Detection and follow-up of carcinoma of the urinary bladder by flow cytometry.

Abstract

Automated flow cytometry (FCM) has been used to study saline bladder irrigation specimens from nearly 400 patients at Memorial Sloan-Kettering Cancer Center during the two-year period March 1979–March 1981. These include 36 patients with papilloma, 35 with noninvasive papillary transitional cell carcinoma, 71 with flat carcinoma in situ, and 52 with invasive carcinoma of the bladder, as well as 110 well patients with a history of low-stage bladder tumors (98 had two or more examinations) and 100 patients without neoplastic disease of the bladder. The false-positive rate for patients with normal bladders or non-neoplastic bladder diseases was 2% (two patients); both had severe cystitis and bladder calculi. The false-negative rate for the group with histologically proven tumors was 18%; excluding papilloma it was 7%. A FCM diagnosis of bladder tumor antedated the development of cystoscopically visible tumor by up to 12 months in 18 patients. Fourteen additional patients have positive FCM at present with or without positive conventional cytology and continue to be followed. These data suggest that FCM can provide an objective quantitative measure of the exfoliated epithelial cells in bladder irrigation specimens, and is at least as sensitive and specific as conventional urine cytology for the detection of cancer cells. An interpretation of each specimen is recorded on a computer-generated hard copy replica of the two-dimensional scattergrams, or pseudo-three-dimensionl projection of the data and used by the clinician as a permanent report of that specimen. FCM has a practical application in the detection and diagnosis of bladder carcinoma among subjects at high risk, and is of value in monitoring the course of this disease and anticipating recurrence following conservative treatment.