Urine cytology is a feasible tool for assessing erythematous bladder lesions after bacille Calmette‐Guérin (BCG) treatment

Nurminen, Pertti; Ettala, Otto; Seppänen, Marjo; Taimen, Pekka; Boström, Peter J.; Kaipia, Antti

doi:10.1111/bju.14470

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…In that publication, slightly lower sensitivity and specificity values, 39% and 77%, respectively, were reported. 18 Guy et al included 130 patients, and both sensitivity (56%) and specificity (92%) of post-BCG cytology were reported. 24 Notably, neither investigation applied the TPS classification system.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Previous studies investigating the diagnostic accuracy of post-BCG cytology demonstrated wide variation in sensitivity, ranging from 33% to 67%. 17,18 However, none of those studies consistently used the TPS.…”

Section: Introductionmentioning

confidence: 99%

“…Notably, changes, including prominent nucleoli, reactive atypia, cytoplasmic vacuolization and inclusions, and an increase in granulocytes, can be observed even months after the last BCG instillation 15,16 . Previous studies investigating the diagnostic accuracy of post‐BCG cytology demonstrated wide variation in sensitivity, ranging from 33% to 67% 17,18 . However, none of those studies consistently used the TPS.…”

Section: Introductionmentioning

confidence: 99%

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Impact of bacillus Calmette‐Guerin intravesical therapy on the diagnostic efficacy of The Paris System for Reporting Urinary Cytology in patients with high‐grade bladder cancer

Hermans

Jokisch

Volz

et al. 2021

Cancer Cytopathology

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Background In high‐grade urothelial carcinoma (UC) of the bladder, bacillus Calmette‐Guerin (BCG) therapy is a therapeutic mainstay, and urinary cytology is recommended to detect recurrences. However, intravesical BCG instillations can induce morphologic changes in urothelial cells. The authors investigated the impact of BCG therapy on the efficacy of urinary cytology. Methods Matched pathology and cytology samples from patients undergoing transurethral resection of the bladder after BCG therapy were assessed. Cytology samples were graded according to The Paris System for Reporting Urinary Cytology. Diagnostic quality criteria were tested for different cutoff definitions, and the results were compared between those obtained <100 versus ≥100 days after the last BCG instillation. In addition, the oncologic outcome of false‐positive results was assessed. Results In total, 389 matched cases from 197 patients who had a history of high‐grade UC (HGUC) were identified. Sixty cases (15.7%) were diagnosed as high‐grade urothelial bladder cancer. The cytology diagnoses were as follows: non‐HGUC, 191 cases (49.1%); atypical urothelial cells, 80 cases (20.6%); suspicious for HGUC, 56 cases (14.4%); and HGUC, 56 cases (14.4%). Interrater reliability was substantial (κ = 0.660). Sensitivity increased from 45% to 75% when cases diagnosed as suspicious for HGUC were also counted as positive. Notably, sensitivity was reduced within the first 100 days after BCG therapy (61.9%) compared with sensitivity at longer intervals (82.1%). Reactive atypia (odds ratio, 4.155; 95% confidence interval, 2.136‐8.085; P < .001) and cellular degeneration (odds ratio, 5.050; 95% CI, 2.094‐12.175; P < .001) of urothelial cells were associated with false‐positive rates, and 44.7% of patients who had a false‐positive cytology classification presented with HGUC during follow‐up. Conclusions BCG therapy has a short‐term adverse impact on the efficacy of urinary cytology. After BCG therapy, cases classified as suspicious for HGUC should be considered positive. Importantly, patients with false‐positive cytology findings should be closely monitored.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of bacillus Calmette‐Guerin intravesical therapy on the diagnostic efficacy of The Paris System for Reporting Urinary Cytology in patients with high‐grade bladder cancer

