Positive Voided Urine Cytology Research Articles

Prediction of pathological up-staging after radical nephroureterectomy in patients with upper tract urothelial carcinoma.

The diagnostic accuracy of computed tomography urography for upper tract urothelial carcinoma is high; however, difficulties are associated with precisely assessing the T stage. Preoperative tumor staging has an impact on treatment options for upper tract urothelial carcinoma. We herein attempted to identify preoperative factors that predict pathological tumor up-staging, which will facilitate the selection of treatment strategies. We retrospectively identified 148 patients with upper tract urothelial carcinoma who underwent computed tomography urography preoperatively followed by radical nephroureterectomy without preoperative chemotherapy at our institution between 2000 and 2021. Preoperative factors associated with cT2 or lower to pT3 up-staging were examined using a multivariate logistic regression analysis. Ninety out of 148 patients were diagnosed with cT2 or lower, and 22 (24%) were up-staged to pT3. A multivariate analysis identified a positive voided urine cytology (HR 4.69, p = 0.023) and tumor length ≥ 3cm (HR 6.33, p = 0.003) as independent predictors of pathological tumor up-staging. Patients diagnosed with cT2 or lower, but with preoperative positive voided urine cytology and/or tumor diameter ≥ 3cm need to be considered for treatment as cT3.

Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

BackgroundPerformance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).MethodsClinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.ResultsPreoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52).ConclusionPreoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

Is it necessary to carry out intraoperative retrograde upper urinary tract cytology examination in bladder cancer patients with normal upper urinary tract appearance and suspicious or positive voided urine cytology?

Is it necessary to carry out intraoperative retrograde upper urinary tract cytology examination in bladder cancer patients with normal upper urinary tract appearance and suspicious or positive voided urine cytology?

Positive voided urine cytology predicts worse pathological findings of nephroureterectomy specimens in patients with upper tract urothelial carcinoma: does selective ureteral cytology have an additional efficacy?

After radical nephroureterectomy, substantial numbers of patients with upper tract urothelial carcinoma are ineligible for adjuvant chemotherapy owing to diminished renal function. Accurate pre-operative prediction of worse pathological findings in radical nephroureterectomy specimens can guide appropriate patient selection for neoadjuvant chemotherapy. Herein, we evaluated pre-operative voided urine cytology and the additional efficacy of selective ureteral cytology for predicting pathological features in upper tract urothelial carcinoma patients. This retrospective cohort study comprised 722 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy. Patients with concomitant bladder cancer and those who received neoadjuvant therapy were excluded. Finally, 437 patients with urinary cytology data were enrolled in the study. We assessed the positive voided urine and selective ureteral cytology for predicting higher pathological T stage (≥ pT3), higher tumor grade (3) and positive lymphovascular invasion. Previous bladder cancer, tumor location, clinical T stage and voided urine cytology (P = 0.029) were independently associated with ≥ pT3, whereas selective ureteral cytology was not. Gender, clinical N category and voided urine cytology (P = 0.017) were independently associated with tumor Grade 3, whereas selective ureteral cytology was not. Hydronephrosis, clinical T stage, clinical N category and voided urine cytology (P = 0.0021) were independently associated with lymphovascular invasion, whereas selective ureteral cytology was not. Pre-operative positive voided urine cytology was an independent predictor for worse pathological findings in radical nephroureterectomy specimens, while selective ureteral cytology had no additional efficacy. However, further studies with larger numbers of patients and complete data sets are needed to select patients for more aggressive treatments including neoadjuvant chemotherapy.

