Urinary cytology for the detection of urothelial carcinoma of the bladder-a flawed adjunct to cystoscopy?

Christian Bolenz, Ann Marie West, Nicolas Ortiz, Wareef Kabbani, Yair Lotan

Research output: Contribution to journalArticle

11 Citations (Scopus)

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). 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. 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. 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.

Original languageEnglish (US)
Pages (from-to)366-371
Number of pages6
JournalUrologic Oncology: Seminars and Original Investigations
Volume31
Issue number3
DOIs
StatePublished - Apr 2013

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Cystoscopy
Cell Biology
Urinary Bladder
Carcinoma
Urinary Bladder Neoplasms
Neoplasms
Research Personnel
Urine
Biopsy
Pathologists

Keywords

  • Bladder cancer
  • Cytology
  • Diagnostic use
  • Marker
  • Urinary bladder neoplasms
  • Urine

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Urinary cytology for the detection of urothelial carcinoma of the bladder-a flawed adjunct to cystoscopy? / Bolenz, Christian; West, Ann Marie; Ortiz, Nicolas; Kabbani, Wareef; Lotan, Yair.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 31, No. 3, 04.2013, p. 366-371.

Research output: Contribution to journalArticle

Bolenz, Christian ; West, Ann Marie ; Ortiz, Nicolas ; Kabbani, Wareef ; Lotan, Yair. / Urinary cytology for the detection of urothelial carcinoma of the bladder-a flawed adjunct to cystoscopy?. In: Urologic Oncology: Seminars and Original Investigations. 2013 ; Vol. 31, No. 3. pp. 366-371.
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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). 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. 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. 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.",
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