title: Quick-staining urinary cytology and bladder wash image analysis with an integrated risk classification: a worthwhile improvement in the follow-up of bladder cancer?
abstract: BACKGROUND
  With an end toward an increase in patient quality of life, morphologic methods were tested for their combinatory value in expanding the effectiveness of follow-up appointments and finding a more specific supervision of patients with bladder cancer.
  
  
  METHODS
  Voided urine and bladder washing specimens were gathered in 223 follow-up sessions of 124 patients with a history of bladder cancer. Hemacolor (Merck, Darmstadt, Germany)-stained cytospin preparations of voided urine specimens were ready for diagnosis within 15 minutes, and results were available shortly before cystoscopy. Feulgen-Schiff-stained cytospin preparations of bladder washings entered the image analysis system. A special software was used to classify the DNA histogram by a risk factor for bladder cancer.
  
  
  RESULTS
  Follow-up of patients revealed 83 tumor recurrences. Depending on the grade of the underlying tumor, the sensitivity of quick-staining cytology was 86.4%, 46.2%, or 13.6% for grade 3 to grade 1 TCC, respectively. Cytology and image analysis data demonstrated complementary potency. The combination of methods increased sensitivity to 90.9%, 66.7%, and 31.8%, respectively. Although 24 of 140 image analyses denoted high risk for bladder cancer without simultaneously visible tumor, correct evidence of high risk could be found for 92.2%.
  
  
  CONCLUSIONS
  The combinatory use of quick-staining urinary cytology and bladder wash image analysis was demonstrated to be most valuable in diagnosing recurrent bladder cancer and selecting patients needing more intensive follow-up. At a minimum of patients discomfort, the tested combination also seems helpful to surpass diagnostic limits in cystoscopy and cytology caused by therapeutic effects on the bladder epithelium. Cancer (Cancer Cytopathol)
authors.affiliation: Department of Clinical Pathology, University of Vienna, Vienna, Austria.
authors.forename: H G
authors.initials: HG
authors.lastname: Wiener
authors.forename: G W
authors.initials: GW
authors.lastname: Remkes
authors.forename: G
authors.initials: G
authors.lastname: Schatzl
authors.forename: M
authors.initials: M
authors.lastname: Susani
authors.forename: G
authors.initials: G
authors.lastname: Breitenecker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery; D003581:Cytodiagnosis / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D012307:Risk Factors; D013194:Staining and Labeling / Q000379:methods*; D007507:Therapeutic Irrigation; D013997:Time Factors; D001743:Urinary Bladder / Q000166:cytology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery; D014556:Urine / Q000166:cytology*