PD4-07 PREOPERATIVE FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY ON THE DIAGNOSIS IN UPPER URINARY TRACT CANCER

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2015PD4-07 PREOPERATIVE FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY ON THE DIAGNOSIS IN UPPER URINARY TRACT CANCER Seiji Asai, Toshio Kakuda, Kouji Hara, Terutaka Noda, Kenichi Nishimura, Tetsuya Fukumoto, Noriyoshi Miura, Yutaka Yanagihara, Akitomi Shirato, Yuki Miyauchi, Tadahiko Kikugawa, Masao Miyagawa, Nozomu Tanji, and Masayoshi Yokoyama Seiji AsaiSeiji Asai More articles by this author , Toshio KakudaToshio Kakuda More articles by this author , Kouji HaraKouji Hara More articles by this author , Terutaka NodaTerutaka Noda More articles by this author , Kenichi NishimuraKenichi Nishimura More articles by this author , Tetsuya FukumotoTetsuya Fukumoto More articles by this author , Noriyoshi MiuraNoriyoshi Miura More articles by this author , Yutaka YanagiharaYutaka Yanagihara More articles by this author , Akitomi ShiratoAkitomi Shirato More articles by this author , Yuki MiyauchiYuki Miyauchi More articles by this author , Tadahiko KikugawaTadahiko Kikugawa More articles by this author , Masao MiyagawaMasao Miyagawa More articles by this author , Nozomu TanjiNozomu Tanji More articles by this author , and Masayoshi YokoyamaMasayoshi Yokoyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.319AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fluorodeoxygulcose positron emission tomography/computed tomography (FDG-PET/CT) is becoming useful for diagnosis, staging and prognosis in many cancers. In contrary, the use in urological oncology has been slower to develop because the radiotracer is excreted into the urine. Then, to assess the ability of preoperative FDG-PET/CT to detect upper urinary tract cancers (UUTC), compared with pathological examinations of tissues obtained by ureteroscopic biopsy or split cytologic analysis of urines obtained following retrograde pyelography. METHODS Clinicopathological records of patients who were examined by FDG-PET/CT were retrospectively reviewed. Sixty-four patients (66 lesions) with clinically suspected UUTC, who were diagnosed by ureteroscopy or nephroureterectomy or partial ureterectomy at our institution from September 2010 to September 2014, were included. The patient cohort consisted of 51 men and 13 women, with a median age of 73 (range 54–92) years. RESULTS 66 lesions were histologically diagnosed as 59 urothelial carcinomas and 1 clear cell carcinoma and 6 benign lesions. Only 22% of 58 lesions with UUTC had positive voided urine cytology and 45% of 47 lesions had positive split urine cytology. In addition, only 53 % of 15 lesions with UUTC had positive endoscopic biopsy. However, 83% of 60 lesions with UUTC had positive FDG-PET/CT examination. The positive predictive value was 93%. The sensitivities of <pT2 and ≥pT2 were 82% and 83%, respectively, and the sensitivities of G1, G2, and G3 tumors were 100%, 86%, and 82%, respectively. There were no correlations between the sensitivity in FDG-PET/CT and tumor stage or tumor grade. Mean SUVmax was 3.0 and 10.0 in benign lesions and UUTC, respectively. The difference was statistically significant (p=0.027). The ROC analysis showed that a SUVmax cut-off value to discriminate UUTC was 5.6. The sensitivity and the specificity were 76% and 80%, respectively. An area under the curve was 0.800 (Fig). CONCLUSIONS FDG-PET/CT was effective to detect UUTC. Furthermore, SUVmax had a role of supplementary index. FDG-PET/CT may be able to replace of endoscopic biopsy depending on the patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e89 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seiji Asai More articles by this author Toshio Kakuda More articles by this author Kouji Hara More articles by this author Terutaka Noda More articles by this author Kenichi Nishimura More articles by this author Tetsuya Fukumoto More articles by this author Noriyoshi Miura More articles by this author Yutaka Yanagihara More articles by this author Akitomi Shirato More articles by this author Yuki Miyauchi More articles by this author Tadahiko Kikugawa More articles by this author Masao Miyagawa More articles by this author Nozomu Tanji More articles by this author Masayoshi Yokoyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fluorodeoxyglucose positron emission tomography/computed tomography for diagnosis of upper urinary tract urothelial carcinoma.

