Cytohistologic Correlation of Urothelial Cancers– A study of 57 Cases

Transitional cell carcinoma (TCC) comprises about 90% of all primary tumors of urinary bladder. The accuracy of multiple voided urine cytology justifies its continued use as a first line diagnostic and detection technique, particularly for high grade invasive cancers and clinically unsuspected case of carcinoma particularly carcinoma in-situ. In this study 57 cases were taken to see correlation of cytology, histology, stage, morphological pattern and sensitivity and specificity of urothelial cancers. Out of 57, 53 (92.99)% were positive for malignancy and 4(7.01%) were negative. There were 14 (24.56%) non-invasive papillary tumors, 1(1.76%) carcinoma in-situ and 42 (76.68%) invasive carcinoma of all grades and types. Of 14 grade-II non-invasive papillary tumors, 12 (85.72%) were cytologically positive. With only two exceptions, out of 39 all of the invasive carcinomas of all grades and types were identified by cytology as cancerous. A 100% positive cytology was noted in the detection of flat carcinoma in-situ, papillary adenocarcinoma and squamous cell carcinoma of the urinary bladder. Of the total 57 cases of malignant lesions of urinary tract, 53 (92.99%) were positive on cytological examination. The two TCC of the renal pelvis also gave a 100% positive cytologic results. Among invasive carcinoma, stage B1 and B2 urothelial cancers yield highest positive cytologic diagnosis rather than stage 0 and stage A urothelial cancers. For all tumors the sensitivity was 92.99%. The specificity was 100% since there were no false positive cases. The diagnostic accuracy was 93% (approximately). Comparison with previously published data this study showed highest diagnostic accuracy, sensitivity, specificity of voided urine cytology, good correlation with cytology histology and stage of tumor. So voided urine cytology, a very cheap and purely non invasive technique, can be done as an effective method to diagnose urothelial cancers in a developing country like Bangladesh where facilities for other investigations are practically limited.TAJ 2017; 30(1): 1-10

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Does Urine Cytology Still have a Role?

Urologia Journal ◽

10.1177/039156030507200301 ◽

2005 ◽

Vol 72 (3) ◽

pp. 301-306

Author(s):

M. Ciaccia ◽

R. Bertoloni ◽

F. Pinto ◽

A. Calpista ◽

P.F. Bassi

Keyword(s):

Transitional Cell Carcinoma ◽

Cell Carcinoma ◽

Carcinoma In Situ ◽

Transitional Cell ◽

High Sensitivity ◽

Urine Cytology ◽

Low Grade ◽

New Methods

Urine cytology is a reliable and well known tool in the diagnosis and follow-up of patients with transitional cell carcinoma even if it has high sensitivity only in high grade tumors and carcinoma in situ. In order to improve sensitivity of this test in patients with low grade tumors, new methods such as cytometry, microsatellite assays, Immunocyt®, fuorescence in-situ hybridization and Thin-Prep monolayer have been developed. These new assays will be able to increase the cytology detection rate and to predict the outcome of transitional cell carcinoma.

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Utility of Exfoliative Cytology of Voided Urine in Comparison with Ultrasonogram and Cystoscopy Findings in the Diagnosis of Urothelial Cancers

TAJ Journal of Teachers Association ◽

10.3329/taj.v30i2.39136 ◽

2018 ◽

Vol 30 (2) ◽

pp. 39-46

Author(s):

SM Badruddoza ◽

FA Azim ◽

AJE Nahar Rahman ◽

M Kamal ◽

AR Barua ◽

...

Keyword(s):

Urinary Bladder ◽

Cell Carcinoma ◽

Urine Cytology ◽

Invasive Technique ◽

Published Data ◽

Low Grade ◽

Invasive Squamous Cell Carcinoma ◽

Invasive Carcinomas ◽

Positive Results ◽

Grade Iii

Carcinoma of the urinary bladder affects men more often than women and occurs in patients over the age of 50 years. Transitional cell carcinoma (TCC) comprises about 90% of all primary tumor of urinary bladder. In this study a total of 57 cases were taken. The aim of the study was to establish diagnostic role of voided urine cytology, ultrasonography and cystoscopy in urothelial cancers. Out of 57 cases, cytological diagnosis was positive in 53 cases (93%) and negative in 4 cases (7%). There were no atypical or suspicious cases. Of the total cases, cytology was negative only in 7% cases. Among 42 invasive carcinomas 14 (33%) grade III invasive flat carcinoma, one (2%) invasive papillary adenocarcinoma and two (5%) invasive squamous cell carcinoma, each of them gave 100% positive cytology. Of the remaining 25 (60%) invasive papillary TCC, 21 were in grade II and 4 were in grade III. They gave 90% and 100% positive cytologic results. Ultrasonogram of urinary bladder gave 95% (approx.) positive results and out of 57 cases, 3 cases failed to give positive results in ultrasonogram (USG) of the urinary tract. Cystoscopy detected tumor mass in 98% cases and it gave false negative result in 2% cases. Fifty-two tumors had a diameter ranging 1.1- 6 cm. Single lesions were seen in 40 cases, double lesion in one case and multiple in 13 cases. The probability of later invasive carcinomas nearly tripled in-patients with multiple lesions on presentation (13.6%) compared with those who presented with a single lesion (4.6%). Consistent with previously published data, this study showed the highest diagnostic accuracy with high-grade tumors and lowest with low-grade tumors. So in a proper clinical setting, non-invasive technique like voided urine cytology and ultrasonography could be done as a first line cost effective method in the diagnosis of urothelial cancers.TAJ 2017; 30(2): 39-46

