Use Of Urine Cytology Research Articles

From haematuria to nephroureterectomy via urine cytology-A case study.

Upper urinary tract urothelial carcinomas (UTUCs) are uncommon, accounting for only 5%‐10% of urothelial carcinomas. Radical nephroureterectomy with bladder cuff excision is the standard treatment of high‐risk UTUC. Therefore, accurate preoperative diagnosis, including the use of urine cytology, is essential for appropriate patient management. This case study details a patient's pathway from haematuria to nephroureterectomy.

Urine Cytology Rarely Escalates Clinical Management in the Surveillance of Non-muscle-Invasive Bladder Cancer.

The use of urine cytology in the surveillance of non-muscle invasive bladder cancer (NMIBC) is widely variable in clinical practice. We studied the impact of surveillance urine cytology on clinical decision making during NMIBC surveillance. A retrospective chart review was conducted on patients surveilled for clinical NMIBC from 2013 to 2020 with at least one follow-up cytology result after diagnosis. Patients were classified into risk categories according to American Urological Association (AUA) NMIBC guidelines. Data were obtained regarding tumor recurrence pathology and the frequency and findings of surveillance cystoscopies and urine cytologies. Positive (suspicious, malignant) and negative (atypical or negative for malignant cells) cytology results were correlated with cystoscopy and pathology findings when obtained within 3 months of the cytology specimen to determine if cytology impacted plan of care. Two hundred fourteen patients with NMIBC were followed for a median of 34 months, with 1045 urine cytologies collectively obtained over the surveillance period. There were no positive urine cytologies among patients with low-risk NMIBC; therefore, cytology did not change management in this cohort. The potential for cytology to escalate management for patients of any risk group (ie, positive cytology in the absence of positive cystoscopy or pathology findings) occurred in 30 (2.9%) cases. However, clinical decision making was only altered in 4 cases (0.4% of all cytologies). Less than 1% of urine cytology specimens collected during NMIBC surveillance impacted clinical management, none of whom had low-risk disease. The use of urine cytology for surveillance of low-risk NMIBC should continue to be strongly discouraged, as it did not change management in any such cases.

Management, surveillance patterns, and costs associated with low-grade papillary (Ta) nonmuscle-invasive bladder cancer.

464 Background: Low-risk non-muscle invasive bladder cancer (NMIBC) is associated with extremely low rates of progression and cancer-specific mortality, however, these patients may often receive non-guideline recommended and potentially costly surveillance and treatment(s). We sought to describe current surveillance and treatment practices, oncologic outcomes, and cost of care for low-grade papillary (LG Ta) NMIBC and identify predictors of increased cost of care. Methods: This population-based cohort study identified 13,054 patients diagnosed with LG Ta tumors in the Surveillance, Epidemiology and End Results-Medicare linked database from January 1, 2004 through December 31, 2013. The primary outcome was to characterize trends in population-level surveillance and treatment practice patterns over time among LG Ta patients. The secondary outcomes were recurrence, progression, and costs of care. Results: Of the 13,054 patients who met inclusion criteria, 9,596 (73.5%) were male and 3,485 (26.5%) were female, with a median age of 76 (Interquartile Range (IQR): 71–81) years. Rates of surveillance cystoscopy increased over the study period (79.3% to 81.5%, p = 0.007) with patients undergoing a median of three cystoscopies per year (IQR: 2–4). Rates of upper tract imaging utilization also increased, namely the use of computed tomography (CT) or magnetic resonance imaging (MRI) (30.4% to 47%, p < 0.001), with most patients undergoing a median of two imaging tests per year. Similarly, the use of urine cytology or other urine biomarkers also increased (44.8% to 54.9%, p < 0.001). Rates of compliance with current guidelines decreased over time suggesting overutilization of all surveillance testing modalities. A total of 17.2% of patients received intravesical bacillus-Calmette Guerin (BCG) and 6.1% received intravesical chemotherapy (excluding single perioperative dose). Among all LG Ta patients, 1.7% and 0.4% experienced disease recurrence and progression, respectively. Total annual median costs of LG Ta surveillance and care increased 1.6-fold from $34,792 to $53,986 over the study period, with increased expenditures noted among those with disease recurrence ($53,909 and $76,669). Conclusions: Despite low rates of disease recurrence or progression, rates of surveillance testing increased during the study period. Annual cost of care increased over time, particularly among patients with recurrent disease. Efforts to improve adherence to current practice guidelines, with the focus on limiting overutilization of surveillance testing and overtreatment, may mitigate associated rising costs of care.

