoscopy and BladderChek. Cancer was found in 2 patients (stages Tis and Ta). The patient with Tis has dysplastic cytology and Ta tumor had reactive cytology. In our cohort of 434 patients, 288 pts had negative cystoscopy and BladderChek. One cancer was missed, a Ta ureteral urothelial carcinoma with a reactive cytology. CONCLUSIONS In patients with negative cystoscopy and BladderChek, very few cancers are missed and cytology was not effective in detection. Use of a point-of-care test in conjunction with cystoscopy in lieu of cytology could decrease cost, provide immediate results, improve negative predictive value and reduce the uncertainty that results from inconclusive cytologic results.
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Affiliation(s)
- John D Terrell
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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Alameddine M, Nassir A. The influence of urine cytology on our practice. Urol Ann 2012; 4:80-3. [PMID: 22629001 PMCID: PMC3355705 DOI: 10.4103/0974-7796.95550] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/28/2011] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Bladder cancer is a common malignancy. It is ranked ninth among male population in Saudi Arabia. Urine cytology is used by some physicians routinely in the workup for diagnosis and follow-up of patients with urothelial cancer. Our objective is to determine whether urine cytology is still essential in the work up of suspected urothelial cancer patients and to measure its cost-effectiveness. MATERIALS AND METHODS We reviewed all urine cytology reports that were performed over a period of five years from 2006 to 2010 in the International Medical Center in Jeddah, Saudi Arabia. The medical records of patients with cytology reports of both positive for malignant cells and atypical cells suspicious of malignancy were retrospectively, studied for age, sex, nationality, cystoscopic findings, imaging results, and total cost. RESULTS A total of 563 urine cytology tests were done on 516 patients. Two patients were positive for malignant cell and 10 showed atypical cells suspicious of malignancy. All 12 patients underwent imaging and/or cystoscopy as part of their complete work up for hematuria. The two patients with positive cytology had a cystoscopic confirmation of bladder tumor. In the 10 patients with atypical cells, bladder tumor was identified in seven using cystoscopy and/or imaging. The mean age was 54.6±16 year (range 15-95). The total cost was 140,750 SR (37,533 USD) for a yield of 0.3% positive results and 2% atypical cytology. CONCLUSION Routine urine cytology did not affect the diagnostic strategy for urothelial cancer. It should be only used in selected patients.
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Ahn JS, Kim HS, Chang SG, Jeon SH. The clinical usefulness of nuclear matrix protein-22 in patients with atypical urine cytology. Korean J Urol 2011; 52:603-6. [PMID: 22025954 PMCID: PMC3198232 DOI: 10.4111/kju.2011.52.9.603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 07/22/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose Difficulty exists in interpreting the significance of atypical urine cytology. This study was performed to assess the diagnostic utility of nuclear matrix protein-22 (NMP-22) testing when atypical cells are detected during urine cytology. Materials and Methods Among patients whose urine cytology was reported as atypical between January 2004 and December 2009, a total of 275 who also underwent NMP-22 testing were enrolled in the present study. These patients were further divided into the screening group (143 patients examined as outpatients for hematuria) and the follow-up group (132 patients followed up for previously diagnosed bladder cancer). The sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for atypical cytology alone and in conjunction with NMP-22. Results Of the 275 patients exhibiting atypical urine cytology, cancer was confirmed in 85, yielding a positive predictive value of 30.9% (85/275). Of the 96 patients testing positive for NMP-22, 58 were diagnosed with bladder cancer. The positive predictive value in conjunction with NMP-22 was 60.4% (58/96). The sensitivity, specificity, negative predictive value, and accuracy were 68.2% (58/85), 80.0% (152/190), 84.9% (152/179), and 76.2% (210/275), respectively. Testing for NMP-22 in the screening and follow-up groups increased the positive predictive value from 30.0% (43/143) to 64.0% (32/50) and from 31.3% (42/132) to 56.5% (26/46), respectively; there was no significant difference between the screening and follow-up groups (p=0.106). Conclusions When only cases with atypical urine cytology were examined, NMP-22 testing increased the detection rate of bladder cancer regardless of whether the test was used in screening hematuria or in following up patients.
