Low grade transitional cell carcinoma of the bladder. Cytologic Diagnosis by Key Features as Identified by Logistic Regression Analysis

Abstract

Background. Bladder cytology is being used increasingly to detect and monitor early stage bladder cancer. Because of the lack of significant cytomorphologic atypia in low grade transitional cell carcinomas (TCCs), there often is great difficulty in separating these neoplastic cells from benign urothelial cells. Methods. In an attempt to increase diagnostic sensitivity, 82 bladder wash specimens, which included 33 low grade TCCs and 49 nonneoplastic lesions, were reviewed retrospectively. With a stepwise logistic regression analysis, three key cytomorphologic criteria useful in the separation of low grade TCC from benign urothelium were identified. Results. The key cytologic criteria were increased nuclear/cytoplasmic ratios, irregular nuclear borders, and cytoplasmic homogeneity. By using contingency tables, these three criteria combined had a sensitivity of 45% and a specificity of 98% in the diagnosis of low grade transitional cell carcinoma. If any two of the criteria were present, there was a sensitivity of 85% and a specificity of 96%. Conclusions. By using these three criteria, the diagnosis of TCC can be made with a high degree of accuracy in bladder wash specimens.

The clinical relevance of urine-based markers for diagnosis of bladder cancer

“…Although cystoscopy, contrast urography, and ultrasound are to date the most powerful methods for the diagnosis and monitoring of bladder tumors, they are uncomfortable and labor-intensive procedures [2]. Urine cytology, although simple and highly specific, has insufficient sensitivity to be routinely useful, particularly in the diagnosis of well-differentiated, earlystage neoplasms, which are the most amenable to successful treatment [3].…”

CK20 and Ki-67 as significant prognostic factors in human bladder carcinoma

“…Thus, these findings suggest a pressing need to identify patients who are at high risk of disease recurrence following radical cystectomy. The most commonly utilized cytological examination of urine has a high specificity, but gives false-negatives in about half of cases, mainly in patients with low-grade, early stage tumors [6,7]. So it is of great significance to search for a more sensitive and more specific BCa marker that can provide valuable information for the diagnosis and treatment of the disease.…”

Subclassifying atypical urinary cytology specimens

“…Specifically, the finding of necrosis and anisonucleosis consistently is found to be a very specific marker (approaching 100%) of neoplasia, although with a relatively low sensitivity (10%). 10,15 Nevertheless, in my experience, the above classification appears to work for the vast majority of cases that are not classified easily as negative, suspicious, or posi- tive. Hopefully, this method of pattern diagnosis will make the classification of these difficult cases easier, more focused, more rewarding, and more useful clinically.…”