title: Urinary cytology in era of fluorescence endoscopy: redefining the role of an established method with a new reference standard.
abstract: OBJECTIVE
  To assess whether the use of fluorescence endoscopy (FE) decreases the clinical value of urinary cytology compared with the use of white light endoscopy (WLE).
  
  
  METHODS
  The endoscopic, cytologic, and histologic findings of patients who had undergone transurethral resection of the bladder with or without FE were reviewed. The number and characteristics of the tumors that had been overlooked by WLE or FE but detected by cytology were analyzed. An assessment of whether the sensitivity and specificity of urinary cytology changed according to the use of FE or WLE was conducted.
  
  
  RESULTS
  The data from 1705 patients were included. Histologic findings were obtained from 238 patients using WLE and from 1467 patients using FE. Histologically confirmed malignancy was found in 641 patients, and the disease of 1064 was classified as benign. FE was superior to WLE in sensitivity in the detection of bladder cancer (94.3% vs 86.3%, P <.05). Cytology detected 53 of 88 tumors that were not detected by WLE (47 high-grade tumors); 31 tumors were overlooked by FE, of which 20 were detected by cytology (12 were high-grade tumors). The sensitivity and specificity of cytology was 66.0% and 78.4%, respectively. The specificity of cytology using WLE and FE was 75% and 79.1% (P >.05) and the sensitivity was 61.4% and 67.4% (P >.05), respectively.
  
  
  CONCLUSIONS
  Although FE demonstrated a great sensitivity, cytology still has a role even when using FE, because a small group of patients with high-grade tumors were detected by urinary cytology only.
authors.affiliation: Department of Urology, University of Munich, Munich, Germany. Stefan.Tritschler@med.uni-muenchen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Tritschler
authors.forename: Maria-Luisa
authors.initials: ML
authors.lastname: Sommer
authors.forename: Julia
authors.initials: J
authors.lastname: Straub
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Hocaoglu
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Frank
authors.initials: F
authors.lastname: Strittmatter
authors.forename: Dirk
authors.initials: D
authors.lastname: Zaak
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
mesh_terms: D000368:Aged; D003558:Cystoscopy / Q000379:methods; D005453:Fluorescence; D006801:Humans; D012015:Reference Standards; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D014556:Urine / Q000166:cytology*