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Affiliation(s)
- Jae Sung Ahn
- Department of Urology, Kyung Hee University, Graduate School of Medicine, Seoul, Korea
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Huysentruyt CJR, Baldewijns MM, Rüland AM, Tonk RJW, Vervoort PSAM, Smits KM, van de Beek C, Speel EJM. Modified UroVysion scoring criteria increase the urothelial carcinoma detection rate in cases of equivocal urinary cytology. Histopathology 2011; 58:1048-53. [PMID: 21707706 DOI: 10.1111/j.1365-2559.2011.03859.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS UroVysion(®) is a four-target fluorescence in situ hybridization technique for the detection of urothelial carcinoma (UC) in urinary cytology. The aim of this retrospective study was to investigate the UC detection rate of a modified UroVysion test in patients with equivocal urinary cytology. The modification comprised the addition of a cytological prescreening technique and different evaluation criteria. METHODS AND RESULTS Thin-layer slides were prepared from the residual urine samples of 82 patients with equivocal urinary cytology, prestained and prescreened to confirm the presence of atypical urothelial cells. The same slides were used for the UroVysion test, and scored according to different evaluation criteria. The results were compared with the outcomes of cystoscopic and histological findings. UroVysion detected 68% of the UCs when the manufacturer's evaluation criteria were applied. In cases of altered evaluation criteria, the sensitivity increased to 81% when at least one copy number change of a probe target was considered to be a positive test result. The specificity only decreased from 84% to 82%. CONCLUSIONS Our data suggest that the sensitivity of the UroVysion test can be increased by the addition of a cytological pre-screening technique prior to the UroVysion test and a modification of the UroVysion evaluation criteria.
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Jovanovic M, Soldatovic I, Janjic A, Vuksanovic A, Dzamic Z, Acimovic M, Hadzi-Djokic J. Diagnostic value of the nuclear matrix protein 22 test and urine cytology in upper tract urothelial tumors. Urol Int 2011; 87:134-7. [PMID: 21865670 DOI: 10.1159/000330246] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/30/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the diagnostic value of the nuclear matrix protein 22 (NMP22) test in comparison to urine cytology for the detection of upper tract urothelial carcinoma. PATIENTS AND METHODS Patients with transitional cell carcinoma of the upper urinary tract (n = 34) and patients with renal calculosis (n = 25) were included in this study. Voided urine samples and separated catheter urine specimens were assayed for NMP22 and cytological examination. RESULTS The sensitivity of the NMP22 test in separated and voided urine was 73.2 and 70.5%, respectively, compared to 64.7 and 58.8% of urine cytology. The specificity of the NMP22 test in separated and voided urine was 88 and 92%, respectively, compared to 96 and 96% of urine cytology. The combination of separated and voided urine is the best method because the sensitivity is 79.41% and specificity 88%. There is a high agreement of the NMP22 test in voided and separated urine (kappa = 0.795, p < 0.01), indicating that the voided urine is adequate for diagnosis. CONCLUSIONS The NMP22 test has higher sensitivity but lower specificity than cytology. The combination of these two tests could be a very useful diagnostic method for detection of upper urothelial tumors.
