Conventional bladder wash cytology performed by four experts versus quantitative image analysis.

Department of Urology, University Hospital, Nijmegen, The Netherlands.
Modern Pathology (Impact Factor: 6.36). 11/1997; 10(10):976-82.
Source: PubMed

ABSTRACT Bladder wash cytology provides superior results for the detection of bladder malignancies than does voided urine analysis. Image analysis systems have been developed for quantification of cytologic features. In this study, routine bladder wash cytology is compared with an automated image analysis system (QUANTICYT). We studied a random set of 100 bladder wash samples from a population of 1614 patients in follow-up after bladder cancer. Four experienced pathologists interpreted the same 100 Papanicolaou-stained slides. Cytologic and image analysis results were compared for prediction of a cystoscopic lesion, histologic abnormalities, and tumor recurrence. After application of receiver operating characteristic curves, prediction of a cystoscopic lesion by cytology and image analysis was comparable. Both the image analysis system and the cytologic examination detected all of the high-grade lesions. Image analysis was superior to cytologic analysis for the prediction of tumor recurrence after normal findings at cystoscopic examination.

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    ABSTRACT: HintergrundSchlüsselproblem in der Abklärung der schmerzlosen Hämaturie bleibt die Diskriminierung zwischen Tumoren der ableitenden Harnwege und nicht-malignen Erkrankungen. Im Rahmen einer prospektiven Studie wurde die Rolle der Immunzytologie in der Abklärung der schmerzlosen Hämaturie untersucht. Material und MethodenDer uCyt® ist ein kommerziell erhältlicher immunzytologischer Test zum fluoreszenzmikroskopischen Nachweis tumorassoziierter Antigene auf der Oberfläche von Urothelzellen. Von 10/2000 bis 12/2006 wurden 222 konsekutive Patienten mit schmerzloser Hämaturie ohne vorangegangenes Urothelkarzinom in die Studie eingeschlossen. Alle Urinproben wurden zytologisch und immunzytologisch untersucht und bewertet. 211 Proben (95%) waren auswertbar. ErgebnisseDie klinische Abklärung mit Endoskopie und bildgebenden Verfahren ergab bei 10Patienten (4%) ein Harnblasenkarzinom. Andere Ursachen waren eine BPH (27%), Zystitis (inklusive IC, 12%), Urolithiasis (9%), Strikturen der Harnröhre oder der Harnleiter (6%), Papillome (2%) und weitere Erkrankungen (16%). In 52Fällen (23%) konnte keine Diagnose gestellt werden. Die Immunzytologie war bei 8 der 10 Blasentumoren (80%) positiv und bei 178 der übrigen Patienten (89%) negativ. SchlussfolgerungenTrotz niedriger Prävalenz entsprach die beobachtete Sensitivität und Spezifität den aus der Literatur bekannten Ergebnissen. Eine Immunzytologie-gesteuerte Abklärung zugrunde gelegt, hätten 180 aufwändige und invasive Abklärungen eingespart worden. Umgekehrt wären lediglich 29Personen (14%) unnötig abgeklärt worden. In weiteren Untersuchungen soll die Immunzytologie nun bei Patienten geprüft werden, bei denen mit Zytologie, Ausscheidungsurogramm und Zystoskopie keine eindeutige Zuordnung der Hämaturie möglich ist. IntroductionDiscriminating between malignant and nonmalignant conditions remains a challenge in the evaluation of patients with asymptomatic microhematuria. In this prospective study the role of immunocytology in the assessment microhematuria was studied. Material and methodsuCyt® is a commercially available immunocytological assay based on microscopical detection of tumor-associated antigens in urothelial cells by immunofluorescence. Between September 2000 and December 2006, 222 consecutive patients with newly diagnosed painless microhematuria without prior transitional cell carcinoma were included. All urine samples were examined cytologically and immunocytologically. A total of 211 samples (95%) were assessable. ResultsClinical examination by physical examination, cystoscopy, laboratory tests, and imaging yielded bladder cancer in ten cases (4%). Further diagnoses were BPH (27%), cystitis (including IC) (12%), urolithiasis (9%), urethral or ureteral strictures (6%), papilloma (2%), and“further conditions” (16%). In 52 patients (23%) reasons for hematuria were not identified. Immunocytology was positive in 8 of 10 bladder tumors (80%) and negative in 178 patients with non-tumor-related hematuria (89%). ConclusionsThe high sensitivity and good specificity of immunocytology is comparable with that reported in the literature despite a very low disease prevalence in this population. If assessment of these patients would have only been based on immunocytology, 180 costly and invasive diagnostic procedures would have been saved, with only 29 individuals (14%) undergoing these examinations unnecessarily. The authors conclude that these findings justify further investigation of this issue.
