DNA IMAGE-ANALYSIS OF URINARY CYTOLOGY - PREDICTION OF RECURRENT TRANSITIONAL-CELL CARCINOMA

To evaluate the utility of image analysis in monitoring patients with transitional cell carcinoma, we studied, by cytologic means and by ima ge analysis, 78 urinary tract specimens from 66 patients, of whom 49 ( 74%) had a previous history of transitional cell carcinoma The specime ns consisted of 51 (65%) voided urine specimens, 12 (15%) bladder wash ings, 8 (10%) ureteral washings, 3 (4%) ureteral brushings, 2 (3%) ren al pelvic washings, and 2 (3%) catheterized urine specimens. DNA histo grams were classified into five patterns on the basis of their DNA ind ex and the percentage of their cells with DNA content greater than 5c: diploid (single peak in the 2c region with no cells greater than 5c), intermediate (diploid with less than 10% of cells greater than 5c), a neuploid (single peak or multiple peaks between the 2c and 4c region o r more than 10% of cells greater than 5c), tetraploid (at least 10% of cells in the 4c region and a corresponding peak at 8c), and polyploid (multiple peaks in the 2c, 4c, 8c, and 10c regions), Of the 78 cases, 22 were diploid, 24 were intermediate, 29 were aneuploid, one was tet raploid, and two were polypoid. Histologic confirmation or clinical fo llow-up was found in 29 aneuploid cases, 13 intermediate cases, and on e diploid case, Most cases of carcinoma in situ (five of six) and inva sive tumors (12 of 17) were aneuploid, The sensitivity was 100%, and t he specificity was 73% when cytologic and image analysis results were combined, We conclude that image analysis, when combined with cytologi c examination, is a reliable noninvasive diagnostic test for monitorin g patients with transitional cell carcinoma; aneuploidy is specific fo r malignancy; and the presence of cells greater than 5c, although freq uently associated with tumor recurrence, can be seen in non-neoplastic conditions.