Quick-staining urinary cytology and bladder wash image analysis with an integrated risk classification - A worthwhile improvement in the follow-up ofbladder cancer?

BACKGROUND. With an end toward an increase in patient quality of life, morp hologic methods were tested for their combinatory value in expanding the ef fectiveness of follow-up appointments and finding a more specific supervisi on of patients with bladder cancer. METHODS. Voided urine and bladder washing specimens were gathered in 223 fo llow-up sessions of 124 patients with a history of bladder cancer. Hemacolo r (Merck, Darmstadt, Germany)-stained cytospin preparations of voided urine specimens were ready for diagnosis within 15 minutes, and results were ava ilable shortly before cystoscopy. Feulgen-Schiff-stained cytospin preparati ons of bladder washings entered the image analysis system. A special softwa re was used to classify the DNA histogram by a risk factor for bladder canc er. RESULTS. Follow-up of patients revealed 83 tumor recurrences. Depending on the grade of the underlying tumor, the sensitivity of quick-staining cytolo gy was 86.4%, 46.2%, or 13.6% for grade 3 to grade 1 TCC, respectively. Cyt ology and image analysis data demonstrated complementary potency. The combi nation of methods increased sensitivity to 90.9%, 66.7%, and 31.8%, respect ively. Although 24 of 140 image analyses denoted high risk for bladder canc er without simultaneously visible tumor, correct evidence of high risk coul d be found for 92.2%. CONCLUSIONS. The combinatory use of quick-staining urinary cytology and bla dder wash image analysis was demonstrated to be most valuable in diagnosing recurrent bladder cancer and selecting patients needing more intensive fol low-up. At a minimum of patients discomfort, the tested combination also se ems helpful to surpass diagnostic limits in cystoscopy and cytology caused by therapeutic effects on the bladder epithelium. Cancer (Cancer Cytopathol ) 1999;87:263-9. (C) 1999 American Cancer Society.