Hermans

Jokisch

Volz

et al. 2021

Cancer Cytopathology

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“…In these cases, and in patients who have received pelvic irradiation or intravesical therapies, UC has an important role in differentiating non-malignant erythematous urothelium (identified commonly as "red patches" on surveillance cystoscopy) from malignant urothelium/tumour recurrence. 5,9 UC is beneficial if it was positive at initial presentation; in such cases, it can provide confidence to the clinician and reassurance to the patient during surveillance if it remains negative/ benign, or prompts further investigation if it becomes suspicious/malignant. However, as an adjunct to diagnosis in suspected bladder cancer, the value of UC is less clear, mainly when it is performed on all haematuria patients, not just in those in whom bladder (or upper tract) cancer is suspected.…”

Section: Discussionmentioning

confidence: 99%

“…Although atypical UC was not associated with cancer, similarly to previous reports, our data highlighted the strong association of C4 and C5 cytology with high-risk tumours, and tumours that recurred over the follow-up period. 9,14 One could therefore suggest that patients with C4 or C5 cytology could or should be prioritised for TURBT or nephroureterectomy; however, even in cases where we attempted this, waiting times for TURBT were seldom reduced by more than a week, and it is difficult to estimate any potential beneficial effect this may have had on the patient or oncological outcomes.…”

Section: Discussionmentioning

confidence: 99%

Should National Institute for Clinical Excellence (NICE) Guidelines Remove Urine Cytology as a Suggested Adjunct in Suspected Bladder Cancer (haematuria) Investigations?

Moore

Robinson

Kitchen

et al. 2021

Journal of Endoluminal Endourology

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BackgroundDespite National Institute for Clinical Excellence (NICE) guidelines suggesting the use of urine cytology (UC) for the diagnosis of bladder cancer, its use is variable. Reasons for this include sub-optimal sensitivity, financial cost, availability of alternative tests, and uncertainty over interpretation of results. Anecdotally, however, suspicious or malignant UC when other investigations are normal, occasionally leads to a cancer diagnosis. Therefore, we retrospectively assessed a cohort of our haematuria patients to determine the value of UC in cancer diagnosis and the clinical significance of atypical UC (graded as C3). Patients and methodsWe identified 3018 patients with haematuria referred on the suspected cancer pathway (“two-week wait”) in 2015. We retrospectively analysed clinical, demographic, and follow-up/outcome data in a random cohort of 500 cases. ResultsMedian follow up was 58 months. Urological malignancy was diagnosed in 61/500 patients; all were identified by cystoscopy or imaging, i.e., irrespective of UC result. No cases of atypical UC re-presented with a ‘missed’ cancer diagnosis within the five-year follow-up period. However, suspicious and malignant cytology was associated with high-grade/aggressive tumours and subsequent tumour recurrence. ConclusionUrine cytology did not identify any cancers that were not already found by imaging or cystoscopy. Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for transurethral resection of bladder tumour (TURBT), however, it is unclear whether this might benefit patient outcomes. We conclude therefore that UC has no role in haematuria investigations.

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Point de vue de l’urologue : apport de la cytologie urinaire dans le diagnostic et la prise en charge des tumeurs urothéliales

Bajeot,

Roumiguié

2024

Annales de Pathologie

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Urine cytology is a feasible tool for assessing erythematous bladder lesions after bacille Calmette‐Guérin (BCG) treatment

Cited by 6 publications

References 26 publications

Impact of bacillus Calmette‐Guerin intravesical therapy on the diagnostic efficacy of The Paris System for Reporting Urinary Cytology in patients with high‐grade bladder cancer

Impact of bacillus Calmette‐Guerin intravesical therapy on the diagnostic efficacy of The Paris System for Reporting Urinary Cytology in patients with high‐grade bladder cancer

Should National Institute for Clinical Excellence (NICE) Guidelines Remove Urine Cytology as a Suggested Adjunct in Suspected Bladder Cancer (haematuria) Investigations?

Point de vue de l’urologue : apport de la cytologie urinaire dans le diagnostic et la prise en charge des tumeurs urothéliales

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