Diagnostic accuracy of urinary cytology

Diagnostic accuracy of urinary cytology

433 SIDE-BY-SIDE COMPARISON MULTI-CENTER STUDY OF BLADDER CANCER TESTS IN A Lorenzo-Gomez M.F.‘, Schroeder G.L.‘, Hautmann S.H.‘, Friedrich M.G.‘...

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433 SIDE-BY-SIDE COMPARISON MULTI-CENTER STUDY

OF BLADDER

CANCER

TESTS

IN A

Lorenzo-Gomez M.F.‘, Schroeder G.L.‘, Hautmann S.H.‘, Friedrich M.G.‘, Ekici S.2, Huland H.‘, Lokeshwar V.B.’ University of Miami School of Medicine, Urology (M-800) Miami, United States .fAmerica, *University of Miami-School of Medicine, Urology (M-800) Miami, Florida, United States of America, ‘University Hospital Hamburg-Eppendorf, Urology, Hamburg, Germany INTRODUCTION & OBJECTIVES: Monitoring BCa patients for recurrence by a single or combination of non-invasive tests would decrease the number of surveillance cystoscopies, resulting in reduced medical costs and improved patients’ quality of life. The HA-HAase test, which measures urinary hyaluronic acid and hyaluronidase levels, has > 90% sensitivity and 84% specificity in detecting BCa and monitoring its recurrence. In this study we compared the performance of the HA-HAase test with the BTA-Stat (detects complement factor H and H-related protein), Hemastix (hematuria detection) and UBC-Rapid (detects cytokeratins 8 and 18) to detect Bca recurrence, in a multi-center study. MATERIAL & METHODS: Urine specimens were obtained from 139 patients with a history of BCa, from 3 institutions in Germany. The specimens were assayed by the HA-HAase test, the BTA-Stat (Bard/Bion Diagnostics), Hemastix (Bayer Corp.) and UBC-Rapid (IDL Biotech). Cystoscopy and histological findings made the clinical diagnosis. RESULTS: In a side-by-side comparison, the HA-HAase, BTA-Stat, Hemastix andUBC-Rapid had 88.9%, 49.2%, 47.6% and 33.3% sensitivity, respectively. The tests had 82.9% (HA-HAase), 72.4% (BTA-Stat), 78.9% (Hemastix) and 72.4% (UBC-Rapid) specificity, respectively. The accuracy, PPV and NPV of the HAHAase test (85.6%, 81 .I% and 90%) were the highest, followed by Hemastix (64.7%, 65.2%, 64.5%) the BTA-Stat (61.9%, 63.3%, 63.2%), and UBC-Rapid (54.5%, 53.8%, 56.7%), respectively. The high sensitivity of the HA-HAase test increased only slightly (from 88.9% to 90-92%) when it was combined with the BTA-Stat or UBC-Rapid, however, the specificity of such a combination was significantly lower (63%).

434 DIAGNOSTIC WT.‘, A.’

ACCURACY

OF URINARY CYTOLOGY

Plan.? B.‘, Jochims E.‘, Moormann O.‘, Caspers H.P.‘, Jakse G.‘, Boecking

‘Golzheim clinic, Urology, Dusseldorf, Germany, ‘University of Aachen, Urology, Aachen, Germany, ‘University of Dusseldorf, Institute of Cytopathology, Dusseldorf, Germany INTRODUCTION & OBJECTIVES: Urinary cytology is still the golden standard for detection of transitional cell carcinoma of the urinary bladder. The limitations of urinary cytology led to the development of new diagnostic marker and tests, The ideal marker should be rapid, inexpensive and non-invasive with high sensitivity and specificity. If the marker and urinary cytology are negative no offtce cystoscopy are necessary and the urologist may just perform endoscopy in the operating room. There are several candidates, but is urinary cytology still mandatory? MATERIAL & METHODS: 1777 voided urine and bladder wash specimens of 626 patients were evaluated by urinary cytology. Mean age was 62 f 14 years (4 -89). Spontaneously voided urine specimens were analysed by conventional cytology. Staining was performed as described by Papanicolaou. Urinary cytology was performed independently by different members of our pathology department using standard techniques. After collection of the voided urine and bladder wash specimens, respectively all patients underwent transurethral resection of suspicious bladder areas as first line therapy if cystoscopy and/or preceding biopsy was positive. Statistical differences were analysed using the 2-sided Fisher’s exact test and Cochran’s test. A p-value<0.05 was considered significant. RESULTS: Histology revealed a transitional cell carcinoma of the urinary bladder in 142 patients. 353 patients had no history of bladder cancer and bladder cancer was excluded by cystoscopy and randomised biopsies in all patients. In a total of 503 patients urinary cytology had a sensitivity of 38,2% and a specificity of 98,3% with a positive and negative predictive value of 90,6 and 78,6 respectively. Sensitivity increased significantly with malignancy grade @<0.05). Multiple samples could not improve sensitivity in detecting low-grade tumours. In high-grade tumours sensitivity improved from initial 52,2% up to 78,3% after the third sample. In sensitivity and specificity of spontaneously voided urine and barbotage washing samples no statistically significant difference was detected.

