SCREENING FOR UROTHELIAL MALIGNANCIES BY CYTOLOGIC ANALYSIS AND FLOW-CYTOMETRY IN A COMMUNITY UROLOGIC PRACTICE - A PROSPECTIVE-STUDY

A prospective study was initiated to compare the ability of flow cytom etry and cytologic analysis to detect malignant cells in urine obtaine d at the time of cystoscopy. The population studied consisted of patie nts from general urologic practices who were undergoing cystoscopy in a single community hospital. Over a 1-yr period, 335 specimens from 31 7 patients were studied, Nineteen biopsy-proven urothelial malignancie s were identified. Cytologic examination of urine obtained at the time of cystoscopy was positive in seven of these cases, and an aneuploid population of cells was identified by flow cytometry in three cases. A ll three cases of high-grade transitional cell carcinoma and carcinoma in situ were correctly identified by the combination of cytolose exam ination and flow cytometry; however, only four of 16 low-grade superfi cial papillary transitional cell carcinomas were recognized cytologica lly, with only one being aneuploid. The combination of cytologic analy sis and flow cytometry did not increase the diagnostic sensitivity abo ve that achieved with cytologic testing alone (overall sensitivity, 37 %). We conclude that flow cytometry and cytolose analysis, either indi vidually or in combination, are too insensitive for use in a routine s creening program for urothelial malignancy in a community hospital set ting because of the inability of either method to detect low-grade tra nsitional cell carcinomas reliably.