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The Sensitivity of Bladder Wash Flow Cytometry, Baldder Wash Cytology and Voided Cytology in the Detection of Bladder Carcinoma
EARLY DETECTION OF UROLOGIC CANCER BY HEMAlURIA HOMESCREENING IN HEALTHY MEN OVER AGE Edward M. Messing~ Theresa B. Young~ Vernon
, and Jennifer
b~ehbie'~ Madison, WI (Presentat1on to be made by Or. Mess',ng) To determine whether hematur1a screening using a urinary dipstick could detect early stage transitional cell carcinoma {TCC) of the bladder and renal cell carcinoma (RCC), a home testing program in whkh unselected healthy men ;::age 50 was undertaken. Subjects, solicited by mall, were asked to test their urine daily for 5 days and then weekly thereafter. If a single test was >"trace• positive men underwent a urolog1c evaluation which c~nslsted of physical examination, microscopic urinalysis (UA), urine culture, complete blood count, intravenous urogram, cystoscopy, and bladder wash cytology. 538 men were contacted, 355 (66%) agreed to participate and so far, 235 (44%) have tested their urine for 9 months or until hematuria has occurred. 41 men have had at least l positive test, of wh1ch 29 have agreed to be evaluated (4 refused, 5 had been recently worked-up for hematur1a and 3 were considered too 111 to be evaluated). In 24 of 29 men (83%), a cause for hematuria has been found, and in 14 (48¼) the cause has required immediate medical/surgical treatment. 8 men (3.4% of participants) have had TCC (N=5) or RCC (N=3), all detected at stages where therapy was likely to be curative. Other serious causes of hematuria included obstructing calculi (N=3) and bladder outlet obstruction with urinary retent1on of >200 ml (N=3). The degree of hematuria was unrelated to the seriousness of its underlying cause and in almost all instances, hematuria was extremely intermlttant. The cost of negative screening in this population (dipstick negative men and dipstick positive men with no serious cause detected) was $30/subject/year To date, no dipstick negative participant has been found to have a serious urologlc disease. We conclude that: l) because of hematuria's 1nterm1ttency, screening must be performed repeatedly; and 2) hematuria homescreen1ng with urinary dipsticks Is feasible, economical, and capable of detecting cancers and other serious urologlc diseases at early stages.
447
PATIENTS WITH BLADDER TUMORS, Masaaki Tachibana,* Seido Jitsukawa, * Tomohiko Iigaya 1 * Shiro Baba,* Makoto Hata* and Hiroshi Tazaki 1 Tokyo, Japan (Presentation to be made by Dr. Tachibana) A total of 446 flow cytometric DNA histograms from 120 patients were analyzed to find whether flow cytometry (FCM) can replace conventional urological examinations including cystoscopy in followup of patients with bladder cancers, These 120 patients included those with cystoscopically visible tumors and those without tumors but have history of bladder cancers, Specimens for FCM were obtained by bladder washing with 50 ml of normal saline. Also performed simultaneously was conventional urine cytology. Seventy-five point three percent of 198 FCMs from 100 patients who had cystoscopically visible tumors revealed abnormal DNA distribution, whereas 44.6% of them positive urine cytology, Particurally 1 8809% from grade-3 bladder tumors showed positive FCM results, Furthermore, 80. 7% of tumors could be detected when both FCM and urine cytology were utilized. When a correlation between FCM and urine cytology of the 446 specimens was evaluatedr 17.7% was both positive and 52.5% both negative, thus agreement of the results between cytology and FCM was noted in 70% of the 446 specimens. Eighty-four percent of those of positive urine cytology specimens showed positive FCM. .Meanwhile, 26.7% of the 446 specimens showed positive FCM results but had negative urine cytology, These results indicated that the analysis of DNA histograms of bladder irrigation specimens by FCM can predict latent neoplastic lesions in the bladder" 'rhis technique can decrease the frequency of but can not totally eliminate cystoscopy in followup of patients with bladder twnors. Bladder tumors tend to become invasive with increasing grade of the tumor. With high diagnostic accuracy to detect high grade bladder tumors, FCM technique should be a valuable adjunct in the management of patients with bladder tumors.
