Postoperative bladder washing cytology after transurethral resection. Can it predict the recurrence of urothelial carcinoma?
OBJECTIVE
To assess the ability of postoperative bladder washing cytology, performed immediately after transurethral resection of mostly stage Ta or T1 papillary urothelial carcinoma, to predict early recurrence.


METHODS
In a 1-year period, preoperative and postoperative bladder washing cytology specimens were sampled from patients undergoing transurethral resections in which all visible tumor was removed. There were 38 resections in 32 patients.


RESULTS
Postoperative cytology was satisfactory in 35 of 38 cases and positive in 17 (49%) after a mean of 6.9 months. Follow-up of these 35 transurethral resections disclosed a 15/17 (88%) recurrence rate after positive cytology and a 4/18 (22%) recurrence rate after negative cytology (P < .001). Postoperative cytology demonstrated a sensitivity for recurrence of 79%, specificity of 88%, positive predictive value of 88% and negative predictive value of 77%. In contrast, tumor in the transurethral resection specimen had a positive predictive value of 54% for recurrence, and its grade and stage were inferior to cytology in predicting recurrence.


CONCLUSIONS
Postoperative bladder washing cytology is a useful adjunct to the management of papillary urothelial carcinoma. A positive result, signifying residual tumor, should encourage prompt follow-up and possibly repeat transurethral resection.
Iczkowski
Kenneth A
KA
Department of Pathology, Immunology and Laboratory Medicine (113), VA Medical Center, 1601 S.W. Archer Road, Gainesville, Florida 32608-1197, USA. iczkoka@pathology.ufl.edu
Katz
Giora
G
Cascione
Carl J
CJ
D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D003584:Cytological Techniques; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology