Summary Lactate dehydrogenase (LDH) isoenzyme distribution was examined in 106 urine samples being tested cytologically for evidence of bladder cancer; the samples were selected to have <20 leucocytes and erythrocytes per high power field and the LDH pattern determined by electrophoresis. The Papanicolaou stained-smears showed 68 negative, 17 suspicious and 21 positive. The LDH M-fraction of the urinary supernatant in cytologically positive cases was significantly greater than in negative cases, although the latter included a few false negative samples. Some of the false negatives gave positive results for the LDH M-fraction; these results suggest that the determination of LDH isoenzymes in the urine is useful in diagnosing urinary tract cancers, including early stage, and for follow-up of patients with bladder cancers after surgical resection.Because of such advantages as the ease of sample collection, the ability to test frequently and the absence of risk to patients, urine cytology has been regarded as one of the most useful diagnostic procedures for the screening of urinary tract neoplasms as well as for their post-operative follow-up (Fujii et al., 1982 (Fujii et al., 1982).The presence of lactate dehydrogenase (LDH) activity in urine was initially reported by Rosalki and Wilkinson (1959). Although Wacker and Dorfman (1962) noted elevated levels of LDH activity in the urine of patients with carcinoma of the urinary tract, the elevation of total urinary LDH activity is not now assumed to be cancer specific (Posey & Morgan, 1977). Increased urinary LDH may reflect contamination of urine with cells such as polymorphonuclear leucocytes, or proteinuria rather than the presence of neoplasia (Mirabile et al., 1966;Malik et al., 1983). It has also been suggested that urinary LDH isoenzyme patterns vary according to the site of inflammation in the urinary tract (Devaskar & Montogomery, 1978). However, unless urine is heavily contaminated with inflammatory cells, the M-fraction of urinary LDH may increase with the rising stage and the grade of the bladder tumour (Mortomiya et al., 1975(Mortomiya et al., , 1979. Therefore, it has been emphasised that the combination of urinary cytology and the determination of urinary LDH isoenzymes may be of value in the diagnosis of bladder tumours (Motomiya et al., 1975(Motomiya et al., , 1979. In the present study, urinary LDH isoenzymes were evaluated in urinary specimens examined by routine cytology.
Materials and methodsUrinary specimens collected from routine cytology were centrifuged at 1,500 r.p.m. for 10 min. The method. Simultaneously, air-dried smears were also prepared for Giemsa stain to determine the number of contaminating leucocytes and erythrocytes per high powered field (x 400). Cytological findings were interpreted as negative, suspicious or positive for malignant cells in the Papanicolaou-smears.Thus, a total of 106 specimens which contained less tjhan 20 leucocytes and less than 20 erythrocytes per high power field and were cytologically diagnosed as negative...