Should National Institute for Clinical Excellence (NICE) Guidelines Remove Urine Cytology as a Suggested Adjunct in Suspected Bladder Cancer (haematuria) Investigations?

Background Despite National Institute for Clinical Excellence (NICE) guidelines suggesting the use of urine cytology (UC) for the diagnosis of bladder cancer, its use is variable. Reasons for this include sub-optimal sensitivity, financial cost, availability of alternative tests, and uncertainty over interpretation of results. Anecdotally, however, suspicious or malignant UC when other investigations are normal, occasionally leads to a cancer diagnosis. Therefore, we retrospectively assessed a cohort of our haematuria patients to determine the value of UC in cancer diagnosis and the clinical significance of atypical UC (graded as C3). Patients and methods We identified 3018 patients with haematuria referred on the suspected cancer pathway (“two-week wait”) in 2015. We retrospectively analysed clinical, demographic, and follow-up/outcome data in a random cohort of 500 cases. Results Median follow up was 58 months. Urological malignancy was diagnosed in 61/500 patients; all were identified by cystoscopy or imaging, i.e., irrespective of UC result. No cases of atypical UC re-presented with a ‘missed’ cancer diagnosis within the five-year follow-up period. However, suspicious and malignant cytology was associated with high-grade/aggressive tumours and subsequent tumour recurrence. Conclusion Urine cytology did not identify any cancers that were not already found by imaging or cystoscopy. Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for transurethral resection of bladder tumour (TURBT), however, it is unclear whether this might benefit patient outcomes. We conclude therefore that UC has no role in haematuria investigations.

Discrepancy between German S3 Guideline Recommendations and Daily Urologic Practice in the Management of Nonmuscle Invasive Bladder Cancer: Results of a Binational Survey

Introduction: Guideline recommendations are meant to help minimize morbidity and to improve the care of nonmuscle invasive bladder cancer (NMIBC) patients but studies have suggested an underuse of guideline-recommended care. The aim of this study was to evaluate the level of adherence of German and Austrian urologists to German guideline recommendations. Methods: A survey of 27 items evaluating diagnostic and therapeutic recommendations (15 cases of strong consensus and 6 cases of consensus) for NMIBC was administered among 14 urologic training courses. Survey construction and realization followed the checklist for reporting results of internet e-surveys and was approved by an internal review board. Results: Between January 2018 and June 2019, a total of 307 urologists responded to the questionnaire, with a mean response rate of 71%. The data showed a weak role of urine cytology (54%) for initial diagnostics although it is strongly recommended by the guideline. The most frequently used supporting diagnostic tool during transurethral resection of the bladder was hexaminolevulinate (95%). Contrary to the guideline recommendation, 38% of the participants performed a second resection in the case of pTa low-grade NMIBC. Correct monitoring of Bacille Calmette-Guérin (BCG) response with cystoscopy and cytology was performed by only 34% of the urologists. Conclusions: We found a discrepancy between certain guideline recommendations and daily routine practice concerning the use of urine cytology for initial diagnostics, instillation therapy with a low monitoring rate of BCG response, and follow-up care with unnecessary second resection after pTa low-grade NMIBC in particular. Our survey showed a moderate overall adherence rate of 73%. These results demonstrate the need for sharpening awareness of German guideline recommendations by promoting more intense education of urologists to optimize NMIBC care thus decreasing morbidity and mortality rates.

