Positive urine cytology but negative white-light cystoscopy: an indication for fluorescence cystoscopy?
OBJECTIVE
To evaluate the possible benefit of fluorescence cystoscopy (FC) in detecting cytologically 'confirmed' lesions when assessing urothelial carcinoma of the bladder, as negative white-light cystoscopy in cases of a positive cytological finding represents a diagnostic dilemma.


METHODS
From January 1996 to December 2006, 348 patients, who had cystoscopy for surveillance or due to suspicion of urothelial carcinoma, presented with an entirely negative white-light cystoscopy at our hospital. However, 77 of the 348 patients (22.2%) were diagnosed with a positive cytological finding. All patients had white-light cystoscopy first and a bladder-wash cytological specimen was obtained, then FC, followed by cold-cup biopsies and/or transurethral resection of the bladder tumour.


RESULTS
In the 77 patients with a positive cytological specimen FC enabled the detection of the precise site of malignancy within the bladder in 63 (82%). As malignant or premalignant lesions, there were 18 moderate dysplasias, 27 carcinoma in situ (CIS), and 18 pTa-1/G1-3 tumours. Moreover using FC, malignant or premalignant lesions were detected in 43 of 271 patients (15.9%) who had a negative cytological specimen (15 moderate dysplasias, six CIS, 22 pTa-1/G1-3).


CONCLUSIONS
This study shows that FC is beneficial in the detection of malignant and premalignant lesions, if there is negative white-light cystoscopy but positive urine cytology. The immediate identification of the exact site of a malignant lesion during FC enables the physician to diagnose and treat these patients more accurately and with no delay.
Karl
Alexander
A
Department of Urology, Ludwig-Maximilians-University, LMU, Munich, Germany. alexander.karl@med.unimuenchen.de
Tritschler
Stefan
S
Stanislaus
Peter
P
Gratzke
Christian
C
Tilki
Derya
D
Strittmatter
Frank
F
Knüchel
Ruth
R
Stief
Christian G
CG
Zaak
Dirk
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology; D003558:Cystoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods; D008875:Middle Aged; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014556:Urine / Q000166:cytology; D055815:Young Adult