title: Usefulness of urine cytology as a routine work-up in the detection of recurrence in patients with prior non-muscle-invasive bladder cancer: practicality and cost-effectiveness.
abstract: OBJECTIVE
  To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness.
  
  
  METHODS
  We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected.
  
  
  RESULTS
  Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041).
  
  
  CONCLUSIONS
  Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.
authors.affiliation: Department of Urology, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Bong Gi
authors.initials: BG
authors.lastname: Ok
authors.affiliation: Department of Urology, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Yoon Seob
authors.initials: YS
authors.lastname: Ji
authors.affiliation: Department of Urology, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Young Hwii
authors.initials: YH
authors.lastname: Ko
authors.affiliation: Department of Urology, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Phil Hyun
authors.initials: PH
authors.lastname: Song
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003558:Cystoscopy / Q000191:economics; D003581:Cytodiagnosis / Q000191:economics / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D009367:Neoplasm Staging; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics; D016482:Urinalysis / Q000191:economics / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology / Q000601:surgery; D014556:Urine / Q000166:cytology*
keywords: Cytology; Urinary bladder neoplasms; Urine