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Affiliation(s)
- M Jovanovic
- Urology Clinic, Clinical Center of Serbia, Belgrade, Serbia
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Fradet Y. Screening for bladder cancer: the best opportunity to reduce mortality. Can Urol Assoc J 2011; 3:S180-3. [PMID: 20019981 DOI: 10.5489/cuaj.1192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bladder cancer kills more women than cervical cancer and is also a significant cause of mortality in men. Little progress has been made in improving survival in patients with advanced bladder cancer. Two pilot studies using microhematuria screening have shown that screening for bladder cancer results in close to 80% downstaging, with high-grade cancers being detected before they have invaded the bladder wall. Results of long-term follow-up even suggest a striking reduction in bladder cancer mortality. The main obstacles to screening for bladder cancer may be overcome if a higher-risk population is identified by designing a risk scale for exposure to cigarette smoke and occupational carcinogens, and through genetic testing for susceptibility to cancer and home hematuria screening, which in itself identifies a population with approximately 3% to 4% risk of bladder cancer. The feasibility and cost effectiveness of screening for bladder cancer can be significantly improved by incorporating a secondary screening strategy using a more sensitive and specific bladder cancer marker that is currently available, and by limiting urological evaluations to patients who show positive results on one or more of these tests. Bladder cancer is the most costly cancer to treat in the United States and pharmacoeconomic studies suggest that screening for bladder cancer could not only save lives but also reduce costs per year-life saved. A pilot study is underway and the urology community should be very supportive of studies to validate this opportunity.
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Aharony S, Baniel J, Yossepowitch O. Clinically unconfirmed positive urinary cytology: diagnostic implications and oncological outcomes. BJU Int 2011; 108:E179-83. [DOI: 10.1111/j.1464-410x.2011.10210.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Arora VK, Sarungbam J, Bhatia A, Singh N, Agrawal V, Aggarwal S. Usefulness of NMP22 as an adjunct to a typical urine cytology and low-grade urothelial carcinoma. Diagn Cytopathol 2011; 38:788-90. [PMID: 20014314 DOI: 10.1002/dc.21286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The usefulness of urine cytology combined with NMP22 was evaluated for the primary diagnosis of urothelial carcinoma. Of 53 clinically suspected patients, histopathological diagnoses were low-grade urothelial carcinoma (25), high-grade urothelial carcinoma (13), and inflammatory lesions (15). Cytology was positive in 25 and negative in 14 patients. Fourteen of 25 low-grade urothelial carcinoma and 11/13 high-grade urothelial carcinoma were diagnosed correctly on urine cytology. Atypical cells seen in 14 patients were categorized as inconclusive for malignancy. The overall sensitivity of urine cytology was 65.8%, whereas specificity was 100%. NMP22 was positive in 33 patients. Of these 30, 18 low-grade and 12 high-grade lesions were true positive. Of the 20 NMP22, eight negative cases were false-negative. Ten of 15 with negative histopathology were also negative for NMP22, three were false-positive, and two showed erratic results. Nine of 14 cases with atypical urine cytology were positive for NMP22. Eight of these showed low-grade carcinoma on histopathology. The sensitivity of BladderChek NMP22 test was 79%, whereas specificity was 80%. NMP22 BladderChek test is a useful adjunct to urine cytology in atypical and low-grade carcinoma.
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Affiliation(s)
- Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Shahdra, Delhi 110095, India.
