Urinary Cytodiagnosis: Can It Have a Different Prognostic Implication than a Diagnostic Test?

Abstract

In order to assess the clinical implications of the cytology of voided urine, we analyzed 65 patients among 147 cases of transitional cell carcinoma (TCC) in relation to the cytohistologic correlation and prognostic significance. Urinary cytology detected 42.6% of bladder tumors, 59% of renal pelvic tumors, and 35.3% of ureteral carcinomas. None of the 3 cases of grade-1 upper urinary tract tumors was detected by preoperative urinary cytology. Tumors with positive cytology were associated with epidermal growth factor receptor expression (p = 0.0009) and a higher fraction of tumor proliferation as defined by Ki-67 immunohistochemistry (p = 0.0038). Anaplastic tumor cells in urine correlated fairly well with muscular invasion (p = 0.018) and the DNA aneu-ploidy of the tumor (p = 0.0038). Tumors with muscular invasion were more likely to be detected by cytologic examination (p = 0.013). In urinary bladder carcinoma (n = 107), patients with positive cytology had a higher incidence of tumor recurrence (p = 0.004), and had an unfavorable prognosis (p = 0.0001) with a median follow-up of 46 months. In Ta-T1 tumors (n = 87), urinary cytology had prognostic value in terms of risk of recurrence (p = 0.0001), and poor patient outcome (p = 0.0001). Our data suggest that urinary cytology can offer important biological information on TCC and may be used as a simple and effective short-term prognostic indicator.

Prevention and Treatment of Urothelial Premalignant and Malignant Lesions

“…In terms of prognosis, abnormal voided urinary cytology prior to initial diagnostic cystoscopy has been reported in several studies to be predictive of an increased likelihood of new occurrences (27)(28)(29). Tut et al (28) proposed that this association correlates with loss of the cell adhesion molecule E-cadherin which is particularly deficient in more aggressive tumors (30) and is associated with a reduced new occurrence-free interval in Ta/T1 disease (31).…”

Fluorescence In Situ Hybridization Study of Chromosome Abnormalities of Upper Urinary Tract Urothelial Carcinoma in Paraffin-Embedded Tissue

“…Although cytologic examination of exfoliated cells in voided urine is an excellent tool for detecting high-grade urothelial tumors, with sensitivity as high as 95% and specificity higher than 90%, 21 its role in the diagnosis of UUT-UC is controversial because its sensitivity can diminish to 25%. 22 The collection of urine specimens with ureteral catheterization improves the sensitivity of this method from 35% to 88% 23 but produces discomfort to the patient. Nevertheless, whatever method is used for obtaining the urine specimen, the lack of sensitivity persists, probably because of the difficult cytologic interpretation of the UUT cells.…”

Does voided urine cytology have biological significance?

“…Smith et al [ 6] reported that urine cytology at presentation in patients with superficial TCC is highly predictive of tumour recurrence. Moreover, Chow et al [ 7] reported that positive VUC at diagnosis is a predictor of tumour recurrence and is associated with multifocal disease at presentation.…”