0022-534 7/78/ :291-0051$02. 00/0 THE JOURNAL OF UROLOGY
Copyright© 1978 by The Williams & Wilkins Co.
PRE-CLINICAL CYTOLOGICAL DIAGNOSIS OF BLADDER CANCER LA WREN CE J. GEISSE*
AND
DUANE N. TWEED DALE
From the Department of Pathology, University of Missouri Medical Center, Columbia, Missouri
ABSTRACT
The records' of 100 recent urology service patients with bladder neoplasms were evaluated for correlation of cytological findings with clinical and histological diagnoses. At the time of diagnosis 83 patients had synchronous positive biopsies and cytologies, 3 had negative cytologies (even though urothelial cancer was present) and the remaining 14 had abnormal cytologies but clinical examination was negative. Of these 14 patients invasive cancer has been identified subsequently in 11, while 3 have not yet returned for clinical followup. Analysis of the 11 patients in whom cancer was proved eventually reveals 14 distinct periods, ranging from 1 to 37 months, in which cytologies were abnormal and concurrent clinical examinations and histological diagnoses were negative. Ten of these periods preceded tumor recurrence and the other 4 antedated the first occurrence of cancer. A relationship was found between a cytological diagnosis of carcinoma in situ or severe dysplasia and the presence or future appearance of low grade clinical cancer. Cytologies containing overtly malignant cells more commonly were associated with or preceded the appearance of high grade cancers. In these 11 patients the sensitivity of a single spontaneously voided urine specimen was 97 per cent but the sensitivity was 100 per cent when 2 or more specimens were submitted per patient. Bladder barbotages were 100 per cent sensitive. More than 90,000 new cases of bladder carcinoma will be diagnosed this year, almost double the number 10 years ago. Fifty per cent of these patients will die in 5 years if treated with current protocols; if untreated, 50 per cent will die in 14 months. 1 Many factors contribute to the lethality of bladder cancer, not the least of which is its relatively late diagnosis. Presently, bladder cancer is almost always diagnosed cystoscopically, followed by histological confirmation, random biopsies providing infrequent exceptions. Recent evidence confirms that these methods of diagnosis often are inadequate to identify all malignant areas and may even miss a tumor completely. 2 • '3 More importantly, the early urothelial lesions preceding overt cancer (for example carcinoma in situ) are not usually identified cystoscopically or, when visualized, mimic cystitis.''· 4 When the cancer does become visible cystoscopically metastatic disease may be imminent. s Cytology would seem to provide one answer to early diagnosis of bladder cancer. Examination of exfoliated urothelial cells present in the urine has been shown to be diagnostic many researchers but a modality for population ~w,or;no,IT Or routine Ul
Copyright© 1978 by The Williams & Wilkins Co.
PRE-CLINICAL CYTOLOGICAL DIAGNOSIS OF BLADDER CANCER LA WREN CE J. GEISSE*
AND
DUANE N. TWEED DALE
From the Department of Pathology, University of Missouri Medical Center, Columbia, Missouri
ABSTRACT
The records' of 100 recent urology service patients with bladder neoplasms were evaluated for correlation of cytological findings with clinical and histological diagnoses. At the time of diagnosis 83 patients had synchronous positive biopsies and cytologies, 3 had negative cytologies (even though urothelial cancer was present) and the remaining 14 had abnormal cytologies but clinical examination was negative. Of these 14 patients invasive cancer has been identified subsequently in 11, while 3 have not yet returned for clinical followup. Analysis of the 11 patients in whom cancer was proved eventually reveals 14 distinct periods, ranging from 1 to 37 months, in which cytologies were abnormal and concurrent clinical examinations and histological diagnoses were negative. Ten of these periods preceded tumor recurrence and the other 4 antedated the first occurrence of cancer. A relationship was found between a cytological diagnosis of carcinoma in situ or severe dysplasia and the presence or future appearance of low grade clinical cancer. Cytologies containing overtly malignant cells more commonly were associated with or preceded the appearance of high grade cancers. In these 11 patients the sensitivity of a single spontaneously voided urine specimen was 97 per cent but the sensitivity was 100 per cent when 2 or more specimens were submitted per patient. Bladder barbotages were 100 per cent sensitive. More than 90,000 new cases of bladder carcinoma will be diagnosed this year, almost double the number 10 years ago. Fifty per cent of these patients will die in 5 years if treated with current protocols; if untreated, 50 per cent will die in 14 months. 1 Many factors contribute to the lethality of bladder cancer, not the least of which is its relatively late diagnosis. Presently, bladder cancer is almost always diagnosed cystoscopically, followed by histological confirmation, random biopsies providing infrequent exceptions. Recent evidence confirms that these methods of diagnosis often are inadequate to identify all malignant areas and may even miss a tumor completely. 2 • '3 More importantly, the early urothelial lesions preceding overt cancer (for example carcinoma in situ) are not usually identified cystoscopically or, when visualized, mimic cystitis.''· 4 When the cancer does become visible cystoscopically metastatic disease may be imminent. s Cytology would seem to provide one answer to early diagnosis of bladder cancer. Examination of exfoliated urothelial cells present in the urine has been shown to be diagnostic many researchers but a modality for population ~w,or;no,IT Or routine Ul