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Piaton É, Advenier AS, Benaïm G, Petrucci MD, Lechevallier FM, Ruffion A. Cellules urothéliales atypiques (AUC) : une formulation inspirée du système de Bethesda applicable à la cytologie urinaire. Ann Pathol 2011; 31:11-7. [DOI: 10.1016/j.annpat.2010.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/26/2010] [Accepted: 09/26/2010] [Indexed: 10/18/2022]
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Lotan Y, Shariat SF, Schmitz-Dräger BJ, Sanchez-Carbayo M, Jankevicius F, Racioppi M, Minner SJP, Stöhr B, Bassi PF, Grossman HB. Considerations on implementing diagnostic markers into clinical decision making in bladder cancer. Urol Oncol 2010; 28:441-8. [PMID: 20610281 DOI: 10.1016/j.urolonc.2009.11.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 10/27/2009] [Accepted: 11/04/2009] [Indexed: 01/11/2023]
Abstract
Bladder cancer is a common disease that is often detected late and has a high rate of recurrence and progression. Cystoscopy is the main tool in detection and surveillance of bladder cancer but is invasive and can miss some cancers. Cytology is frequently utilized but suffers from a poor sensitivity. There are several commercially available urine-based tumor markers currently available but their use is not recommended by guideline panels. Markers such as the Urovysion FISH assay and the NMP22 BladderChek test are approved for surveillance and detection in patients with hematuria. The added benefit of these markers and other commercially available markers (e.g. Ucyt+, BTA stat) has not been well investigated though it appears these markers are insufficiently sensitive to replace cystoscopy. Additional studies are needed to determine the clinical scenarios where bladder markers are best utilized (screening, surveillance, early detection, evaluating cytologic atypia) and what impact they should have on clinical decision making. Furthermore, a variety of issues and barriers can affect the movement of clinical tests from research to clinical practice. This article addresses some of the challenges facing research and medical communities in the delivery and integration of markers for bladder cancer diagnosis. Moreover, we attempt to outline criteria for the clinical utility of new bladder cancer diagnostic markers.
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Affiliation(s)
- Yair Lotan
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Lotan Y. Editorial comment. Urology 2010; 75:1282; author reply 1282-3. [PMID: 20513488 DOI: 10.1016/j.urology.2009.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 10/05/2009] [Accepted: 10/07/2009] [Indexed: 11/18/2022]
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Turner B, Baithun S, Grey A, Pati J. Nuclear matrix protein 22 is superior to voided urine cytology. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2010. [DOI: 10.1111/j.1749-771x.2010.01087.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schlomer BJ, Ho R, Sagalowsky A, Ashfaq R, Lotan Y. Prospective Validation of the Clinical Usefulness of Reflex Fluorescence In Situ Hybridization Assay in Patients With Atypical Cytology for the Detection of Urothelial Carcinoma of the Bladder. J Urol 2010; 183:62-7. [DOI: 10.1016/j.juro.2009.08.157] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Bruce J. Schlomer
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Richard Ho
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arthur Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Raheela Ashfaq
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Ordon M, Boerner S, Zlotta AR, Jewett MA, Fleshner N. The fate of an unsatisfactory urine cytology test among patients with urothelial carcinoma. BJU Int 2009; 104:1641-5. [DOI: 10.1111/j.1464-410x.2009.08650.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria. BMC Urol 2009; 9:12. [PMID: 19744317 PMCID: PMC2751768 DOI: 10.1186/1471-2490-9-12] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 09/10/2009] [Indexed: 11/30/2022] Open
Abstract
Background We determine the utility of serial urinary cytologies in patients presenting with microscopic hematuria who were evaluated with upper and lower urinary tract studies to rule out a malignancy. Methods Two hundred and thirty-seven patients with the diagnosis of microscopic hematuria were evaluated at an inner-city tertiary care hospital. Of these 239 patients, 182 patients had 405 cytologies obtained as part of their evaluation for hematuria. In addition, all patients had their lower urinary tract and upper tract thoroughly evaluated. Results Two hundred and seventy four cytology samples were read as normal, 104 (26%) as atypia, 7 (2%) as suspicious/malignant, and 20 (5%) as unsatisfactory. Seventeen patients (9.3%) had biopsy confirmed bladder cancer. Of these 17 patients, 2 had normal cytology, 11 had atypia, and 5 had suspicious/malignant. No patient had a positive cytology and a negative biopsy. Overall the number of hematuric patients harboring bladder cancer was small (7%). Cytology #1 detected 4 cases of cancer, cytology #2 detected an additional case and cytology #3 did not detect any additional cancers. Conclusion Because of this low prevalence of bladder cancer in patients presenting with microscopic hematuria and the low sensitivity of detecting bladder cancers, the utility of urinary cytology in the initial evaluation of patients with hematuria may be minimal. The exact role of urinary cytology in the evaluation of hematuria is unknown.