The purpose of this study was to assess the ability of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to detect upper urinary tract urothelial carcinomas (UTUC) compared with pathological examination of tissues obtained by ureteroscopic biopsy and split cytologic analysis of urine obtained after retrograde pyelography. Clinicopathological records of patients at our institution were retrospectively reviewed. Fifty patients with clinically suspected UTUC, who were histologically diagnosed by nephroureterectomy, partial ureterectomy, or endoscopic biopsy, were included. The patient cohort included 42 men and 8 women, with a median age of 73 (range 54-92) years. Only 27 % of 49 patients with UTUC had positive voided urine cytology, and 33 % of 40 patients had positive split urine cytology. In addition, 40 % of 10 patients had a positive endoscopic biopsy. However, 83 % of 48 patients with UTUC had positive results from FDG-PET/CT examination. The positive predictive value of FDG-PET/CT was 95 %. There were no correlations between sensitivity and tumor stage or tumor grade. Sensitivity of FDG-PET/CT for patients with and without diabetes mellitus was 60 and 89 %, respectively. These preliminary results from a small number of patients revealed that FDG-PET/CT enabled effective detection of UTUC.

Bladder cancer: Normal cystoscopy, malignant cytology in NMIBC: why biopsy?

Bladder biopsy of normal-looking mucosa, as determined by cystoscopy, might not add clinical value in patients with positive voided-urine cytology after treatment of non-muscle-invasive bladder cancer. Methods to add value to bladder biopsies, such as characterization of molecular alterations, should be considered.

Significance of Positive Urine Cytology on Progression and Cancer-Specific Mortality of Non–Muscle-Invasive Bladder Cancer

BackgroundPositive results from voided urine cytology (VUC) indicate the fragility of the intercellular adhesion of bladder cancer cells, a critical biological process for invasion and metastasis, along with the presence of atypical cells. Few studies have focused on the prognostic role of VUC in non–muscle-invasive bladder cancer (NMIBC). MethodsBetween 2000 and 2010, 326 patients diagnosed pathologically with Ta or T1 bladder urothelial carcinoma underwent 597 transurethral resections of bladder tumor (TURBTs). Clinicopathological data were prospectively collected at each TURBT. Reports of cells of class IIIb or greater were considered positive VUC results. Muscle-invasive or metastatic recurrences were considered progression. Risk factors for progression and cancer-specific mortality (CSM) were determined using time-fixed and time-dependent Cox models. Variables at the study entry and at each TURBT were used for time-fixed and time-dependent models, respectively. ResultsThe 5-year cumulative progression and CSM rates were, respectively, 7% and 5% (median follow-up, 46 months). The 5-year cumulative progression and CSM rates for patients with positive VUC were 20% and 15%, respectively, compared with 2% (P < .0001) and 2% (P = .0002), respectively, for patients with negative VUC results. A positive VUC result was a significant and independent risk factor for progression and CSM in the time-fixed and time-dependent models. In time-dependent models, 7 predictors for progression or CSM were identified (positive VUC results, T1 disease, lack of intravesical instillation, higher prior recurrence rate, higher histological grade, male gender, and advanced age), whereas 3 predictors were identified in time-fixed models (positive VUC, T1 disease, and higher prior recurrence rate). VUC results consistently outperformed histological grade as a prognostic predictor. ConclusionPositive VUC results predict the progression and CSM of NMIBC, independent of and outperforming histological grade.

