Presence of carcinoma in situ and high 2c-deviation index are the best predictors of invasive transitional cell carcinoma of the bladder in patients with high-risk Quanticyt

Objectives. Karyometric analysis (Quanticyt) has proved of value as a cytol ogic marker for bladder cancer. This study was conducted to identify diagno stic and prognostic factors in a high-risk Quanticyt population to predict the prognosis of transitional cell carcinoma (TCC) of the bladder. Methods. Quanticyt is a karyometric system for quantitative bladder wash cy tologic findings based on two nuclear features: the 2c-deviation index (2cD I) and the mean of nuclear shape. Samples are scored as low, intermediate, or high risk. Before 1995, 109 patients with high-risk quantitative bladder wash cytologic findings were identified at our clinic. Four patients with previous invasive tumors were excluded. Results. Histologically proven malignancy was found in 54 of 105 patients a t first high-risk quantitative bladder wash cytologic findings. Invasive TC C was found in 16 patients, and another 10 patients had progression during a median follow-up of 3.7 years. in univariate analysis, the presence of ca rcinoma in situ (CIS), highest tumor grade, 2cDI, and highest tumor stage w ere significant predictors of progression. The presence of CIS proved to be the only predictor of progression in the multivariate analysis. A 2cDI of 2.00 c(2) or higher was a significant predictor of CIS, invasive TCC, and p rogression. At follow-up analysis after negative cystoscopy, 2cDI showed a tendency toward predicting progression. Conclusions. These data confirm earlier findings that CIS is an important m arker of progression. 2cDI as assessed by quantitative cytology is a practi cal tool to predict CIS, invasive TCC, and subsequent progression. A 2cDI o f 2.00 c(2) can be used to further stratify high-risk quantitative bladder wash cytologic findings. (C) 2000, Elsevier Science Inc.