ANCILLARY TECHNIQUES IN THE FOLLOW-UP OF TRANSITIONAL-CELL CARCINOMA - A COMPARISON OF CYTOLOGY, HISTOLOGY AND DEOXYRIBONUCLEIC-ACID IMAGE-ANALYSIS CYTOMETRY IN 91 PATIENTS

Purpose: Voided urine and bladder washing cytology are used frequently in the evaluation of transitional cell carcinoma of the bladder. As p art of an ongoing investigation we report on the role of deoxyribonucl eic acid (DNA) image analysis cytometry as an adjunct to cytology in t he followup of patients with transitional cell carcinoma. Materials an d Methods: Urine cytology and image analysis cytometry were performed independently on aliquots of voided urine, catheterized urine or bladd er washings from 91 patients with previous or active transitional cell carcinoma of the bladder, and the results were compared to those of c oncurrent biopsy and clinical followup. Results: Of 75 recurrent trans itional cell carcinomas 42 were detected by cytology, while 63 and 64 were identified by image analysis cytometry and biopsy, respectively, for a sensitivity of 57, 84 and 85%, respectively. Combined cytology a nd image analysis cytometry detected 67 recurrences, for an overall se nsitivity of 89%. Of 11 cases undetected by concurrent biopsy 9 had ab normal DNA histograms with transitional cell carcinoma at followup and 2 were DNA diploid but with grade 1 transitional cell carcinoma at fo llowup. Of 12 cases undetected by image analysis cytometry 8 were grad e 1 and 4 were grade 2 transitional cell carcinoma. Conclusions: Urine cytology and image analysis cytometry detect most recurrent tumors. T heir combined use is indicated in the followup of patients with bladde r transitional cell carcinoma.