Intravesical Seeding of Upper Urinary Tract Urothelial Carcinoma Cells During Nephroureterectomy: An Exploratory Analysis from the THPMG Trial

The Pirarubicin Monotherapy Study Group trial was a randomized Phase II study that evaluated the efficacy of intravesical instillation of pirarubicin in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. This study conducted further analysis of the Pirarubicin Monotherapy Study Group cohort, focusing on intravesical seeding of cancer cells. Using the data from the Pirarubicin Monotherapy Study Group trial, bladder recurrence-free survival rates and factors associated with bladder recurrence in the control group were analyzed. Of 36 patients in the control group, 14 with positive urine cytology had more frequent recurrence when compared with the 22 patients with negative cytology (P = 0.004). Based on the multivariate analysis in the control group, voided urine cytology was an independent predictive factor of bladder recurrence (hazard ratio, 5.54; 95% confidence interval 1.12-27.5; P = 0.036). Of 72 patients in the Pirarubicin Monotherapy Study Group trial, 31 had positive urine cytology. Among the 31 patients, 17 patients who received pirarubicin instillation had fewer recurrences when compared with 14 patients who received control treatment (P = 0.0001). On multivariate analysis, pirarubicin instillation was an independent predictor of better recurrence-free survival rates in the patients with positive urine cytology (hazard ratio, 0.02; 95% confidence interval, 0.00-0.53; P = 0.018). Of 21 patients with bladder recurrence, 17 had recurrent tumor around cystotomy or in the bladder neck compromised by the urethral catheter, supporting the notion that tumor cells seeded in the injured urothelium. Intravesical instillation of pirarubicin immediately after nephroureterectomy significantly reduced the bladder recurrence rate in patients with positive voided urine cytology. The results suggest that intravesical seeding of upper urinary tract urothelial carcinoma occurs during nephroureterectomy.

Narrow-Band Imaging Flexible Cystoscopy in the Detection of Clinically Unconfirmed Positive Urine Cytology

Introduction: The objective of this study was to investigate the value of narrow-band imaging (NBI) cystoscopy in the detection of patients with positive voided urine cytology (VUC) who have no evidence of disease after standard initial investigations. Patients and Methods: Between February 2009 and December 2010, 12 patients with positive or suspicious VUC but no regular endoscopic evidence of cancer were investigated with NBI flexible cystoscopy. All the specimens were biopsied both under NBI and white light imaging (WLI). Random biopsies of bladder and prostatic urethra were performed in cases without suspect lesions. Results: Fourteen NBI cystoscopies were carried out in 12 patients. Non-muscle-invasive bladder cancer was diagnosed in 5 of 12 (42%) patients on the first NBI. One patient had carcinoma in situ diagnosed on repeat NBI 3 months later. The sensitivity and specificity in diagnosing unconfirmed positive VUC was 78 and 91% for NBI vs. 50 and 80% for WLI. Conclusions: NBI cystoscopy significantly improves detection of unconfirmed positive VUC over WLI. It should be carried out early in the investigation of such patients before random biopsies and ureteroscopy.

A Prospective Comparison of the NMP22 Bladderchek® Assay and Voided Urine Cytology in the Detection of Bladder Transitional Cell Carcinoma: Is it Time up for Urine Cytology?

Objectives: To prospectively compare the performance of voided urine cytology (VUC) and the Matritech NMP22 BladderChek® assay (NMP22) in their ability to detect urothelial transitional cell carcinoma (TCC). Methods: Successive patients presenting to our haematuria clinic were enrolled. All patients underwent ultrasound scan (US), intravenous urography (IVU), flexible cystoscopy and VUC. If bladder TCC was detected, urine was tested using the NMP22 BladderChek® assay. The study group (group I) comprised 110 patients diagnosed with bladder tumour on flexible cystoscopy. The control group (group II) included 52 patients with a history of haematuria but no demonstrable bladder tumour. The TCC detecting ability of both the NMP22 BladderChek® assay and VUC were compared. Results: In group I, the NMP22 result was positive in 62.7% (69/110) patients, while a positive VUC result was noted in 52.0% (52/100) patients. The overall sensitivity, specificity, positive predictive and negative predictive values for NMP22 vs. VUC were 62.7% vs. 52.0%; 86.5% vs. 95.5%; 90.8% vs. 96.3% and 52.3% vs. 48.0% respectively (not significant). The performance of both urine tests improved with increasing tumour grade ( p ≤ 0.05). False positive rate in group II was 13.5% (7/52) for NMP22 and 4.5% (2/42) for VUC. Conclusion: The diagnostic accuracy of the NMP22 BladderChek® assay for TCC detection is equivalent to conventional VUC, but the NMP22 BladderChek® has distinct advantages to promote its use over VUC.