448
THE SENSITIVITY OF BLADDER WASH FLOW CYTOMETRY, BALDDER WASH CY'EOLOGY AND VOIDED CYTOLOGY IN THE DETECTION OF BLADDER CARCINOMA. *Robert A. Badalament,,*Dane
THE ROLE OF FLOW CYTOMETRIC DNA-ANALYSIS IN FOLLOWUP OF
K.
Hermansen, *Marek
Kimmel,
*Helen Gay and *Myron R. Melamed, New York, NY (Presentation to be made by Dr. Badalamenti The sensitivity of voided urinary cytology (VUC), bladder wash cytology (B"IC) and bladder wash flow cytometry (BWFCM) was studied in 70 ients wifh biopsy proven bladder carcinoma papil loma, 14 'I'A, 18 TIS, 19 Tl and 8 T2 tumors). One to five VUC per patient (mean 2.5) were obtained within the 24 hours preceeding biopsy. Immediate 1 y before endoscopy a b 1 adder WC\sh specimen was obtained and divided for cyto 1 og ic dnd f 1 ow cytometric examinations. For ull T catc:gories combinedp the sensitivity was 41%, 41%, and 60% for 1, 2 and 3 voided cytologic examinations per patient, respectivel The sensitivity of a single BWC was 61%, a of a single BWFCM \Vas 86%. The results indicate that one Bls/f'CM is more sensitive than 3 \/UC (binomial test; p=0.006), that one BWC is more sensitive than 2 VUC (p=0.01), and that one Bl•lFCM is more sensitive than one BWC (p=0.003). These findings remain significant (p<0.02) when papil lomas and T2 tumors are ex-c~luded from the analysis. In patients with bladder cancer, irrigation specimens appear to be more sensitive than voided urinary samples and that BWFCM is more sensitive BWC
THE SENSITIVITY OF FLOW CYTOMETRY (FCM) COMPARED WITH CO"NVENTIONAL CYTOLOGY IN 'l'l!E D~'IECTION 01• SUPLRPlCI BLADDER CARCJNOMA. RObfrt A. Eadalament, Fimruel, Helen Gay 1 Edrr,und c Cibas and Myron R. Melamed, New York, NY (present~tion tc te rnade by Dr. EadJlarrent) 228 patients (pts) with biopsy proven superficial bladder cancer were divided in 3 grou by 'l' category: 110 with TIS, 54 with 'l'I\,
and
with Tl tumors.
O~e to six conventional
(voidEd) cytologies per pt (mean 2.8) were obtained within the 24 hcur period prececding bicpsyo For a 11 '1 or ies combined, the sensitivity was 49%f 54 1 62%, and 66% for 1, 2, 3, and 4 cytclogic examinations i-:er pt, respectively" Cytologic sensitivity varied according tc T category; it was greater in the TIS and Tl ics than in the 'IA catc(Jory. cytology, a subset of 103 iwmediately prier to biopsy, a tl irriyation pertcrmE·d 11vhich was subsequc.~ntly ana 1 yzed by FC'fvl. Tl~e sensitivity of a :::: ir.CJ 1 e FCJ.v~ exctmination for a 11 T categories combinecl was 78%. As witll cytology, the sensitivity cf FCM varied with 1' category: it wns greater in TIS and Tl categories than in the TA category" Within the subset of 103 pts, the sensitivity ot one FCM exawination was superior (bino1nial test; p~0.05) to that of one or two q,tologic exa1r:inations for TP. turr:or2 and to that of one, twc or three cytologic exarr.inations for TIS, 'l'l and all T categories combined. Only three of 103 patients had their cancers detected by cytology and not by FCM. The data indicates that in pts with superficial bladder cancer FCM is more sensitive than voided cytole~y and that when used jointly sensitivity is not appreciably i r,crE.-ased. 1
215A
, and Jennifer
