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Unformatted text preview: DOI:10.1111/j.1365-2303.2006.00426.x Is urinary tract cytology still useful for diagnosis of bladder carcinomas? A large series of 592 bladder washings using a five-category classification of different cytological diagnoses C. Garbar*, C. Mascaux and E. Wespes *Department of Pathology, AZ-VUB, Free University of Brussels, Brussels, Belgium, Department of Pathology, Hospital Erasme, Free University of Brussels, Brussels, Belgium and Department of Urology, CHU de Charleroi, Espace sante , Charleroi, Belgium Accepted for publication 2 November 2006 C. Garbar, C. Mascaux and E. Wespes Is urinary tract cytology still useful for diagnosis of bladder carcinomas? A large series of 592 bladder washings using a five-category classification of different cytological diagnoses Background: The aim of this study was to estimate the efficiency of a recent five-category urinary cytological classification. Methods: A total of 592 bladder washings were fixed immediately with Saccomannos fixative. All samples were centrifuged in a Hettich cyto-centrifuge. For each sample, the reference standard was the histology when a lesion was present at the time of cystoscopy. A five-category cytological classification was used: negative, suspicious of low (S-Lg) or high (S-Hg) grade neoplasia and consistent with low (Lg) or high (Hg) grade neoplasia. Results: For cytological diagnoses of S-Lg and Lg, sensitivity was 37% and specificity was 95% for the histological diagnosis of low-grade non-invasive urothelial papillary tumour (Lg-UPT), which included papillary urothelial neoplasm of low malignant potential and low-grade urothelial carcinoma. For cytological diagnosis of S-Hg and Hg, sensitivity was 44% for high-grade non-invasive urothelial papillary carcinoma (Hg-UPC), 70% for carcinoma in situ (CIS) and 81% for invasive carcinoma (T1 and higher). Specificity was 99% in each case. Cytological diagnosis of S-Hg or Hg was not found for Lg-UPT (0/59) and no cytological diagnosis of S-Lg or Lg was found for invasive carcinoma, but was seen for Hg-UPC in 10% (3/28) and for CIS in 6% (3/50) of cases. Conclusion: Despite the absence of international consensus, the recent five-category cytological classification for urine is accurate for current urological practice. Keywords: cytodiagnosis, urine cytology, urine diagnosis, bladder washings, transitional cell carcinoma, laboratory techniques Background Urinary tract cytology is variously used by urologists and practitioners, probably because of the large difference in efficiency reported in the literature. It is known that urinary tract cytology offers poor sensitivity for low-grade urothelial neoplasias such as non-invasive urothelial papillary carcinoma (UPC) grade1, and better sensitivity for high-grade neopla- sias such as UPC grade2, UPC grade3, carcinoma in situ (CIS) and invasive carcinoma. All authors agree that urinary tract cytology is very specific....
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