Hexylaminolaevulinate fluorescence cystoscopy in patients previously treated with intravesical bacille Calmette‐Guérin

OBJECTIVE To determine if hexylaminolaevulinate fluorescence cystoscopy (HAL-FC) has the potential to improve the diagnosis of bladder cancer in patients who have been treated with bacille Calmette-Guérin (BCG). PATIENTS AND METHODS Patients scheduled for rigid cystoscopy after BCG therapy were recruited prospectively between April 2005 and February 2006. Patients received HAL (Hexvix, PhotoCure ASA, Oslo, Norway) and the D-light system (Storz, Tuttlingen, Germany) was used to detect fluorescence. The bladder was mapped and biopsies taken under white light and then using HAL-FC. The main outcome was the frequency and nature of additional pathology detected by HAL-FC. Twenty-seven patients (21 men and six women; median age 70 years, range 49-82) underwent 32 HAL-FC. RESULTS Recurrent bladder cancer was detected in 11 of the 32 (34%) examinations. HAL-FC detected additional pathology in five of the 27 (19%) patients. In two of these cases the additional pathology was clinically significant (one pT4G3 intraprostatic transitional cell carcinoma and one intravesical pT1G2 + carcinoma in situ), whereas in three cases the pathology was hyperplasia/dysplasia. Overall, the false-positive biopsy rate with HAL-FC was 63%. In the presence of positive voided urine cytology six of eight patients had recurrent bladder tumour and the false-positive biopsy rate was only 34%. Urine cytology was positive in four of five of the patients in whom additional pathology was detected by HAL-FC. CONCLUSIONS Clinically significant occult pathology can be detected using HAL-FC after BCG therapy, but in <10% of cases. The rate of false-positive biopsies is high but in our hands appears to be lower than with white-light guided biopsies after BCG. Our pragmatic approach is to use HAL-FC after BCG when clinical suspicion is high, and when the preoperative voided urine cytology is positive.

The usefulness of ureterorenoscopic examination in evaluation of upper tract disease

The objective of the present study was to clarify the indications, usefulness and limitations of ureterorenoscopy. From January 1998 to June 2004, 72 consecutive patients (48 men and 24 women) with a mean age of 66 years (range, 27-83 years) underwent ureterorenoscopy to diagnose upper urinary tract tumors (UUT). Median follow-up was 24 months (range, 1-73 months). Patients were divided into four subgroups by voided urine cytology and preoperative radiographic findings. Group A (n=11, 15.3%), positive voided urine cytology and positive preoperative radiographic findings; group B (n=5, 6.9%), positive cytology and negative radiographic findings; group C (n=48, 66.7%), negative cytology and positive radiographic findings and group D (n=8, 11.1%), frank hematuria originating from the UUT but negative cytology and negative radiographic findings. We compared the findings of ureterorenoscopic examination and biopsy with the results of retrograde pyelography and cytology of upper tract urine. For each examination, the following diagnostic indices were assessed: sensitivity, specificity, positive-predictive-value (PPV) and negative-predictive-value (NPV) and accuracy. Statistical analysis was performed using McNemar's test. For ureterorenoscopy, sensitivity was 94%, specificity 59%, PPV 72%, NPV 92% and accuracy 76%. For biopsy, sensitivity was 77%, specificity 100%, PPV 100%, NPV 80% and accuracy 88%. Accuracy of ureterorenoscopy tended to be superior to that of retrograde pyelography. Ureterorenoscopy was most useful in the group which consisted of 48 patients (66.7%) with negative voided urine cytology and positive preoperative radiographic findings. This group was the only group in which accuracy of ureterorenoscopic biopsy was superior to that of urine cytology, significantly (P=0.03). Results indicated that ureterorenoscopy is most suitable and gives superior accuracy in patients with positive radiographic findings and negative voiding cytology. Ureterorenoscopic biopsy of the upper urinary tract would provide useful information when considering therapeutic strategies, such as nephron-sparing management.