b~ehbie'~ Madison, WI (Presentat1on to be made by Or. Mess',ng) To determine whether hematur1a screening using a urinary dipstick could detect early stage transitional cell carcinoma {TCC) of the bladder and renal cell carcinoma (RCC), a home testing program in whkh unselected healthy men ;::age 50 was undertaken. Subjects, solicited by mall, were asked to test their urine daily for 5 days and then weekly thereafter. If a single test was >"trace• positive men underwent a urolog1c evaluation which c~nslsted of physical examination, microscopic urinalysis (UA), urine culture, complete blood count, intravenous urogram, cystoscopy, and bladder wash cytology. 538 men were contacted, 355 (66%) agreed to participate and so far, 235 (44%) have tested their urine for 9 months or until hematuria has occurred. 41 men have had at least l positive test, of wh1ch 29 have agreed to be evaluated (4 refused, 5 had been recently worked-up for hematur1a and 3 were considered too 111 to be evaluated). In 24 of 29 men (83%), a cause for hematuria has been found, and in 14 (48¼) the cause has required immediate medical/surgical treatment. 8 men (3.4% of participants) have had TCC (N=5) or RCC (N=3), all detected at stages where therapy was likely to be curative. Other serious causes of hematuria included obstructing calculi (N=3) and bladder outlet obstruction with urinary retent1on of >200 ml (N=3). The degree of hematuria was unrelated to the seriousness of its underlying cause and in almost all instances, hematuria was extremely intermlttant. The cost of negative screening in this population (dipstick negative men and dipstick positive men with no serious cause detected) was $30/subject/year To date, no dipstick negative participant has been found to have a serious urologlc disease. We conclude that: l) because of hematuria's 1nterm1ttency, screening must be performed repeatedly; and 2) hematuria homescreen1ng with urinary dipsticks Is feasible, economical, and capable of detecting cancers and other serious urologlc diseases at early stages.
447
PATIENTS WITH BLADDER TUMORS, Masaaki Tachibana,* Seido Jitsukawa, * Tomohiko Iigaya 1 * Shiro Baba,* Makoto Hata* and Hiroshi Tazaki 1 Tokyo, Japan (Presentation to be made by Dr. Tachibana) A total of 446 flow cytometric DNA histograms from 120 patients were analyzed to find whether flow cytometry (FCM) can replace conventional urological examinations including cystoscopy in followup of patients with bladder cancers, These 120 patients included those with cystoscopically visible tumors and those without tumors but have history of bladder cancers, Specimens for FCM were obtained by bladder washing with 50 ml of normal saline. Also performed simultaneously was conventional urine cytology. Seventy-five point three percent of 198 FCMs from 100 patients who had cystoscopically visible tumors revealed abnormal DNA distribution, whereas 44.6% of them positive urine cytology, Particurally 1 8809% from grade-3 bladder tumors showed positive FCM results, Furthermore, 80. 7% of tumors could be detected when both FCM and urine cytology were utilized. When a correlation between FCM and urine cytology of the 446 specimens was evaluatedr 17.7% was both positive and 52.5% both negative, thus agreement of the results between cytology and FCM was noted in 70% of the 446 specimens. Eighty-four percent of those of positive urine cytology specimens showed positive FCM. .Meanwhile, 26.7% of the 446 specimens showed positive FCM results but had negative urine cytology, These results indicated that the analysis of DNA histograms of bladder irrigation specimens by FCM can predict latent neoplastic lesions in the bladder" 'rhis technique can decrease the frequency of but can not totally eliminate cystoscopy in followup of patients with bladder twnors. Bladder tumors tend to become invasive with increasing grade of the tumor. With high diagnostic accuracy to detect high grade bladder tumors, FCM technique should be a valuable adjunct in the management of patients with bladder tumors.
