URINARY CYTODIAGNOSIS CAN IT HAVE A DIFFERENT PROGNOSTIC IMPLICATION THAN A DIAGNOSTIC-TEST

In order to assess the clinical implications of the cytology of voided urine, we analyzed 65 patients among 147 cases of transitional cell c arcinoma (TCC) in relation to the cytohistologic correlation and progn ostic significance. Urinary cytology detected 42.6% of bladder tumors, 59% of renal pelvic tumors, and 35.3% of ureteral carcinomas. None of the 3 cases of grade-1 upper urinary tract tumors was detected by pre operative urinary cytology. Tumors with positive cytology were associa ted with epidermal growth factor receptor expression (p = 0.0009) and a higher fraction of tumor proliferation as defined by Ki-67 immunohis tochemistry (p = 0.0038). Anaplastic tumor cells in urine correlated f airly well with muscular invasion (p = 0.018) and the DNA aneuploidy o f the tumor (p = 0.0038). Tumors with muscular invasion were more like ly to be detected by cytologic examination (p = 0.013). In urinary bla dder carcinoma (n = 107), patients with positive cytology had a higher incidence of tumor recurrence (p = 0.004), and had an unfavorable pro gnosis (p = 0.0001) with a median follow-up of 46 months. In Ta-T1 tum ors (n = 87), urinary cytology had prognostic value in terms of risk o f recurrence (p = 0.0001), and poor patient outcome (p = 0.0001). Our data suggest that urinary cytology can offer important biological info rmation on TCC and may be used as a simple and effective short-term pr ognostic indicator.