As. Shabaik et al., ROLE OF DNA IMAGE CYTOMETRY IN THE FOLLOW-UP OF PATIENTS WITH URINARY-TRACT TRANSITIONAL CELL-CARCINOMA, Analytical and quantitative cytology and histology, 15(2), 1993, pp. 115-123
Detection of recurrent urinary tract transitional cell carcinoma (TCC)
is a frequent diagnostic challenge in exfoliative cytology because of
the difficulty in distinguishing reactive changes from low grade tumo
rs. This study evaluated the role of DNA analysis by image cytometry (
ICM) as a diagnostic aid to cytology. Eighty-seven urine samples from
patients with a known history of transitional cell carcinoma were exam
ined by both cytology and ICM, and the results were compared with conc
urrent surgical biopsy specimens and patients' follow-up data. Twenty-
seven patients were also examined by cystoscopy, and the results were
compared to those of DNA analysis, cytology and biopsy. Urine samples
were cytocentrifuged and stained with Papanicolaou stain for general c
ytology and Feulgen stain for ICM. DNA ploidy and the proliferating ce
ll fraction (SG2M) were measured using the CAS 200 image analyzer. Amo
ng the 87 specimens included in the study, 59 were from patients consi
dered to have recurrent disease when urine was obtained. Of the 59 rec
urrences, 33 were detected by cytology, 50 by ICM and 50 by biopsy, re
sulting in 55%, 85% and 85% sensitivity, respectively. When combined,
cytology and ICM detected 53 recurrences and achieved 90% sensitivity.
Nine cases originally undetected by biopsy had abnormal DNA histogram
s and were found to have TCC on follow-up examination. All cases undet
ected by ICM were low grade lesions with DNA diploidy and low prolifer
ation. Among the 27 patients examined by cystoscopy, 14 had recurrent
disease; 5,13 and 6 of those cases were detected by cystoscopy, DNA an
alysis and cytology, respectively. The present data indicate that DNA
analysis by ICM is a useful adjunct to cytopathology in the follow-up
of patients with TCC of the urinary tract and that recurrence may go u
ndetected if using cystoscopy, cytology or biopsy alone.