The sensitivity of bladder wash flow cytometry (BWFCM), voided urinary cytology (VUC), and cytology of catheterized urine obtained at the time of cystoscopy (CUC) were reviewed on all women evaluated for bladder cancer at Memorial Sloan-Kettering Cancer Center between June 1985 and December 1986. This comprised sixty-four episodes of pathologically proven bladder cancer in 48 women. Considering positive and suspicious results jointly the sensitivities of BWFCM, CUC and 3 VUC were 75%, 64% and 56%, respectively. If only positive results were considered (i.e., suspicious results considered as negative), the sensitivities of BWFCM, CUC and 3 VUC were 64%, 31% and 32%, respectively. The sensitivities of these tests are less than for a predominantly male population, presumably related to the presence of squamous epithelium and greater frequency of pyuria. However, bladder wash flow cytometry and conventional cytology are still a very valuable addition to cystoscopic examination, and the combination of BWFCM with conventional cytology is more sensitive than either procedure alone.Key terms: Bladder wash flow cytometry, voided urinary cytology, cystoscopyThe diagnosis and surveillance of patients with suspected bladder cancer are a multimodality process that may include cystoscopy, biopsy, cytology, and, in recent years, flow cytometry of bladder irrigation specimens. Data on the sensitivity of this latter examination have been based on patients unselected for sex, in a primarily male population (1). The urinary bladder in women is known to undergo squamous metaplasia, particularly about the trigone (6), and a difference in the cytology of urine specimens from men and women is well recognized (7). Both voided urine and bladder irrigation specimens of women contain more squamous epithelium and frequently more inflammatory cells than is the case in men. We have been concerned that these squamous and inflammatory cells in specimens from women might mask the presence of small populations of DNA aneuploid cells and lower the sensitivity of flow cytometry. Hence, this study was designed to evaluate the sensitivity of flow cytometry in the diagnosis of carcinoma of the bladder specifically in the female urologic patient.
MATERIALS AND METHODS Selection of Patients and Tumor CategoryForty-eight female patients evaluated a t Memorial Sloan-Kettering Cancer Center (MSKCC), over a n 18 month period in 1985 and 1986, had 64 separate episodes of histologically proved bladder cancer and simultaneous bladder wash flow cytometry (BWFCM). All patients were also evaluated by urinary cytology within 24 h r prior to the endoscopic biopsy. Based on the biopsy results, the neoplasms were divided into three groups: 26 low-grade, superficial papillary carcinomas (Ta and Tl); 13 grade 11-111, muscle-infiltrating carcinomas (T2); and 25 in situ carcinomas (TIS).Patient Population All 48 patients were white women ranging in age from 33 to 87 years, with a mean age of 63.9 years.~~~~~ ~