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Turner B, Allchorne P, Pati J, Baithun S. Urine cytology is an unnecessary expense in the evaluation of adult haematuria. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2009. [DOI: 10.1111/j.1749-771x.2009.01072.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Turner B. Bladder cancer: an update. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2008. [DOI: 10.1111/j.1749-771x.2008.00059.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prospective Evaluation of the Clinical Usefulness of Reflex Fluorescence In Situ Hybridization Assay in Patients With Atypical Cytology for the Detection of Urothelial Carcinoma of the Bladder. J Urol 2008; 179:2164-9. [DOI: 10.1016/j.juro.2008.01.105] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Indexed: 11/20/2022]
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Lotan Y. Editorial Comment. J Urol 2008. [DOI: 10.1016/j.juro.2007.11.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Lam T, Nabi G. Potential of urinary biomarkers in early bladder cancer diagnosis. Expert Rev Anticancer Ther 2008; 7:1105-15. [PMID: 18028019 DOI: 10.1586/14737140.7.8.1105] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Carcinoma of urinary bladder ranks among the top ten most common cancers worldwide. Approximately 80% of the disease is superficial (limited to mucosa and lamina propria) at the time of presentation. However, the majority of these tumors recur and 15-20% progress into muscle-invasive disease. Cystoscopic surveillance of the urinary bladder remains the standard of care to identify these recurrences on follow-up. Not only is this an invasive procedure, but the sensitivity of cystoscopy can be as low as 70%, so there can be up to 30% of tumors that are missed. Urinary cytology, with recognized limitations, has been used as an adjunct to this procedure, pending discovery of alternate urinary biomarkers. In the past decade there has been tremendous advancement in producing urinary biomarkers for urinary bladder cancer research, reflecting advancements in genomics and proteomics. An ideal biomarker should be able to replace cystoscopic examination and be cost effective. Unfortunately, most of the identified protein or molecular biomarkers have failed this test. This article critically appraises the status of these urinary biomarkers in urinary bladder cancer, in addition to highlighting some of the difficulties in this research area.
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Affiliation(s)
- Thomas Lam
- University of Aberdeen, Academic Urology Unit, First floor, Health Sciences Building, Aberdeen AB25 2ZD, UK.
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Glatz K, Willi N, Glatz D, Barascud A, Grilli B, Herzog M, Dalquen P, Feichter G, Gasser TC, Sulser T, Bubendorf L. An International Telecytologic Quiz on Urinary Cytology Reveals Educational Deficits and Absence of a Commonly Used Classification System. Am J Clin Pathol 2006. [DOI: 10.1309/6396qubu6hejbmpl] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Smellie WS, Forth JO, McNulty CAM, Hirschowitz L, Lilic D, Gosling R, Bareford D, Logan E, Kerr KG, Spickett GP, Hoffman J, Galloway A, Bloxham CA. Best practice in primary care pathology: review 2. J Clin Pathol 2006; 59:113-20. [PMID: 16443724 PMCID: PMC1860327 DOI: 10.1136/jcp.2005.031526] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2005] [Indexed: 11/04/2022]
Abstract
This second best practice review examines five series of common primary care questions in laboratory medicine: (1) laboratory testing for allergy, (2) diagnosis and monitoring of menopause, (3) the use of urine cytology, (4) the usefulness of the erythrocyte sedimentation rate, and (5) the investigation of possible urinary tract infection. The review is presented in a question-answer format. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents, and evidence based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S Smellie
- Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK.