Long-term follow-up of noninvasive bladder tumours (stage Ta): recurrence and progression.

To evaluate long-term recurrence-free and progression-free survival of noninvasive bladder tumours (stage Ta), and the significance of simple risk factors, including concomitant epithelial dysplasia. The study included 217 patients with primary noninvasive bladder tumour (stage Ta) who were followed routinely for up to 20 years. Voided urine cytology (VUC) and preselected site biopsies (PSB) were obtained prospectively to evaluate the significance of concomitant epithelial dysplasia. The mean follow-up was 84 months (maximum 238). Of all tumours, 39% did not relapse, a further 20% recurred infrequently (less than once a year) and 41% recurred frequently, amongst which the most frequent were multiple and early recurrent tumours; 42 (19%) tumours progressed to stage T1+ and 23 (11%) progressed further (stage T2+ or metastases). No grade 1 tumours became invasive. Positive VUC or PSB, a short recurrence-free period or multiplicity, and size > 3 cm were significant predictive factors. The treatment and surveillance of epithelium-confined bladder tumours are discussed. Concomitant dysplasia and early recurrence are associated with considerable risk of progression in the long-term follow-up in a group of otherwise low-risk superficial bladder tumours (stage Ta).

Diagnostic Value of Voided Urine and Bladder Barbotage Cytology in Detecting Transitional Cell Carcinoma of the Urinary Tract

In this article we report on our experience with the use of urine cytology for the screening and diagnosis of transitional cell carcinoma (TCC) of the bladder and upper urinary tracts at our institution between January 1987 and December 1995. A total of 76 patients were included in the study. All patients had voided urine cytology studies read as positive or highly suspicious for malignancy and no prior history of TCC of the urinary tract. All these patients subsequently underwent cystoscopy, bladder/ureteral barbotage cytology, random bladder biopsies, and radiographic studies of the upper tracts. Of the 76 patients with positive urine cytology, 53 also had barbotage urine cytologies which were positive. Six of these patients were found to have cystoscopically evident TCC of the bladder, and 1 patient had upper tract TCC. Three other patients subsequently went on to develop TCC of the bladder at 52, 89 and 111 months of follow-up. An additional patient was diagnosed with upper tract TCC at 12 months of follow-up. Among the 23 patients with negative bladder/ureteral barbotage cytology, 3 patients, 2 at the time of initial cystoscopy, and one 15 months later, showed evidence of TCC. Median patient follow-up was 97 (range 35–132) months. Thus of 76 patients with initial positive voided urine cytology studies, only 9 proved to have TCC at initial work-up, while 5 other patients were diagnosed with TCC during a median follow-up of 97 months. The statistical diagnostic values of the bladder/ureteral barbotage urine cytology studies at the time of cystoscopic work-up were: sensitivity 77%; specificity 31%; positive predictive value 13%, and negative predictive value 91%. Our data suggest that in patients without a previous history of TCC, the diagnostic value of bladder barbotage urine cytology is insignificant, and therefore not cost effective to be included as part of the routine work-up of TCC. Moreover, in patients with initially positive voided urine cytology and negative work-up, if the cytology subsequently becomes negative, the likelihood of the development of TCC is low. However, if the initially positive cytology continues to remain positive, there is a much higher probability of TCC being detected in this population.