English

BACKGROUND Urine cytology when combined with cystoscopy remains a gold standard in screening and surveillance of urothelial carcinoma. Paris system for reporting urine cytology (PSRUC) gives seven well defined diagnostic criteria. We aimed to analyse utility of urine cytology in patients with urogenital symptoms, compare existing institutional system (EIS) with PSRUC and assess the performance of both reporting systems in predicting subsequent high-grade urothelial carcinoma on histopathology. METHODS A five year retrospective study included a total of 146 urine samples from 74 patients. Each case was assigned a category according to both EIS and PSRUC system. After cyto-histological correlation, sensitivity, specificity and diagnostic accuracy of urine cytology in detecting malignancy using PSRUC and EIS were determined. Performance of urine cytology in predicting subsequent high grade urothelial carcinoma (HGUC) was assessed for both reporting systems. RESULTS PSRUC resulted in reduction in number of cases assigned to atypical category (10.5 % vs. 3.4 %) and increase in low grade carcinomas assigned to NGUC category (66 % vs. 100 %). Positive predictive value (PPV) for predicting subsequent high grade urothelial carcinoma for HGUC and SHGUC category remained the same (100 %). Sensitivity (66.67 % vs. 55.5 %), specificity (100 % vs. 85.71 %) and diagnostic accuracy (81 % vs. 68.75 %) was improved with application of PSRUC when compared to EIS. Two cases of genitourinary tuberculosis were diagnosed. CONCLUSIONS PSRUC improves predictive accuracy of subsequent high-grade urothelial carcinoma on histopathology and it ensures uniformity in reporting. Judicious use of urine cytology might aid in early diagnosis of infectious conditions like tuberculosis. KEYWORDS PSRUC, Urine Cytology, High Grade Urothelial Carcinoma

The Usefulness of Urine Cytology in 290 Routine Voided Samples with Hematuria and Follow Up with Histopathology in 60 Cases

The Usefulness of Urine Cytology in 290 Routine Voided Samples with Hematuria and Follow Up with Histopathology in 60 Cases

Practice Patterns of Academic Urologists for Evaluating Microscopic Hematuria-How Well are We Following the Guidelines?

Asymptomatic microscopic hematuria is a common clinical entity that may portend significant urinary tract disease. Guidelines vary in how asymptomatic microscopic hematuria should be evaluated, with the AUA (American Urological Association) guidelines arguably being the most comprehensive. We evaluated the practice patterns of academic urologists with respect to the 2012 AUA asymptomatic microscopic hematuria guidelines. Records of patients who underwent evaluation for asymptomatic microscopic hematuria between 2012 and 2015 were retrospectively examined. The use of imaging, cystoscopy and urine cytology was analyzed. Factors such as age, gender, smoking status, history of nonurological malignancy, history of pelvic irradiation, presence of irritative voiding symptoms, use of anticoagulation, number of red blood cells on microscopic urinalysis and evaluation by an oncology fellowship trained urologist were assessed. Multivariable logistic regression analysis was performed to explore the association between patient or physician factors and adherence to the AUA guidelines. Among 1,049 patients with asymptomatic microscopic hematuria 247 (23.5%) were evaluated in complete accordance with AUA guidelines. Rates of adherence to the guidelines regarding imaging, cytology and cystoscopy were 48.2%, 54.2% and 72.5%, respectively. Much of nonadherence was due to lack of cross-sectional imaging (46.4%) and excessive use of urine cytology (45.8%). Guideline adherence was independently associated with smoking history, irritative voiding symptoms, history of nonurological malignancy and evaluation by a nononcology trained urologist. Overall adherence of urologists to the AUA asymptomatic microscopic hematuria guidelines was suboptimal. Efforts in limiting the use of urine cytology to high risk patients may be the most effective way of improving adherence.

Clinical usefulness of urine cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction.

IntroductionScreening for bladder cancer in patients with neurogenic lower urinary tract dysfunction is a challenge. Cystoscopy alone is not sufficient to detect bladder tumors in this patient group. We investigated the usefulness of combined cystoscopy and urine cytology.Materials and methodsBy a systematic chart review, we identified all patients with neurogenic lower urinary tract dysfunction who underwent combined cystoscopy and urine cytology testing. In patients with suspicious findings either in cytology or cystoscopy, transurethral resection was performed.ResultsSeventy-nine patients (age 54.8±14.3 years, 38 female, 41 male) were identified; 44 of these used indwelling catheters. Cystoscopy was suspicious in 25 patients and cytology was suspicious in 17 patients. Histologically, no tumor was found in 15 patients and bladder cancer was found in 6 patients. Sensitivity for both cytology and cystoscopy was 83.3%; specificity was 43.7% for cytology and 31.2% for cystoscopy. One bladder tumor was missed by cytology and three tumors were missed by cystoscopy. If a biopsy was taken only if both findings were suspicious, four patients would have been spared the procedure, and one tumor would not have been diagnosed.ConclusionA combination of cystoscopy and urine cytology can improve bladder tumor detection rates and lower the number of unnecessary biopsies.

Guideline of guidelines: asymptomatic microscopic haematuria.

