Cytology, flow cytometry, image analysis, and interphase cytogenetics by fluorescence in situ hybridization in the diagnosis of transitional cell carcinoma in bladder washes: A comparative study

Abstract

The diagnosis of transitional cell carcinoma (TCC) in bladder washes is a diagnostic challenge to cytology. This study assessed the role of flow cytometry (FCM), image analysis (IA), and interphase cytogenetics by fluorescence in situ hybridization (FISH) as adjuncts in the cytodiagnosis of TCC in bladder washes. Forty separate samples of bladder washes were prospectively evaluated by conventional cytology (CY), FCM, IA, and FISH, and the results were compared with the subsequent surgical biopsy specimens which revealed 26 TCC (3 GR I, 6 GR II, 17 GR III) and 14 benign lesions. Using histology as the "gold standard" and following the previously published criteria for detection of TCC by CY, FCM, IA, and FISH, the concordance rates between histology and CY, FCM, IA, and FISH were 75, 74, 89, and 83%, respectively. CY, FCM, IA, FISH, and histology were concordant in 54% of the cases. The sensitivity of CY, FCM, IA, and FISH were 61, 72, 91, and 73%, respectively, while the specificity were 100, 80, 83, and 100%, respectively. The combined sensitivity of all the parameters was 96%. Interestingly, the false positive cases by FCM and IA showed cystitis. We conclude that IA has the highest sensitivity in detecting TCC in bladder washes followed by FISH, FCM, and CY, while CY and FISH have the highest specificity. This study indicates that FCM, IA, and FISH are useful adjuncts to cytology in the diagnosis of TCC in bladder washes. The finding of DNA-aneuploidy in cystitis warrants further investigation.

Bladder Cancer Associated Glycoprotein Signatures Revealed by Urinary Proteomic Profiling

“…VUC can be used to diagnose new malignancy, yet while it has a specificity of >93%, its sensitivity is only 25-40%, especially for low-grade and lowstage tumors. 4 Furthermore, results are not available rapidly, it is prone to interobserver variation, and it is relatively expensive. Understandably, a good deal of research has focused on identifying potential urine tumor markers with higher sensitivity than urine cytology.…”

Diagnostic accuracy of optical coherence tomography in bladder cancer patients: A systematic review and meta-analysis

“…Cystoscopic evaluation is available for papillary transitional cell carcinoma (TCC); however, it is of low diagnostic sensitivity and specificity for differentiating non-papillary TCC, particularly CIS (29)(30)(31). Urine cytology has been proven to have potential advantages for bladder CIS and high-grade neoplasms, but is of quite low sensitivity for low-grade lesions and follow-up investigations of bladder cancer (32). The abovementioned methods are invasive detection techniques that remain insufficiently validated in terms of diagnosis and follow-up, particularly for low-grade bladder cancer.…”

Ancillary methods for the detection of recurrent urothelial neoplasia

“…49 Early hope that DNA aneuploidy would be a major adjunct to the cytologic detection of recurrent urothelial carcinoma ultimately gave way to the reality that the technique could improve on the sensitivity and specificity of cytology only to a marginal degree. 50,51 Improvements in flow cytometric techniques, including dual parameter immunoflow cytometry, have achieved an increased sensitivity for the detection of WHO system Grade 1 transitional cell carcinomas (urothelial neoplasms of low malignant potential) to 86%. 52 The introduction of DNA content measurements by digital static image analysis (Fig 3) in the late 1980s also reported an increase in the sensitivity and specificity for the detection of recurrent urothelial malignancies.…”