CONCLUSIONS: BCa recurrence can be effectively monitored by an accurate non-invasive test like the HA-HAase test. The HA-HAase test appears to be superior to the BTA-Stat, Hemastix and UBC-Rapid tests. SOURCE OF FUNDING: NIH/NCI CA72821 & ACS Florida Affiliate (VBL); the Scientific and Technical Research Council of Turkey (SE).

CONCLUSIONS: The results of this study, recent literature and a widespread practical use prove, that urinary cytology has its place as an additive diagnostic tool being a cheap procedure with known limitations. Nevertheless, additional tests or marker are mandatory and the successful combination of such non-invasive, urine bound methods underline the predictive potential of urinary cytology in bladder cancer.

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436

URINARY LEVEL ACTIVATOR AND BLADDER CANCER

OF UROKINASE-TYPE ITS RECEPTOR IN THE

PLASMINOGEN DETECTION OF

Zumbrlnel

Casella R.‘, Shariat S.‘, Monoski M.‘, Lerner S. ‘University Hospital. Urology. Basel. Switzerland. Urology, Houston, United States of America

5-AMINOLEVULINIC CYSTOSCOPY FOR RESULTS

‘Baylor College of Medicine.

INTRODUCTION St OBJECTIVES: We have previously found that plasma levels of urokinase-type plasminogen activator (uPA) and its receptor (uPAR) were elevated in bladder cancer patients and associated with features of biologically aggressive disease. In the present study, we tested the hypothesis that elevated urinary levels of uPA and uPAR would predict the presence of bladder malignancy. We compared the performance of uPA and uPAR with that of bladder washout cytology in the non-invasive diagnosis of bladder tumour. MATERIAL & METHODS: We utilized an enzyme-linked immunosorbent assay to compare levels of uPA and uPAR in urine collected before cystoscopy in 122 bladder cancer patients and 107 controls. 72 patients had clinical Tis or Ta malignancy and 50 had invasive disease (?TI); 85 patients had clinical grade 1or 2 tumours and 37 had grade 3 turnours. For cytology, only high grade atypia was considered positive. RESULTS: Urinary levels of uPA and uPAR were higher in cancer patients than in controls (P
ACID (5-ALA) INDUCED FLUORESCENCE SUPERFICIAL BLADDER CANCER: 5 YEAR

A., Bichler K.H.. Stenrl A

University of Tubingen,

Urology, Tiibingen. Germany

INTRODUCTION & OBJECTIVES: Several investigators reported that 5aminolevulinic acid induced fluorescence cystoscopy (= photodynamic diagnosis, PDD) improves the detection of bladder cancer. Only few studies reported on long term results. We would like to present our results from the past 5 years using PDD. MATERIAL & METHODS: From Jan. 1997 to Dec. 2001, 226 patients that are being suspected of bladder cancer a 1.5% ALA solution was given intravesically 2-4 hours prior to cystoscopy. The cystoscopy was performed first m white-light (WL) mode and suspected tumour areas were documented. Subsequently the bladder was inspected in PDD mode. In total 717 biopsies were taken and the endoscopic findings of WL and PDD were evaluated separately and compared later on the histopathological results. RESULTS: Tumours were diagnosed in 263/717 biopsies. 2121263 turnouts were detected in WL and 2531263 in PDD. In addition to that 86 dysplasias were found, out of which only 28 were detected in WL, 80 however were diagnosed through the PDD. The sensitivity in the detection of bladder cancer for WL- and PDD-cystoscopy was 81% and 96% respectively. These results were statistically significant (p
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