Diagnostic accuracy of preoperative urinary smear test in patients with bladder urothelial carcinoma in a high-volume center.
OBJECTIVE
To determine diagnostic accuracy of urinary cytology (smear test) in patients with preoperative diagnosis of urothelial bladder carcinoma.


METHODS
Clinical records of the patients with urotelial bladder carcinoma at the Instituto Nacional de Cancerología (Bogotá D.C.,Colombia) from January 2006 to November 2010 were reviewed. Demographic data, pathological reports of preoperative cytology and definitive surgery, tumor classification and time between sample taking for cytology and final pathology were extracted. Descriptive statistics and graphs for continuous and categorical variables were performed.


RESULTS
We included 52 patients, 20 underwent cystectomy and 32 transurethral resection of the bladder tumor (TURB). 41 were male. Mean age was 66.6 ± 10.7 years. 151 smears were obtained before surgery, with a median of 3 smears performed per patient at 2.5 ± 1.8 months before definitive surgery. 107 were negative, 14 low grade positive and 30 high grade positive. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 30.7%, 90.9%, 97.7%, 9.34%, 3.37 and 0.76 respectively. When the high-grade cytology was compared with the high-grade definitive report some characteristics increased (Sensitivity 47.4%, Specificity: 97.8%, Positive Likelihood Ratio: 21.8) and also when compared with muscle invasion (Sensitivity: 73.9, Positive Likelihood Ratio: 7.27 ).


CONCLUSIONS
Preoperative cytology has sensitivity and specificity similar to those described in other clinical settings. Also noteworthy is that one high-grade preoperative cytology has a high positive likelihood ratio for high-grade tumor and invasive tumor (≥T2).
Departamento Urologia. Hospital San Vicente Fundacion. Medellin.Madrid.Colombia.
Jaime Alejandro
JA
Restrepo-Gonzalez
Universidad de Cali. Colombia.
Herney Andrés
HA
Garcia-Perdomo
Servicio de Urologia.Instituto Nacional de Cancerologia. Bogota.Colombia.
Rodolfo
R
Varela
D000368:Aged; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000601:surgery; D003105:Colombia; D003430:Cross-Sectional Studies; D015653:Cystectomy; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000601:surgery; D014556:Urine / Q000166:cytology*