The aim of the present study was to review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH). We reviewed the haematuria guidelines from: the American Urological Association; the consensus statement by the Canadian Urological Association, Canadian Urologic Oncology Group and Bladder Cancer Canada; the American College of Physicians; the Joint Consensus Statement of the Renal Association and British Association of Urological Surgeons; and the National Institute for Health and Care Excellence. All guidelines reviewed recommend evaluation for AMH in the absence of potential benign aetiologies, with the evaluation including cystoscopy and upper urinary tract imaging. Existing guidelines vary in their definition of AMH (role of urine dipstick vs urine microscopy), the age threshold for recommending evaluation, and the optimal imaging method (computed tomography vs ultrasonography). Of the reviewed guidelines, none recommended the use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation. Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, AMH represents a valuable future research opportunity.

Molecular Characterization of Polyomaviruses (BKV, JCV) in a Symptomatic Kidney Transplant Recipients in Sudan

Background: The present study was to investigate the polyomaviruses (BKV, JCV) in asymptomatic kidney transplant recipients and to characterize the polyomaviruses circulating in Sudan. Methodology: A total of 100 plasma and 100urine samples were collected randomly from renal transplant recipients, attending Sudanese Renal Transplantation Society, at the period between September 2012 to March 2013, and subjected to polymerase chain reaction assay to detect viral DNA, urine cytology also done to identify viral inclusion (decoy cell), DNA sequencing was done for some gene to confirm the result, phylogenetic analysis of BKV, JCV based on T large gene were done MEGA 6 software. Results: Among the 100 renal transplant patients the polyomaviruses were detected in 3 urine specimens 3/100 (3%) by using urine cytology technique, that showed nuclear inclusions (decoy cells). And also detected in 32 urine specimens 32/100 (32%) while only 6/100 (6%) of virus nucleic acid had been present in their patients plasma, by using conventional PCR method. Successful sequences of BK, JCV virus on T large gene were done for 6 specimens from the virus isolate PCR products. Conclusions: This is the first report on molecular characterization that describes the circulation of polyomaviruses (BKV, JCV) in Sudan, Human polyomavirus is related to different clinical manifestations among renal transplant patients. The routine use of urine cytology and PCR on urine and plasma is a useful tool for the rapid and sensitive detection of reactivated BKV in asymptomatic recipients.

Urethelial Dysplasia and Desquamation Associated with Urinary Tract Infection: A Case-controlled Study

This study explored use of urine cytology as an early first-line approach in the laboratory diagnosis of dysplasia associated with urinary tract infection. Fifty (50) patients attending the obstetrics and gynaecology clinic at Madonna University Teaching Hospital and 50 apparently healthy subjects were recruited for the study. Urine samples were cultured and analyzed using the dipstick and Giemsa methods. The result of this study revealed significant higher number of nitrite positive samples, bacteria and pus cells when female test subjects were compared with apparently healthy female subjects (p<0.05). The frequency of Staphylococcus aureus, Escherichia coli, Streptococcus faecalis and C. albicans identified is 50.6, 27.3, 10.4 and 9.1 %, respectively while other isolated Coliforms amounted to 2.6%. Microscopy revealed marked cytolyses, desquamation and abnormal nuclear/cytoplasmic ratio. S. aureus and E. coli induced higher exfoliation and morphological change (72.7%) compared to other isolates. In conclusion, this study suggests that chronic bacterial infection could lead to accelerated desquamation of cells and urothelial carcinoma. More so, it revealed that females are at a higher risk of developing epithelial neoplasia following UTI when compared to the males. Thus, urine smears could be used as first line approach in the early diagnosis of urothelial malignancy.