448
THE SENSITIVITY OF BLADDER WASH FLOW CYTOMETRY, BALDDER WASH CY'EOLOGY AND VOIDED CYTOLOGY IN THE DETECTION OF BLADDER CARCINOMA. *Robert A. Badalament,,*Dane
THE ROLE OF FLOW CYTOMETRIC DNA-ANALYSIS IN FOLLOWUP OF
K.
Hermansen, *Marek
Kimmel,
*Helen Gay and *Myron R. Melamed, New York, NY (Presentation to be made by Dr. Badalamenti The sensitivity of voided urinary cytology (VUC), bladder wash cytology (B"IC) and bladder wash flow cytometry (BWFCM) was studied in 70 ients wifh biopsy proven bladder carcinoma papil loma, 14 'I'A, 18 TIS, 19 Tl and 8 T2 tumors). One to five VUC per patient (mean 2.5) were obtained within the 24 hours preceeding biopsy. Immediate 1 y before endoscopy a b 1 adder WC\sh specimen was obtained and divided for cyto 1 og ic dnd f 1 ow cytometric examinations. For ull T catc:gories combinedp the sensitivity was 41%, 41%, and 60% for 1, 2 and 3 voided cytologic examinations per patient, respectivel The sensitivity of a single BWC was 61%, a of a single BWFCM \Vas 86%. The results indicate that one Bls/f'CM is more sensitive than 3 \/UC (binomial test; p=0.006), that one BWC is more sensitive than 2 VUC (p=0.01), and that one Bl•lFCM is more sensitive than one BWC (p=0.003). These findings remain significant (p<0.02) when papil lomas and T2 tumors are ex-c~luded from the analysis. In patients with bladder cancer, irrigation specimens appear to be more sensitive than voided urinary samples and that BWFCM is more sensitive BWC
THE SENSITIVITY OF FLOW CYTOMETRY (FCM) COMPARED WITH CO"NVENTIONAL CYTOLOGY IN 'l'l!E D~'IECTION 01• SUPLRPlCI BLADDER CARCJNOMA. RObfrt A. Eadalament, Fimruel, Helen Gay 1 Edrr,und c Cibas and Myron R. Melamed, New York, NY (present~tion tc te rnade by Dr. EadJlarrent) 228 patients (pts) with biopsy proven superficial bladder cancer were divided in 3 grou by 'l' category: 110 with TIS, 54 with 'l'I\,
and
with Tl tumors.
O~e to six conventional
(voidEd) cytologies per pt (mean 2.8) were obtained within the 24 hcur period prececding bicpsyo For a 11 '1 or ies combined, the sensitivity was 49%f 54 1 62%, and 66% for 1, 2, 3, and 4 cytclogic examinations i-:er pt, respectively" Cytologic sensitivity varied according tc T category; it was greater in the TIS and Tl ics than in the 'IA catc(Jory. cytology, a subset of 103 iwmediately prier to biopsy, a tl irriyation pertcrmE·d 11vhich was subsequc.~ntly ana 1 yzed by FC'fvl. Tl~e sensitivity of a :::: ir.CJ 1 e FCJ.v~ exctmination for a 11 T categories combinecl was 78%. As witll cytology, the sensitivity cf FCM varied with 1' category: it wns greater in TIS and Tl categories than in the TA category" Within the subset of 103 pts, the sensitivity ot one FCM exawination was superior (bino1nial test; p~0.05) to that of one or two q,tologic exa1r:inations for TP. turr:or2 and to that of one, twc or three cytologic exarr.inations for TIS, 'l'l and all T categories combined. Only three of 103 patients had their cancers detected by cytology and not by FCM. The data indicates that in pts with superficial bladder cancer FCM is more sensitive than voided cytole~y and that when used jointly sensitivity is not appreciably i r,crE.-ased. 1
215A