Evaluation of the Value of Combined Urine Cytology and Cystoscopy for Follow-up of Superficial Transitional Cell Carcinoma of the Urinary Bladder.

Objective: Cystoscopic biopsy is the most accurate technique used to assess the efficacy of treatment and to detect recurrence of superficial TCC of urinary bladder. Implementation of voided urine cytology to detect tumor cells in urine samples may represent an additional tool. The aims of this study are: (1) To estimate the reliability of combined cystoscopy and urine cytology examination in the follow-up of cases of superficial urinary bladder carcinoma, which might help to restrict cystoscopic biopsies for these cases with its morbidity and cost, (2) To discuss the diagnostic pitfalls of cytologic examination in these cases.

Patients And Methods: This is a prospective study, on 93 patients with superficial TCC of urinary bladder who were initially treated by complete TUR with or without adjuvant intravesical therapy with Bacillus Calmette - Guerin (BCG) (120mg÷instillation) every week for 6 weeks. Cystoscopic findings, urine cytology and histologic results of cystoscopic biopsies were assessed.

Results: By histologic examination, 41 (44%) cases were recurrent TCC and 52 (56%) were reported as negative for recurrence. By cystoscopic examination there were 36 positive cases, 4 of them were false positive. Out of the 57 negative cases for recurrence cystoscopically, 9 were histologically positive and were considered as false negative results. By cytology, 28 cases were positive, 3 were false positive, and 65 were negative for recurrence, 16 of them were false negative. Most of false negative cases were low grade TCC. Sensitivity of cytology and cystoscopy in the detection of recurrence was 61% and 78% respectively. When the two examinations were combined, sensitivity was 100%, and specificity was 92.3%.

Conclusion: For follow-up of superficial bladder carcinoma, the combination of negative cystoscopic findings and negative urine cytology may replace routine biopsies with their morbidity and cost.

Key Words: Superficial bladder carcinoma - Cytology and Cystoscopy - Follow-up.