PD17-02 THE USE OF CYTOLOGY DURING THE WORKUP OF PATIENTS WITH PRIMARY MICROSCOPIC HEMATURIA: GUIDELINE COMPLIANCE PATTERNS AMONG A COHORT OF ACADEMIC UROLOGISTS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II1 Apr 2016PD17-02 THE USE OF CYTOLOGY DURING THE WORKUP OF PATIENTS WITH PRIMARY MICROSCOPIC HEMATURIA: GUIDELINE COMPLIANCE PATTERNS AMONG A COHORT OF ACADEMIC UROLOGISTS Patrick Samson, Paras Shah, Derek Friedman, Karly Stoltman, Vinay Patel, Simpa Salami, Andrew Ng, Manaf Alom, Jessica Kreshover, Joph Steckel, Manish Vira, Lee Richstone, Louis Kavoussi, and Justin Han Patrick SamsonPatrick Samson More articles by this author , Paras ShahParas Shah More articles by this author , Derek FriedmanDerek Friedman More articles by this author , Karly StoltmanKarly Stoltman More articles by this author , Vinay PatelVinay Patel More articles by this author , Simpa SalamiSimpa Salami More articles by this author , Andrew NgAndrew Ng More articles by this author , Manaf AlomManaf Alom More articles by this author , Jessica KreshoverJessica Kreshover More articles by this author , Joph SteckelJoph Steckel More articles by this author , Manish ViraManish Vira More articles by this author , Lee RichstoneLee Richstone More articles by this author , Louis KavoussiLouis Kavoussi More articles by this author , and Justin HanJustin Han More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1167AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The diagnostic utility of urine cytology in the workup of patients with primary microscopic hematuria (MH) has come into question given most urologic malignancies are reliably detected with cross-sectional imaging and cystoscopy. As such, the current AUA guidelines for MH regard cytology as an optional test, reserved for those who have concerning risk factors for malignancy. We evaluate the practice patterns of a cohort of twenty-three academic urologists serving a large geographical area with respect to the use of urine cytology in the workup of patients with primary MH. METHODS We retrospectively reviewed 2736 patients evaluated for MH between 2012 and 2015. Patients were stratified as “high-risk” if they possessed one or more risk factors for malignancy as specified by the AUA microscopic hematuria guidelines (smoking history, irritative voiding symptoms, chemotherapy exposure, and pelvic irradiation) versus “low-risk” if they lacked risk factors. Fisher's exact test was used to compare proportions of patients receiving cytology as part of their workup, stratified by risk group and urologist training (five oncology fellowship trained vs eighteen non-oncology fellowship trained). RESULTS Among 1761 patients with primary MH, 856 had risk factors that justified the use of cytology. Despite this, cytology was utilized in the evaluation of over 90% of low-risk patients. Interestingly, the rate of usage of cytology was significantly higher in low-risk compared with high-risk patients (90.7% vs 86.9%; p=0.002). When stratified by type of fellowship training, urologic oncologists were more likely to order cytology for low-risk patients compared with non-oncology trained urologists (98.9% vs 89.8%; p=0.004). The sensitivity for urothelial malignancy was 42.9%, whereas the positive predictive value among high-risk patients was 7.3%. CONCLUSIONS Despite being classified by current guidelines as an optional test, cytology remains a highly utilized screening tool for both low- and high-risk patients presenting with primary MH by both oncology-trained and non-oncology trained urologists. Given its marginal diagnostic yield, use of cytology likely represents an unnecessary medical expenditure especially in low risk patients. Stricter guideline statements are required to reduce its indiscriminate use during workup of patients with primary MH. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e399 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Patrick Samson More articles by this author Paras Shah More articles by this author Derek Friedman More articles by this author Karly Stoltman More articles by this author Vinay Patel More articles by this author Simpa Salami More articles by this author Andrew Ng More articles by this author Manaf Alom More articles by this author Jessica Kreshover More articles by this author Joph Steckel More articles by this author Manish Vira More articles by this author Lee Richstone More articles by this author Louis Kavoussi More articles by this author Justin Han More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation and screening of mRNA S100A genes as serological biomarkers in different stages of bladder cancer in Egypt.

Calcium-binding proteins S100A are multifunctional proteins that show altered expression in various diseases and cancers. This study aimed at validating an easier and less time-consuming technique to evaluate the value of combined use of messenger RNA (mRNA) S100A genes in comparison and combination with voided urine cytology in detection of bladder cancer patients. Blood and urine specimens were collected from patients (n = 120) with histologically confirmed bladder carcinoma who are classified according to bladder cancer stage into four groups and from healthy volunteers (n = 30). Histopathology examination, bilharzias antibody detection, urine cytology, and mRNA expression of S100A genes were estimated for all subjects by real time polymerase chain reaction (RT-PCR). Results indicate that each of the investigated S100A genes can be used as diagnostic marker for bladder cancer. Both S100A4 and S100A6 can be used to differentiate between different stages of bladder cancer. S100A7 can be used for the diagnosis of squamous cell carcinoma. Both S100A8 and S100A9 can be used for detection of invasive bladder carcinoma while S100A11 can be used for early detection of superficial bladder carcinoma. The overall sensitivity and specificity for the studied S100A genes ranged from 73 to 90 and 84 to 92, respectively. The combined use of urine cytology with the investigated S100A genes increased sensitivity from 56% up to a range of 87-96%. In conclusion, serum S100A genes can be useful as potential serological biomarkers for bladder cancer, and combined use of urine cytology with S100A genes can improve the sensitivity for detection of bladder cancer.