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Sokol ER, Patel SR, Clemons JL, Sung VW, Rardin CR, Myers DL. The usefulness of urinary cytology testing in the evaluation of irritative voiding symptoms. Am J Obstet Gynecol 2005; 192:1554-9. [PMID: 15902157 DOI: 10.1016/j.ajog.2004.10.627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the clinical usefulness of urinary cytology testing for the evaluation of urothelial cancer in women with irritative voiding symptoms who were examined at a urogynecology service. STUDY DESIGN Urinary cytology studies results that were obtained from January 1, 2000, to December 31, 2002, were cross-matched with the Rhode Island Department of Health Cancer Registry to identify those women who were diagnosed with urinary tract malignancies. The prevalence of urothelial cancer was determined, and the sensitivity, specificity, and positive and negative predictive values of urinary cytologic testing were calculated for 2 common classification strategies: (1) consideration of atypical cytologic test results to be normal and (2) consideration of atypical cytologic test results to be abnormal. RESULTS Among 1516 cross-matched cytologic test results from 1324 patients, 5 urothelial cancers were identified. Two of the 5 malignancies were associated with positive cytology results. The prevalence of urothelial cancer was 0.38% (95% CI, 0.1%, 0.9%). When atypical cytology studies were classified as normal, the sensitivity of urinary cytology was 40% (95% CI, 7.2%, 83.0%); the specificity was 99.9% (95% CI, 99.5%, 100%); the positive predictive value was 66.7% (95% CI, 12.5%, 98.2%), and negative predictive value was 99.8% (95% CI, 99.2%, 100%). In contrast, when atypical cytology results were classified as abnormal, the sensitivity and negative predictive value remained the same, but the specificity declined to 93.6% (95% CI, 92.1%, 94.8%), and the positive predictive value decreased to 2.3% (95% CI, 0.4%, 8.8%). CONCLUSION The low prevalence of urothelial cancers and low sensitivity of urinary cytology studies severely limit the usefulness of this test in the evaluation of women with irritative voiding symptoms.
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Affiliation(s)
- Eric R Sokol
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Women and Infants Hospital, Brown Medical School, Providence, RI, USA.
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Sokol ER, Patel SR, Sung VW, Rardin CR, Weitzen S, Clemons JL, Myers DL. Results of urine cytology testing and cystoscopy in women with irritative voiding symptoms. Am J Obstet Gynecol 2005; 192:1560-5. [PMID: 15902158 DOI: 10.1016/j.ajog.2004.10.629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to assess rates of urinary cytologic abnormalities and cystoscopic outcomes in women with irritative voiding symptoms who were examined at a urogynecology clinic. STUDY DESIGN All urinary cytology studies results that were sent between January 1, 2000, and July 31, 2003, for the evaluation of irritative voiding symptoms were reviewed. Data were then extracted from the charts of a subset of these patients to evaluate cystoscopic outcomes. Demographics, risk factors for urothelial cancer, laboratory results, and radiology imaging results were then analyzed and compared between patients with and without abnormal cytology and cystoscopic results. RESULTS Of the 1783 total urinary cytology that were reviewed, 1661 test results were read as normal (93.2%); 112 test results (6.3%) were read as atypical, and 3 test results (0.2%) were read as unsatisfactory. Seven cytologic test results were categorized as suspicious or malignant, which accounts for only 0.4% of all cytologic test results that were sent. Of the 564 consecutive women whose cases were chosen for subanalysis, cytology was normal in 91.5% and atypical in 8.5% of cases. No cytology were suspicious or malignant. Cystoscopic findings were normal in 548 patients (97.2%). Only 1 patient (0.2%) received a diagnosis of transitional cell carcinoma. CONCLUSION Urinary cytology and cystoscopy are low yield tests and should not be used routinely in the initial evaluation of women with irritative voiding symptoms.