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Contribution of Cytology, Colposcopy, Target Biopsy and Conization to the Early Diagnosis of Precancerous and Cancerous Lesions of the Cervix Uteri

Tumori Journal ◽

10.1177/030089167806400406 ◽

1978 ◽

Vol 64 (4) ◽

pp. 389-398 ◽

Cited By ~ 2

Author(s):

Silvia Cecchini ◽

Lucia Bonardi ◽

Gioia Cipparrone ◽

Mario Ottaviano ◽

Gabriella Pieroni

Keyword(s):

Early Diagnosis ◽

Diagnostic Accuracy ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Diagnostic Methods ◽

Cervix Uteri ◽

Cone Biopsy ◽

Valid Test ◽

Target Biopsy

The study is based on. 334 cytologic suspect or positive women observed in the area of Florence. Cytologic diagnoses of dysplasia, carcinoma in situ (CIS), and invasive carcinoma are related to the histologic reports. To the same histologic reports are related the colposcopic aspects. Lastly, diagnoses made by target biopsy are compared with the final diagnoses made by cone biopsy. The 3 diagnostic methods and their diagnostic accuracy are then compared. As regards dysplasia, the diagnostic precision of cytology is 40.2% and for target biopsy is 76.9%. In the diagnosis of CIS, cytology shows a diagnostic accuracy (77.7%) that is a little lower than that of target biopsy (81.7%). In invasive carcinoma, cytology has a good diagnostic precision (88.2%), which becomes 100% if the diagnosis is made by target biopsy. The correlation between colposcopic aspects and histologic reports is not very reliable. We conclude that cytology is a valid test in an extensive mass screening, that colposcopy is essential to execute target biopsy, and that the latter is useful in defining dysplasia and invasive carcinoma diagnoses. On the contrary, in the case of CIS, target biopsy does not greatly increase cytology diagnostic precision.

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Significance of p53 Overexpression in Urinary Bladder Transitional Cell Carcinoma In Situ Before and After Bacillus Calmette-Guerin Treatment

The Journal of Urology ◽

10.1097/00005392-199805000-00117 ◽

1998 ◽

Vol 159 (5) ◽

pp. 1768-1769

Author(s):

K. Ick ◽

M. Schultz ◽

P. Stout ◽

K. Fan

Keyword(s):

Urinary Bladder ◽

Transitional Cell Carcinoma ◽

Cell Carcinoma ◽

Carcinoma In Situ ◽

Transitional Cell ◽

Bacillus Calmette Guerin ◽

Bladder Transitional Cell Carcinoma ◽

P53 Overexpression ◽

Before And After

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Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.4.1638 ◽

2020 ◽

Vol 36 (4) ◽

Cited By ~ 1

Author(s):

Muhammad Tanveer Sajid ◽

Muhammad Rafiq Zafar ◽

Hussain Ahmad ◽

Saif Ullah ◽

Zahoor Iqbal Mirza ◽

...

Keyword(s):

Urinary Bladder ◽

Diagnostic Accuracy ◽

Transitional Cell Carcinoma ◽

Cell Carcinoma ◽

Roc Curve ◽

Predictive Value ◽

Gold Standard ◽

Transitional Cell ◽

Urine Cytology ◽

Female Ratio

Objective: To determine diagnostic accuracy of NMP 22 and urine cytology in the detection of transitional cell carcinoma (TCC) urinary bladder taking cystoscopy as a gold standard in patients having provisional diagnosis of bladder cancer (BC). Methods: This cross sectional validational study enrolled 380 patients fulfilling selection criteria and was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan form July 2018 to July 2019. The urine sample collected underwent NMP22 and cytological analysis followed by rigid cystoscopy. Reports of all three tests divided patients into positive or negative for malignancy as per defined criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of NMP 22, urine cytology and their combination was determined. Receiver operating characteristic (ROC) curve analysis performed and area under the curve (AUC) compared among these tests. Results: The average age of patients was 53.08 ± 12.41 years having male to female ratio 3.75:1(300 males and 80 females). NMP 22 had better sensitivity and comparable specificity to cytology (81.9 & 81.2% vs 54 & 93.9%). Combination of NMP 22 / cytology outperformed both in terms of sensitivity (91.63 vs 81.83 vs 53.96), NPV (87.59 vs 77.46 vs 61.02) and diagnostic accuracy (85.26 vs 81.58 vs 71.32) but at the cost of specificity (76.97 vs 81.21 vs 93.94) and PPV (83.83 vs 85.02 vs 92.06). ROC curve revealed statistically significant higher AUC (0.843 vs .815 vs .73) for combination as compared to NMP 22 and Cytology (p<0.001). Conclusion: NMP22 is a quick, point of care test having higher sensitivity, NPV and accuracy but similar specificity and PPV to urine cytology for detection of TCC urinary bladder. Combination outperformed both in terms of sensitivity while having modest specificity. doi: https://doi.org/10.12669/pjms.36.4.1638 How to cite this:Sajid MT, Zafar MR, Ahmad H, Saif Ullah, Mirza ZI, Shahzad K. Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1638 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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