Prevalence of atypical urine cytology in patients treated with gemcitabine-cisplatin (GC) for urothelial carcinoma (UC).

363 Background: The prevalence of atypical urothelial cells (AUC) in the general population is estimated to range between 2-23% with known variability between individual pathologists’ use of this diagnosis. At our institution, the AUC rate for all urinary tract cytology (UTC) is 6.1%. Increased rates of urothelial atypia have been described in pts receiving certain systemic and intravesical therapies for UC. This may confound the use of UTC for post-therapy surveillance. Our objective is to describe the prevalence of urothelial atypia in pts treated with GC, as it is currently unknown. Methods: Patients who received at least one cycle of GC for UC at a single institution from 1/1/2007-9/30/2014 were identified. Demographics, clinical characteristics, treatment setting, number of cycles, and specimen type were recorded. Urine cytology reports were reviewed and tabulated. Results: Seventy-four pts treated with GC were identified. Median age at treatment was 65 (range 42-80); 58 (78%) were male. Median number of cycles was 4 (range 1-9). Treatment settings were: 15 (20%) neoadjuvant, 38 (51%) adjuvant, and 21 (28%) metastatic. Ten (14%) pts were previously treated with intravesical therapy (9 BCG, 1 mitomycin). Thirty-six (49%) pts had urine cytology available. Twenty-seven (75%) pts had at least 1 urine cytology within 12 months post-chemotherapy, with 44 total specimens. Nine (25%) pts had cytology performed &gt;1-year post treatment. Cytology specimens within 12 months post-chemotherapy were reviewed. Two out of 44 specimens had AUC (5%), with all other cases negative. The pts with AUC were male, received adjuvant therapy, had prior radical cystectomy with orthotopic neobladder reconstruction, and had no intravesical therapy. Conclusions: The prevalence of AUC in pts treated with GC was similar to the general population. Chemotherapy with GC does not appear to morphologically affect urothelial cells. If atypical UTC is seen in this population, the cause should be investigated, as GC does not appear to influence urothelial changes. Additional study is needed to characterize the impact of systemic therapy on urothelial atypia and to guide the use of urine cytology for post-therapy surveillance.

The Value of Combined Use of Survivin mRNA and Matrix Metalloproteinase 2 and 9 for Bladder Cancer Detection in Voided Urine

Objective: In a trial to improve the diagnostic efficacy of conventional urine cytology we determine survivin RNA and matrix metalloproteinase 2 and 9 in urine of bladder cancer cases.Method: Voided urine specimens were collected from patients with histologically confirmed bladder urothelial carcinoma (Group 1;n= 46), urological patients without urothelial carcinoma (Group 2;n= 20), and healthy volunteers (Group 3;n= 20). Urine cytology, survivin RNA was estimated by qualitative nested RT-PCR and MMP-2, MMP-9 activity were detected by gelatin zymography. The expression of survivin RNA and matrix metalloproteinase 2 and 9 in bladder cancer was compared with benign and normal cases.Results: Positivity rates of survivin RNA and MMPs zymography were significantly different among the 3 groups. Urine survivin detection by qualitative nested RT-PCR showed 76.1% sensitivity and 95% specificity. The overall sensitivity, specificity of urinary MMP zymography was 67.3%, 90% respectively. The combined use of urine cytology with urine survivin or MMPs zymography increased sensitivity of urine cytology from 50% to 84.7%. The highest sensitivity (95.6%) was obtained on combining the three markers.Conclusion: Survivin RNA and MMPS zymography can be considered as promising noninvasive markers for bladder cancer early detection. Combined use of the three markers improved the sensitivity for detecting bladder cancer.

The routine use of urine cytology in initial assessment in a one stop hematuria clinic: The controversy continues, but can it be resolved?

The routine use of urine cytology in initial assessment in a one stop hematuria clinic: The controversy continues, but can it be resolved?