    Der Urologe 01/2008; 47(2):190-194. DOI:10.1007/s00120-007-1598-9 · 0.44 Impact Factor
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    ABSTRACT: Urothelial carcinoma accounts for 90% of all the cases of bladder cancer. Although many cases can be easily managed by local excision, urothelial carcinoma rather frequently recurs, tends to progress to muscle invasion, and requires regular follow-ups. Urine cytology is a main approach for the follow-up of bladder tumors. It is noninvasive, but it has low sensitivity of around 50% with using the conventional cytospin preparation. Liquid-based cytology (LBC) has been developed as a replacement for the conventional technique. We compared the cytomorphometric parameters of ThinPrep® and cytospin preparation urine cytology to see whether there are definite differences between the two methods and which technique allows malignant cells to be more effectively discriminated from benign cells. The nuclear-to-cytoplasmic ratio value, as measured by digital image analysis, was efficient for differentiating malignant and benign urothelial cells, and this was irrespective of the preparation method and the tumor grade. Neither the ThinPrep® nor the conventional preparation cytology was definitely superior for distinguishing malignant cells from benign cells by cytomorphometric analysis of the adequately preserved cells. However, the ThinPrep® preparation showed significant advantages when considering the better preservation and cellularity with a clear background.
    The Korean Journal of Cytopathology 01/2008; 19(2). DOI:10.3338/kjc.2008.19.2.136
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    ABSTRACT: BACKGROUND With an end toward an increase in patient quality of life, morphologic methods were tested for their combinatory value in expanding the effectiveness of follow-up appointments and finding a more specific supervision of patients with bladder cancer.METHODS Voided urine and bladder washing specimens were gathered in 223 follow-up sessions of 124 patients with a history of bladder cancer. Hemacolor (Merck, Darmstadt, Germany)-stained cytospin preparations of voided urine specimens were ready for diagnosis within 15 minutes, and results were available shortly before cystoscopy. Feulgen-Schiff–stained cytospin preparations of bladder washings entered the image analysis system. A special software was used to classify the DNA histogram by a risk factor for bladder cancer.RESULTSFollow-up of patients revealed 83 tumor recurrences. Depending on the grade of the underlying tumor, the sensitivity of quick-staining cytology was 86.4%, 46.2%, or 13.6% for grade 3 to grade 1 TCC, respectively. Cytology and image analysis data demonstrated complementary potency. The combination of methods increased sensitivity to 90.9%, 66.7%, and 31.8%, respectively. Although 24 of 140 image analyses denoted high risk for bladder cancer without simultaneously visible tumor, correct evidence of high risk could be found for 92.2%.CONCLUSIONS The combinatory use of quick-staining urinary cytology and bladder wash image analysis was demonstrated to be most valuable in diagnosing recurrent bladder cancer and selecting patients needing more intensive follow-up. At a minimum of patients discomfort, the tested combination also seems helpful to surpass diagnostic limits in cystoscopy and cytology caused by therapeutic effects on the bladder epithelium. Cancer (Cancer Cytopathol) 1999;87:263–9. © 1999 American Cancer Society.
    Cancer 10/1999; 87(5):263 - 269. DOI:10.1002/(SICI)1097-0142(19991025)87:5<263::AID-CNCR5>3.0.CO;2-O · 5.20 Impact Factor