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Owens CL, Ali SZ. Atypical squamous cells in exfoliative urinary cytology: Clinicopathologic correlates. Diagn Cytopathol 2005; 33:394-8. [PMID: 16299739 DOI: 10.1002/dc.20344] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Presence of atypical squamous cells (ASC) in voided urine is an uncommon finding that may be the harbinger of an underlying malignant process. ASCs in urine may precede a de novo histologic diagnosis of malignancy or be the first sign of a recurrence in the lower urinary tract, or the gynecologic tract (in women). This study analyzed all urine cytology specimens with such diagnoses, with reference to their final histologic outcome. All urine cytology cases (n = 17,446) that included ASCs, evaluated at The Johns Hopkins Hospital between 1989 and 2003 (14 yr), were reviewed for diagnoses. ASCs as defined in this study are keratinizing cells with large and hyperchromatic smudgy nuclei, high N/C ratio, abnormal nuclear or cytoplasmic shapes, and densely orangeophilic cytoplasm. These cases lacked the qualitative and quantitative criteria for malignancy. The final reference outcome was determined by subsequent histologic and clinical follow-up. Of these 17,446 urine specimens, 55 cases (0.3%) from 47 patients had ASCs present. Thirty-two of the 47 patients had adequate follow-up. In 8 of these 32 patients (25%), a diagnosis of squamous-cell carcinoma (SCC) of the urinary bladder or urothelial carcinoma (UC) with squamous differentiation was made on subsequent histologic examination. In two cases (6%) a diagnosis of high-grade cervical SCC was established on subsequent follow-up. Twenty two of 32 cases (69%) remained benign on histologic and prolonged clinical follow-up. We conclude that ASCs in urine are rare (0.3% in this series). An interpretation of ASCs in a urine specimen is made when there is insufficient qualitative/quantitative evidence for a carcinoma diagnosis. ASCs in urine are a clinically valid diagnostic category (31% were later diagnosed with SCC). Most patients with urinary ASCs do not develop malignancy and, therefore, these cells may represent a reactive/inflammatory process most commonly due to vaginal contamination (in women) or exfoliation from the distal urethra (in men). Rarely, ASCs may exfoliate from a uterine cervical SCC and, therefore, a pelvic examination should be considered in such patients.
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Affiliation(s)
- Christopher L Owens
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287-6417, USA.
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Nabi G, Greene D, O'Donnell MO, Donnel MO. Suspicious urinary cytology with negative evaluation for malignancy in the diagnostic investigation of haematuria: how to follow up? J Clin Pathol 2004; 57:365-8. [PMID: 15047737 PMCID: PMC1770277 DOI: 10.1136/jcp.2003.009696] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To define the natural history of patients with suspicious urinary cytology and negative initial evaluation for malignancy in the investigation of haematuria. PATIENTS AND METHODS Data from the hospital information support system on urinary cytology examinations carried out at one centre were audited over a period of 24 months. There were 102 patients who had suspicious urinary cytology for malignant cells with negative initial evaluation. Follow up investigations, treatment, and final outcome were noted. RESULTS There were 102 patients with suspicious urinary cytology and negative initial evaluation for malignancy in 24 months, with a mean follow up of 15.7 months. Seventy patients had no obvious pathology on initial investigations. Forty one patients were found to have urological malignancies (29 bladder, eight ureteric, and four prostate) on follow up. All patients diagnosed as having urothelial malignancies on follow up had either persistent suspicious cytology (29) or recurrent haematuria (eight). The mean duration for appearance of lesions was 5.6 months (range, 3-12 months). Three patients had suspicious digital rectal examination and biopsies confirmed adenocarcinoma of the prostate. One patient had urinary retention and transurethral resection of prostate showed prostatic adenocarcinoma. The presence of suspicious cells on repeat urine analysis was the only significant factor in predicting the presence of urothelial tumours (p = 0.002). CONCLUSION Patients with persistent suspicious/positive cytology or recurrent haematuria need further evaluation and follow up. Asymptomatic patients or patients with obvious benign pathology do not require repeat evaluation. Careful urological evaluation, including prostate, should be carried out in these patients.
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Affiliation(s)
- G Nabi
- Academic Urology Unit, Department of Surgery, University of Aberdeen, Aberdeen AB25 2ZD, UK.
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