The value of combined use of survivin mRNA and matrix metalloproteinase 2 and 9 for bladder cancer detection in voided urine.

Objective: In a trial to improve the diagnostic efficacy of conventional urine cytology we determine survivin RNA and matrix metalloproteinase 2 and 9 in urine of bladder cancer cases. Method: Voided urine specimens were collected from patients with histologically confirmed bladder urothelial carcinoma (Group 1; n = 46), urological patients without urothelial carcinoma (Group 2; n = 20), and healthy volunteers (Group 3; n = 20). Urine cytology, survivin RNA was estimated by qualitative nested RT-PCR and MMP-2, MMP-9 activity were detected by gelatin zymography. The expression of survivin RNA and matrix metalloproteinase 2 and 9 in bladder cancer was compared with benign and normal cases. Results: Positivity rates of survivin RNA and MMPs zymography were significantly different among the 3 groups. Urine survivin detection by qualitative nested RT-PCR showed 76.1% sensitivity and 95% specificity. The overall sensitivity, specificity of urinary MMP zymography was 67.3%, 90% respectively. The combined use of urine cytology with urine survivin or MMPs zymography increased sensitivity of urine cytology from 50% to 84.7%. The highest sensitivity (95.6%) was obtained on combining the three markers. Conclusion: Survivin RNA and MMPS zymography can be considered as promising noninvasive markers for bladder cancer early detection. Combined use of the three markers improved the sensitivity for detecting bladder cancer.

Cytological findings in routine voided urine samples with hematuria from a tertiary care center in south India

Background:Regardless of the availability of newer and more sophisticated modalities of investigation, urinary tract cytology still remains the most commonly used non-invasive test for the diagnosis of bladder cancer.Aims:As hematuria is the commonest presenting symptom in patients with malignancy of urinary tract, we undertook this study to know the usefulness of urine cytology in evaluation of the hematuric patients for malignancy.Materials and Methods:A total of 21,557 fresh voided urine samples received at our tertiary care referral centre over a period of three years were included in the study. Of these, 1428 cases had hematuria, criteria of either gross or microscopic. Results:Among these hematuric cases included in the study, 32.5% (464 cases) were found to have positive finding of atypical cells. In these cases with atypia, 9.5% (136 cases) were proved to have malignancy both with the histopathological biopsy and cystoscopic findings. Other cases of atypia were found to be of reactive origin, either due to instrumentation or foreign body. A large number of hematuric cases, that is, 964 cases (67.5%) were negative for atypical cells.Conclusions:The limited ability of urine cytology to detect low grade bladder tumors, its subjectivity and lack of uniformity in reporting, all render urine cytology a less than perfect tool. With added collaboration between clinician and cytopathologist, urine cytology can be used an adjunct tool in evaluation of patients with hematuria.

Challenges in non‐muscle invasive bladder cancer: lessons from a regional review

Surveillance programmes for bladder cancer are invasive and expensive. Existing guidelines are complex, and the capacity to implement these is untested. The present study examined treatment consistency, and ease of guideline implementation, for patients undergoing surveillance of non-muscle invasive bladder cancer. Eligible cancers treated between 1 January 2005 and 30 June 2009 were identified from a prospective database in a regional South Australian Urology service. Each was analysed with respect to the timing of cystoscopic surveillance and the use of intraoperative chemotherapy. For high-risk patients, the use of urine cytology, upper tract imaging, adjuvant therapy and re-resection of T1 cancers was reviewed. Eight hundred and nineteen cystoscopies were performed in the surveillance of 313 cancers in 193 patients. Within each risk category, the pattern of cystoscopic surveillance varied widely. In high-risk patients, the use of cytology, upper tract imaging, adjuvant therapy and re-resection was infrequent (3-56%). An attempt was made to standardize management through the implementation of guidelines. No overall practice improvement was observed after 18 months. Difficulty incorporating new algorithms into practice and ensuring a consistent longitudinal focus in care were felt contributory. Of 78 low-risk cancer patients, 55% underwent more cystoscopies than would have been expected. In 235 cancer patients at high or intermediate risk, 43% received less follow-up than would have been recommended. Surveillance patterns were inconsistent across all risk categories. The development of consensus recommendations did not significantly alter clinical practice. Implementation of clinical guidelines for this important disease represents a significant challenge in acute hospital settings.